The Achievement of Non-high-density Lipoprotein Cholesterol Target in Patients with Very High Atherosclerotic Cardiovascular Disease Risk Stratified by Triglyceride Levels Despite Statin-controlled Low-density Lipoprotein Cholesterol.

Objectives: We sought to estimate the percentage achievements of non-high-density lipoprotein cholesterol (non-HDL-C) target in patients with very high atheroscleroticcardiovascular diseases (ASCVD) risk stratified by triglyceride (TG) levels despite statin-controlled low-density lipoprotein cholesterol (LDL-C) in the Centralized Pan-Middle East Survey on the under treatment of hypercholesterolemia. Methods: The non-HDL-C target achievement in patients with diabetes mellites (DM) and patients with established ASCVD was defined according to European Society of Cardiology and European Atherosclerosis Society 2019 guidelines for managing dyslipidemia. Patients were stratified to controlled LDL-C defined as < 70 mg/dL (< 1.8 mmol/L) with normal TG < 150 mg/dL (< 1.7 mmol/L) and high TG between 150-400 mg/dL (1.7-4.5 mmol/L). Results: The mean age of our cohort was 58.0±11.0 years, 6.8% (n = 717) were male, 9.7% (104) were smokers, and 48.4% (n = 518) had body mass index of ≥ 30 kg/m2. Those with high TG levels male (76.5% vs. 63.8%; p < 0.001), smokers (16.1% vs. 7.7%; p < 0.001), have metabolic syndrome (77.6% vs. 17.1%; p < 0.001), and low HDL-C levels (79.2% vs. 49.4%; p < 0.001). The majority (93.9%, n = 1008) were on statins (atorvastatin and rosuvastatin) with only 2.2% (n = 24) on the combined statins plus fenofibrate/gemfibrozil. Only 27.4% (n = 294) of patients had non-HDL-C goal attainment. Goal attainment rates in patients with diabetes (3.1% vs. 34,4%; p < 0.001), coronary artery disease (CAD) (2.4% vs. 37.9%; p < 0.001), diabetes plus CAD (0% vs. 40.0%; p < 0.001), and CVD (0% vs. 30.0%; p = 0.048) were significantly lower in those with higher TG levels. Conclusions: A large proportion of statin-controlled LDL-C diabetic patients and patients with established ASCVD with high TGs did not achieve the non-HDL-C target. Our study did not demonstrate an association between ASCVD and high TG levels; and therefore, a follow-up study is highly required to assess long-term ASCVD outcomes in this cohort.

Sex disparity in the management and outcomes of dyslipidemia of diabetic patients in the Arabian Gulf: findings from the CEPHEUS study.

BACKGROUND: Little is known about sex gap in the management and outcomes of dyslipidemia among diabetics in the Arabian Gulf. The aim if this study was to determine sex differences in the management and outcomes of dyslipidemia in diabetic patients in the Arabian Gulf. METHODS: This study was derived from the Centralized Pan-Middle-East Survey on the management of hypercholesterolemia. Patients recruited were aged ≥18 years on lipid lowering drugs for ≥3 months (stable medication for ≥6 weeks). Outcomes were based on the joint Consensus Statement of the American Diabetes Association and American College of Cardiology Foundation. Analyses were performed using univariate and multivariate logistic regression techniques. RESULTS: The mean age of the cohort (n = 3336) was 57 ± 11 years and 45% (n = 1486) were females. Females were less likely to be on rosuvastatin (7.6% vs 12%; P < 0.001), atorvastatin (41% vs 46%; P = 0.005) and combination hypolipidemic therapy (5.6% vs 2.8%; P < 0.001) but more likely to be on simvastatin (51% vs 39%; P < 0.001) than males. Females, especially those with very high atherosclerotic cardiovascular disease (ASCVD) risk status, were also less likely to achieve LDL-cholesterol [adjusted odds ratio (aOR), 0.58; 95% confidence interval (CI): 0.40-0.86; P = 0.006], non-HDL-cholesterol [aOR, 0.68; 95% CI: 0.46-0.99; P = 0.048] and apolipoprotein B [aOR, 0.64; 95% CI: 0.44-0.92; P = 0.016] lipid targets. CONCLUSIONS: Diabetic women were less likely to be on optimal hypolipemic therapy and consequently less likely to attain lipid goals compared to men. This shows a sex gap on dyslipidemia treatment in the region. Diabetic women with very high ASCVD risk status need to be aggressively treated to lower their risk of cardiovascular events.

Gender Disparity in Lipid Target Achievements in High and Very High Atherosclerotic Cardiovascular Disease Risk Patients in the Arabian Gulf.

BACKGROUND: Few studies assessed gender disparity in lipid goal attainment in the Arabian Gulf. Hence, we estimated gender gaps in lipid target achievements among patients at high and very high atherosclerotic cardiovascular disease (ASCVD) risk in the Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolemia (CEPHEUS). METHODS: The study (conducted between November 22, 2009 and July 7, 2010) included 4,384 patients (≥18 years) on lipid lowering drugs at high and very ASCVD risk status from outpatient clinics of 177 specialists and primary care physicians in 6 Arabian Gulf countries. RESULTS: The overall mean age was 57±11 years and 40% (n=1763) were women. Women were more likely to have diabetes mellitus (84 vs 71%; p <0.001) and metabolic syndrome (49 vs 35%; p <0.001) compared with males. Women were less likely to achieve their low-density lipoprotein cholesterol (LDLC) (28 vs 32%; p = 0.002), high-density lipoprotein cholesterol (HDL-C) (42 vs 50%; p <0.001), and apolipoprotein B (Apo B) (38 vs 42%; p = 0.015) targets compared with men. In the very high ASCVD risk cohort, women were significantly less likely to achieve their LDL-C (20 vs 30%; p <0.001), non- HDL-C (34 vs 39%; p = 0.001) and Apo B (34 vs 41%; p <0.001) therapeutic targets compared with men. CONCLUSION: Women in the Arabian Gulf were less likely to achieve their lipid targets than men. The difference was more significant in the very high ASCVD risk group.

Impact of metabolic syndrome on lipid target achievements in the Arabian Gulf: findings from the CEPHEUS study.

BACKGROUND: The aim of this study was to determine the impact of metabolic syndrome (MetS) on lipid target achievements in the Arabian Gulf. METHODS: The centralized pan-middle east survey on the undertreatment of hypercholesterolemia (CEPHEUS) included 4171 high and very high atherosclerotic cardiovascular disease (ASCVD) risk patients from six Arabian Gulf countries. Analyses were performed using univariate statistics. RESULTS: The overall mean age was 57 ± 11 years, 41 % were females and 71 % had MetS. MetS patients were less likely to attain their HDL-C (34 vs. 79 %; P < 0.001), LDL-C (27 vs. 37 %; P < 0.001), non HDL-C (35 vs. 55 %; P < 0.001) and Apo B (35 vs. 54 %; P < 0.001) compared to those without MetS. Within the MetS cohort, those with very high ASCVD risk were less likely to attain their lipid targets compared to those with high ASCVD risk [HDL-C (32 vs. 41 %; P < 0.001), LDL-C (24 vs. 43 %; P < 0.001), non HDL-C (32 vs. 51 %; P < 0.001) and Apo B (33 vs. 40 %; P = 0.001)]. In those with MetS and very high ASCVD risk status, females were less likely to attain their HDL-C (27 vs. 36 %; P < 0.001), LDL-C (19 vs. 27 %; P < 0.001) and Apo B (30 vs. 35 %; P = 0.009) compared to males. CONCLUSIONS: MetS was associated with low lipid therapeutic targets. Women and those with very high ASCVD risk were also less likely to attain their lipid targets in the Arabian Gulf.

Non-high-density lipoprotein cholesterol target achievement in patients on lipid-lowering drugs and stratified by triglyceride levels in the Arabian Gulf.

BACKGROUND: Atherogenic dyslipidemia is highly prevalent in the Arabian Gulf. Non-high-density lipoprotein cholesterol (non-HDL-C) reduction has been proposed as an additional goal to low-density lipoprotein cholesterol (LDL-C) lowering to prevent atherosclerotic cardiovascular disease (ASCVD). Data on non-HDL-C goal attainment in patients with high triglycerides (TGs) on lipid-lowering drugs (LLDs) in the region is scarce. OBJECTIVE: Evaluate non-HDL-C target attainment according to the National Lipid Association in patients on LLDs stratified by TG (<150 [1.69], 150-200 [1.69-2.26], >200 [2.26] mg/dL [mmol/L]) levels in the Arabian Gulf. METHODS: Overall, 4383 patients on LLD treatment from 6 Middle Eastern countries participating in the Centralized Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia study were evaluated. Patients were classified according to TG levels and ASCVD risk. RESULTS: The overall non-HDL-C goal attainment was 41% of the subjects. Non-HDL-C goal was less likely attained in patients with high TGs (12% vs 27% vs 55%; P < .001). Very high ASCVD risk patients with high TGs attained less their non-HDL-C targets compared with those with lower TG levels (8% vs 23% vs 51%; P < .001). Similarly, high ASCVD risk patients with high TGs also failed more in attaining non-HDL-C targets compared with those with lower TGs (26% vs 42% vs 69%; P < .001). In addition, those with high TG also succeeded less in attaining LDL-C and apolipoprotein B goals (P < .001). CONCLUSIONS: A large proportion of very high and high ASCVD patients on LLDs in the Arabian Gulf are not at recommended non-HDL-C targets and hence remain at a substantial residual risk.

Control of Risk Factors for Cardiovascular Disease among Multinational Patient Population in the Arabian Gulf.

We evaluated the control of cardiovascular disease (CVD) risk factors among patients with atherosclerotic cardiovascular disease (ASCVD) in the Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolaemia (CEPHEUS) in the Arabian Gulf. Of the 4398 enrolled patients, overall mean age was 57 ± 11 years, 60% were males, 13% were smokers, 76% had diabetes, 71% had metabolic syndrome and 78% had very high ASCVD risk status. The proportion of subjects with body mass index <25 kgm2, HbA1c <7% (in diabetics), low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/L (100 mg/dL) and <1.8 mmol/L (70 mg/dL) for high and very high ASCVD risk cohorts, respectively and controlled blood pressure (<140/90 mmHg) was 14, 26, 31% and 60%, respectively. Only 1.4% of the participants had all of their CVD risk factors controlled with significant differences among the countries (P < .001). CVD risk goal attainment rates were significantly lower in those with very high ASCVD risk compared with those with high ASCVD risk status (P < .001). Females were also, generally, less likely to attain goals when compared with males (P < .001).