South Africa Faces Dangerous Gaps in Cholesterol Management

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World leaders are squaring off on a complex topic: whether to temporarily waive intellectual property rights for COVID-19 vaccines. The so-called “TRIPs wavier,” debated through the World Trade Organization, could have both short- and long-term consequences for patients.

That leads to a dangerous gap in care, argues a newly released policy paper from the Global Alliance for Patient Access.

As “Cholesterol Management in South Africa: Access and Policy Goals” explains, high cholesterol is common in South Africa. But awareness lags, treatment falls short and disparities persist. These trends are particularly prevalent within the Black African community, the largest demographic group in the country.


A key component of early detection is cholesterol screening. This is critical to identifying familial hypercholesterolemia, or FH, a genetic cause of high cholesterol that impacts one in 250 people globally. But South Africa lacks systematic and well-coordinated screening efforts.

Guidelines & Gaps in Care

The guidelines that inform care in South Africa also present challenges.  Most South Africans receive care through the public health system. But as the paper explains, that system operates from outdated guidelines that do not not match the more current guidance from the South African Heart Association and Lipid and Atherosclerosis Society of Southern Africa. At-risk patients are treated with a “one-size-fits-all approach” that generally entails using a low-dose statin indefinitely.

Because cholesterol management is lifelong and unique for every patient, the paper notes, dose adjustments and personalized treatment should become a standard part of care.

Access to Treatment

Cardiovascular specialists are in short supply in South Africa. As highlighted in the policy paper, only 200 active cardiologists practice in the country of 59 million people — and  only 35 work in the public sector. Meanwhile, the 84% of the South African population that relies on public health care also faces limited treatment options to sufficiently lower their cholesterol.

Policy Recommendations 

To reduce cardiovascular disease and related deaths in South Africa, policymakers need to bolster care for at-risk patients with high cholesterol.  This incudes:

  • Encouraging timely access to optimal cholesterol-lowering treatment
  • Implementing adequate screening measures for early detection
  • Increasing awareness of standard treatment guidelines
  • Improving access to treatment and specialty care
  • Applying a multi-pronged approach to advocacy
  • Supporting additional research

For far too long, cardiovascular disease has been overlooked in South Africa. But now more than ever, the public health care system and policymakers must prioritize early detection, up-to-date prevention methods and access to personalized care.

To learn more, read “Cholesterol Management in South Africa: Access and Policy Goals.”