Patients with ‘bad cholesterol’ at risk of being undertreated, Gulf survey shows

Many high-risk patients are not receiving adequate treatment for high cholesterol, the Cepheus Gulf Trial study has found, prompting UAE doctors to call for greater awareness and research.

ABU DHABI // Up to half the number of patients with high cholesterol levels are being undertreated in the region, substantially increasing their risk of heart attacks, a study claims.

UAE doctors are calling for greater knowledge among medical staff of treatment levels for high cholesterol, and more government funds for research.

“What we found out is that our treatment is suboptimal, not optimal,” said Dr Abdullah Shehab, associate professor and consultant of cardiovascular medicine at UAE University.

“We were unaware that our patients are being undertreated to this extent.”

Dr Shehab and other UAE doctors took part in a regional study that found about 50 per cent of 5,000 patients were not reaching cholesterol treatment targets set by international guidelines.

Researchers released initial findings from the Cepheus Gulf Trial this week after a meeting to further analyse the results.

In the study, funded by pharmaceutical company AstraZeneca, patients in the six Arabian Gulf countries – the UAE, Bahrain, Oman, Qatar, Kuwait and Saudi Arabia – were tested.

“When we are treating patients with cholesterol medication, we want to know what sort of risk factor we have and are we reaching the goal for treating our patients?” said Dr Shehab.

The research is part of a Gulf initiative called Safe at Heart, which also involved health screenings in companies and public places, as well as education.

Researchers will now discuss how to improve cholesterol management in the region.

“Bad cholesterol” is low-density lipoproteins (LDL) that carry fats or lipids to other parts of the body for energy. But too much LDL can lead to cholesterol being deposited in artery walls, increasing the risk of heart attacks and other health problems.

Poor diet, lack of exercise, obesity, excessive alcohol and smoking can lead to high levels of bad cholesterol, and conditions such as diabetes and kidney disease.

The study’s findings have been surprising to some, said Dr Wael Al Mahmeed, president of the Gulf Heart Association in Qatar and former president of the Emirates Cardiac Society.

They show that doctors in the region do well with low-risk patients who are easier to treat, but not as well with those who are high-risk – meaning patients who have already had a heart attack, he said.

Low-risk patients are often younger and a “quick win” for doctors, said Dr Al Mahmeed, who was the principal UAE investigator for the study.

“There’s still a gap in managing these patients,” he said.

One explanation could be "physician inertia", meaning that doctors continue to prescribe the same doses of medication even when patients are not meeting their targets, Dr Al Mahmeed said.

And some doctors surveyed in a questionnaire as part of the study said they rarely talked about bad cholesterol with their patients because they were too busy, Dr Shehab said.

Another problem is physician awareness.

“Awareness of the guidelines is not there among the physicians,” Dr Shehab said. “Everyone uses his own protocol.

“After publishing this study we can do a series of education among the physicians so they understand the importance of lipids and that having high cholesterol is very dangerous.”

Part of the responsibility also lies with patients. They should be aware of their goal levels for not only bad cholesterol, but for blood-pressure levels and sugar, said Dr Al Mahmeed.

“Patients should know their targets,” he said.

“If your LDL cholesterol is not at the target level, then your doctor has to give you another medication or increase the dose of medication to bring that cholesterol down.”