• Vol. 42 No. 8, 379–387
  • 15 August 2013

Prevalence and Control of Hypercholesterolaemia as Defined by NCEP-ATPIII Guidelines and Predictors of LDL-C Goal Attainment in a Multi-Ethnic Asian Population

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ABSTRACT

Introduction: Few studies in Asia have assessed the burden of hypercholesterolaemia based on the global cardiovascular risk assessment. This study determines the burden of hypercholesterolaemia in an Asian population based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) guidelines, and examines predictors of low-density lipoprotein cholestrol (LDL-C) goal attainment.

Materials and Methods: Five thousand and eighty-three Chinese, Malays and Asian-Indians living in Singapore were assigned to coronary heart disease (CHD)-risk category based on the NCEP-ATPIII guidelines. Awareness, treatment and control of hypercholesterolaemia based on riskspecific LDL-C goal were determined, including the use of lipid-lowering therapy (LLT). Cox-regression models were used to identify predictors of LDL-C above goal among those who were aware and unaware of hypercholesterolaemia.

Results: One thousand five hundred and sixty-eight (30.8%) participants were aware of hypercholesterolaemia and 877 (17.3%) were newly diagnosed (unaware). For those who were aware, 39.3% participants received LLT. Among those with 2 risk factors, only 59.7% attained LDL-C goal. The majority of them were taking statin monotherapy, and the median dose of statins was similar across all CHD risk categories. Among participants with 2 risk factors and not receiving LLT, 34.1% would require LLT. Malays or Asian-Indians, higher CHD risk category, increasing body mass index (BMI), current smoking and lower education status were associated with higher risk of LDL-C above goal. Being on LLT reduced the risk of having LDL-C above goal.

Conclusion: The burden of hypercholesterolaemia is high in this multi-ethnic population especially those in the higher CHD risk categories, and might be partly contributed by inadequate titration of statins therapy. Raising awareness of hypercholesterolaemia, appropriate LLT initiation and titration, weight management and smoking cessation may improve LDL-C goal attainment in this population.


Coronary heart disease (CHD) is emerging as the leading cause of death among Asian countries. Changes in the CHD risk factors, in particular the rising prevalence of hypercholesterolaemia, have been implicated in the rising incidence of CHD in the Asia-Pacific region. In a crosssectional population study conducted in Beijing, China between 1984 and 1999, rising total cholesterol levels could explain 77% increase in the additional CHD mortality. In addition to the changes in the dietary preferences (i.e. towards Western diet), they showed that the prescribing level of lipid-lowering treatment was suboptimal despite the rising burden of CHD. By contrast, in the Western countries, a reduction in the burden of CHD has been observed, and was associated with improvements in traditional risk factors, particularly total cholesterol levels.

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