School of Clinical Medicine (ETDs)

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    Secondary prevention and management of dyslipidaemia in patients with coronary artery disease on statin therapy in a tertiary academic centre in Johannesburg
    (University of the Witwatersrand, Johannesburg, 2023-11) Ntila, Patience Mtwakazi; Tsabedze, Nqoba; Mpanya, Dineo
    Background and aims: Low-density lipoprotein-cholesterol (LDL-C) is essential in initiating atherosclerosis, and its control is paramount in reducing future major adverse cardiovascular events. New guidelines recommend an LDL-C target of <1.4 mmol in patients with atherosclerotic cardiovascular disease. However, whether patients on statin therapy achieve these LDL-C targets in South African public hospitals is unknown. Therefore, this study aimed to determine the achievement of LDL-C targets in patients with coronary artery disease (CAD) on statin treatment at a public tertiary academic hospital. Methods: We analysed data from 458 patients with angiographically confirmed CAD on statin therapy, comparing index admission to the most recent follow-up LDL-C level. Results: After a median duration of 17 months (interquartile range: 7 - 31), 93 (20.3%) patients achieved the LDL-C target. Among the 329 (71.8%) patients on a high-potency statin, 76 (23.2%) achieved the LDL-C target. On univariable logistic regression analysis, a history of previous CAD or stroke [odds ratio (OR):1.73; 95% confidence interval (CI): 1.05 - 2.85; p value= 0.031], presentation with non-ST-elevation myocardial infarction [OR:0.55; 95% CI: 0.34 - 0.90; p = 0.017] and unstable angina [OR: 2.25; 95% CI: 1.08 to 4.70; p = 0.030] were related with failure to attain LDL-C targets. Conclusions: Only 20.3% of all patients with atherosclerotic CAD and 23.2% on high-intensity statins achieved the guideline-recommended LDL-C target.
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    Dyslipidaemia in rheumatic diseases
    (2021) Chen, Xiaohui
    Background: It is well established that patients with rheumatic diseases are at high risk of atherosclerosis and cardiovascular disease. Dyslipidaemia is an important modifiable cardiovascular risk factor and in 2018 the Lipid and Atherosclerosis Society of Southern Africa (LASSA) published guidelines with recommended treatment targets for patients with dyslipidaemia. Objectives: To evaluate the prevalence of dyslipidaemia in patients with rheumatic diseases from a South African population, and identify the proportion of these patients receiving lipid lowering agents (LLAs). The aim was to determine the number of patients on LLAs reaching the low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) targets recommended by LASSA guidelines. Methods: This was a retrospective cohort study of 200 adult patients attending the Helen Joseph Hospital outpatient rheumatology clinic from 22 August to 12 December 2018. Clinical and laboratory data from patients with a confirmed diagnosis of rheumatic disease(s) and had their lipogram(s) measured since attending the clinic were analysed. Results: The median age of patients was 54 years (IQR 45-62) with a female predominance of 85.5% (n=171) and the majority 52.5% (n=105) being comprised of black African patients. Primary outcomes: Of the 200 patients enrolled, 127 (63.5%) met the criteria for dyslipidaemia based on their initial lipograms measured at the clinic but only 59 (46.5%) of these patients were on LLAs. At the time of the audit, 164 (82%) patients were eligible to receive LLAs as recommended by the LASSA guidelines, but only 77 (47.2%) were prescribed LLAs. Of these 77, only 22 (28.6%) met the recommended LDL-C targets for very high risk or high risk groups proposed by LASSA. Secondary outcomes: There was a high prevalence of cardiovascular risk factors present in 153 (76.5%) of patients – with hypertension being predominant in 132 (86.3%) patients. The majority of patients, 186 (93%), were on disease modifying agents for rheumatic diseases (DMARDs). A low proportion of 23 (11.5%) patients were on corticosteroids. Conclusion: Despite the high prevalence of dyslipidaemia in patients with rheumatic diseases, the majority of patients did not meet the recommended TC/LDL-C targets suggested by local guidelines. There is a need to raise awareness amongst healthcare practitioners treating this patient population regarding the pertinent aggressive control of dyslipidaemia. Furthermore, owing to the relationship between inflammation and lipids, rheumatic disease itself should perhaps be considered as an independent cardiovascular risk equivalent to other traditional cardiovascular risk factors