Substantiating this is Dr. Omar K. Hallak, board member, Emirates Cardiac Society, and consultant interventional cardiologist at the chief intervention cardiology department, American Hospital, Dubai. “Most patients don’t achieve the desired reduction in their cholesterol levels because they don’t follow the treatment, such as diet and exercise recommendations, despite being treated with cholesterol-lowering medication. Half of patients with high cholesterol don’t achieve results either because the prescribed dose is not enough or the medicine is not the right one. In spite of being on a cholesterol lowering treatment, you might not be at your cholesterol goal, putting you at higher risk of heart disease.”

Coronary heart disease is caused by cholesterol and fat being deposited in the walls of the arteries that supply nutrients and oxygen to the heart. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. Narrowing of the arteries decreases that supply and can cause angina (chest pain) when the heart muscle does not receive enough oxygen. Cholesterol plaques can rupture, resulting in a blood clot formation that completely blocks the artery, stopping all blood flow and causing a heart attack, in which heart muscle cells die from lack of oxygen and nutrients.

Throughout the world, a consultant cardiologist at Jeddah’s King Fahd Hospital says, blood cholesterol levels vary widely. Generally, people who live in countries where blood cholesterol levels are lower, such as Japan, have lower rates of heart disease. Countries with very high cholesterol levels, such as Finland, also have very high rates of coronary heart disease. However, some populations with similar total cholesterol levels have very different heart disease rates, suggesting that other factors also influence risk for coronary heart disease. High cholesterol is more common in men younger than 55 years and in women older than 55 years. The risk for high cholesterol increases with age.

High cholesterol levels are due to a variety of factors including heredity, diet, and lifestyle. Less commonly, underlying illnesses affecting the liver, thyroid, or kidney may affect blood cholesterol levels.

Genes may influence how the body metabolizes LDL (bad) cholesterol. Familial hypercholesterolemia is an inherited form of high cholesterol that may lead to early heart disease.

Excess weight may modestly increase your LDL (bad) cholesterol level. Losing weight may lower LDL and raise HDL (good) cholesterol levels.

Regular physical activity may lower triglycerides and raise HDL cholesterol levels.

Before menopause, women usually have lower total cholesterol levels than men of the same age. As women and men age, their blood cholesterol levels rise until about 60-65 years of age. After the age of 50, women often have higher total cholesterol levels than men of the same age.

Several studies have shown that stress raises blood cholesterol levels over the long term. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they console themselves by eating fatty foods. The saturated fat and cholesterol in these foods contribute to higher levels of blood cholesterol.

To answer the question of how common it is for patients in Saudi Arabia and elsewhere in the GCC not to reach the desired cholesterol levels, a CEPHEUS study was launched in October of 2009, as collaborative project between the Emirates Cardiac Society and AstraZeneca. European data published earlier this year showed that only 50 percent of patients on cholesterol treatment reached their desired treatment goal.

“Our patients differ from Western patients in genes, nature of food and way of living. So we cannot apply their statistics here. We need to have our own studies and this is what CEPHEUS is doing. This is the first step in reducing the incidence of cardiovascular disease and improving the quality of cardiac care in the near future, by being well informed. The finding of the study will mirror the real situation in the Gulf,” Dr. Hallak added.

The problem of hypercholesterolemia management is not restricted to patients who don’t take medications but extends to those who take medications. On the global level, many patients who think that they are safe because of taking medications are actually not. Is the picture different in the GCC? This is what CEPHEUS will unravel.

“This is one of the most important studies in the Arab world. It will give us vital data on how to treat patients. The sample size and reach are excellent. It is the first study that looks into control. Gulf people are a homogenous sample, and they share a way of living, similar food and weather,” Dr. Khalid Humaid Al-Rasadi, consultant biochemist and lipid specialist at Sultan Qaboos University Hospital, Oman, says.

The metabolic syndrome in the GCC countries is around 10-15 percent higher than in most developed countries, with generally higher prevalence rates for women according to a recent systematic review. Hyperlipidimia is an important feature of this syndrome. This has been attributed to physical inactivity, diet quality, lower education and higher incomes. “Addressing the modifiable risk factors of the metabolic syndrome on a population basis is a public health priority. Although the CEPHEUS study will give us the answer about the cholesterol control in metabolic syndrome, we believe more studies should be conducted in the future to look at the control of other modifiable risk factors like diabetes, hypertension and obesity in the GCC states. Doctors will be more assertive and precise in treating their patients by referring their cases to the results of the study,” Dr. Al-Rasadi added.

“The CEPHEUS research project involved monitoring 5,300 patients across the Gulf who are taking lipid lowering medication,” Dr. Fadel Shaker, medical manager, AstraZeneca Gulf, says. It has been proved that a 10 percent overall reduction in cholesterol levels can cut heart disease by half, with scientists saying that men over 40 years of age (a group that is particularly at risk) only have to reduce their cholesterol levels by 10 percent to lower their risk of heart disease by 50 percent.