title: Centralized Pan-Middle East Survey on the Under-Treatment of Hypercholesterolemia: Results from the CEPHEUS II Study in Egypt.
abstract: BACKGROUND
  As part of the CEPHEUS study, CEPHEUS I was conducted in 2010 and 2011 in Cairo and then the CEPHEUS II study was carried out in Alexandria and Delta Regions in Egypt between April 2014 and August 2015 to determine the proportion of dyslipidemic patients on lipid-lowering treatment reaching LDL-C treatment goals.
  
  
  METHODS
  We conducted an open-label, observational, multicenter, cross-sectional survey where 90 investigators enrolled 1127 patients receiving lipid-lowering drugs for at least 3 months. After signing informed consent forms, the study questionnaires were completed by patients and investigators. Blood samples were taken for laboratory investigations. Patients with missing LDL-C data were excluded from the analysis and results from 896 patients were analyzed according to European Atherosclerosis Society and EAS/ESC 2011 guidelines.
  
  
  RESULTS
  Out of 896 patients enrolled based on the risk stratification of EAS/ESC 2011 guidelines, 12.4% were classified as low risk, 20.0% as moderate risk, 2.5% as high risk, and 65.2% as very high risk. Achievement goals were 84.7, 44.7, 18.2, and 22.3% for low-risk, moderate-risk, high-risk, and very high risk patients, respectively, with an overall achievement goal of 34.4%. The study population included 50.2% diabetes, 64.4% hypertension, 54.9% metabolic syndrome, 32.2% family history of cardiovascular disease, 23.1% smokers, and 33.8% secondary prevention. Lipid-lowering agents were prescribed as a monotherapy to 90.1% and in combination in 9.9% with goal achievements of 34 and 38%, respectively (p > 0.05). Statins were prescribed to 86.9% of patients. The most frequent prescribed statins were rosuvastatin (47.1%) and atorvastatin (36.0%), followed by simvastatin (9.2%). Treatment goal was achieved in 34.2, 36.0, and 31.7% for rosuvastatin, atorvastatin, and simvastatin, respectively, with no significant difference in achievement goals (p > 0.05).
  
  
  CONCLUSIONS
  Hypercholesterolemia is still not being effectively managed in many at-risk patients in Egypt. The majority of patients enrolled in the study were being actively treated with lipid-lowering medications yet the percentage goal achievement was less when compared to CEPHEUS results.
authors.affiliation: Monofya University, Egypt, 13127 Mohamed Fareed Street, Bab El-Louk, Cairo, Egypt. ashrafreda5555@gmail.com.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Reda
authors.affiliation: National Heart Institute, Egypt, 1 Mohamed Mahmoud Street, Bab El-Louk, Cairo, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Etman
authors.affiliation: Alexandria University, Egypt, 8 Kamel Morsy Street, El-Shatby, Alexandria, Egypt.
authors.forename: Ali
authors.initials: A
authors.lastname: Abdel-Rahim
authors.affiliation: Ain Shams University, Egypt, 71 Elhegaz Street, Heliopolis, Cairo, Egypt.
authors.forename: Nabil
authors.initials: N
authors.lastname: Farag
authors.affiliation: Benha University, Egypt, 31 Wahby Street, El-Manshia, Benha, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Sanad
authors.affiliation: Cairo University, Egypt, 12 Dokki Street, Dokki, Giza, Egypt.
authors.forename: Sameh
authors.initials: S
authors.lastname: Salamah
keywords: CEPHEUS; CVD; Cardiovascular; Cardiovascular risk; Egypt; Hypercholesterolemia; Statins