Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Prevalence of Cardiovascular Risk Factors and 10-Years Risk for Coronary Heart Disease in the United Arab Emirates

Author(s): Abdulla Shehab*, Sherif Bakir, Hani Sabbour, Asim A. Elnour, Wael Al Mahmeed, Amar M. Salam and Doaa El Kholy

Volume 19, Issue 3, 2023

Published on: 22 July, 2022

Article ID: e210422203892 Pages: 11

DOI: 10.2174/1573399818666220421113607

Price: $65

Abstract

Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries.

Aim: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE.

Objective: The main objective was to report the 10-years risk for CHD in a sample of the UAE population.

Methods: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes).

Results: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors.

The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages.

Conclusion: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.

Keywords: Cardiovascular diseases (CVDs), cardiovascular risk factors, coronary artery disease (CAD), 10-years risk for coronary heart diseases (CHDs), prevalence, hypertension.

[1]
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2015 update: A report from the American Heart Association. Circulation 2015; 131: e29-e322.
[http://dx.doi.org/10.1161/CIR.0000000000000152]
[2]
Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: A clinico epidemiological evidence summary. J Cardiovasc Dis Res 2011; 2(4): 199-205.
[http://dx.doi.org/10.4103/0975-3583.89803] [PMID: 22135477]
[3]
Al Rawahi AH, Lee P, Al Anqoudi ZAM, et al. Cardiovascular disease incidence and risk factor patterns among Omanis with type 2 diabetes: A retrospective cohort study. Oman Med J 2017; 32(2): 106-14.
[http://dx.doi.org/10.5001/omj.2017.20] [PMID: 28439380]
[4]
Alshehri AM. Metabolic syndrome and cardiovascular risk. J Family Community Med 2010; 17(2): 73-8.
[http://dx.doi.org/10.4103/1319-1683.71987] [PMID: 21359028]
[5]
Qiao Q, Gao W, Zhang L, Nyamdorj R, Tuomilehto J. Metabolic syndrome and cardiovascular disease. Ann Clin Biochem 2007; 44(Pt 3): 232-63.
[http://dx.doi.org/10.1258/000456307780480963] [PMID: 17456293]
[6]
Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005; 112(20): 3066-72.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.539528] [PMID: 16275870]
[7]
Supariwala A, Uretsky S, Singh P, et al. Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies. J Nucl Cardiol 2011; 18(2): 207-14.
[http://dx.doi.org/10.1007/s12350-010-9330-3] [PMID: 21184207]
[8]
Hussain SM, Oldenburg B, Wang Y, Zoungas S, Tonkin AM. Assessment of cardiovascular disease risk in South Asian populations. Int J Vasc Med 2013; 2013786801
[http://dx.doi.org/10.1155/2013/786801] [PMID: 24163770]
[9]
World Health Organization. Global Health Observatory Data Repository 2016. Available from: http://www.apps.who.int/gho/data/node.main
[10]
Naghavi M, Abajobir AA, Abbafati C, et al. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390(10100): 1151-210.
[http://dx.doi.org/10.1016/S0140-6736(17)32152-9] [PMID: 28919116]
[11]
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70(1): 1-25.
[http://dx.doi.org/10.1016/j.jacc.2017.04.052] [PMID: 28527533]
[12]
Razzak HA, Harbi A, Shelpai W, Qawas A. Prevalence and risk factors of cardiovascular disease in the United Arab Emirates. Hamdan Med J 2018; 11(3): 105-11.
[http://dx.doi.org/10.4103/HMJ.HMJ_37_18]
[13]
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European association for cardiovascular prevention and rehabilitation (EACPR). Eur Heart J 2016; 37(29): 2315-81.
[http://dx.doi.org/10.1093/eurheartj/ehw106] [PMID: 27222591]
[14]
British Cardiac Society British Hypertension Society. Diabetes UK; HEART UK; Primary care cardiovascular society; stroke association. JBS 2: joint british societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91 (Suppl. 5): v1-v52.
[http://dx.doi.org/10.1136/hrt.2005.079988]
[15]
National Cholesterol Education Program (NCEP) Expert PANEL on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106(25): 3143-421.
[http://dx.doi.org/10.1161/circ.106.25.3143] [PMID: 12485966]
[16]
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014; 129(25) (Suppl. 2): S49-73.
[http://dx.doi.org/10.1161/01.cir.0000437741.48606.98] [PMID: 24222018]
[17]
Chamnan P, Aekplakorn W. Cardiovascular risk assessment in developing world. recent trends in cardiovascular risks 2017. Available from: http://creativecommons.org/licenses/by/3.0 (Accessed on: 23 June 2021).
[http://dx.doi.org/10.5772/intechopen.69041]
[18]
Chamnan P, Simmons RK, Sharp SJ, Griffin SJ, Wareham NJ. Cardiovascular risk assessment scores for people with diabetes: A systematic review. Diabetologia 2009; 52(10): 2001-14.
[http://dx.doi.org/10.1007/s00125-009-1454-0] [PMID: 19629430]
[19]
Brindle P, Beswick A, Fahey T, Ebrahim S. Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: A systematic review. Heart 2006; 92(12): 1752-9.
[http://dx.doi.org/10.1136/hrt.2006.087932] [PMID: 16621883]
[20]
Roth GA, Forouzanfar MH, Moran AE, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med 2015; 372(14): 1333-41.
[http://dx.doi.org/10.1056/NEJMoa1406656] [PMID: 25830423]
[21]
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment. Lancet Diabetes Endocrinol 2014; 2(8): 634-47.
[http://dx.doi.org/10.1016/S2213-8587(14)70102-0] [PMID: 24842598]
[22]
Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014; 371(9): 818-27.
[http://dx.doi.org/10.1056/NEJMoa1311890] [PMID: 25162888]
[23]
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104(22): 2746-53.
[http://dx.doi.org/10.1161/hc4601.099487] [PMID: 11723030]
[24]
Raal FJ, Alsheikh-Ali AA, Omar MI, et al. Cardiovascular risk factor burden in Africa and the Middle East across country income categories: A post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study. Arch Public Health 2018; 76(1): 15.
[http://dx.doi.org/10.1186/s13690-018-0257-5]
[25]
Radaideh G, Tzemos S, Ali TM, Eldershaby Y, Joury J, Abreu P. cardiovascular risk factor burden in the United Arab Emirates (UAE): The Africa Middle East (AfME) Cardiovascular Epidemiological (ACE) Study Sub-Analysis. Inter Cardiovas Forum J l 2017; 11: 6-12.
[http://dx.doi.org/10.17987/icfj.v11i0.414]
[26]
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370(9603): 1929-38.
[http://dx.doi.org/10.1016/S0140-6736(07)61696-1] [PMID: 18063029]
[27]
Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation 2005; 112(23): 3547-53.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.591792] [PMID: 16330695]
[28]
World Health Organization. Country Cooperation Strategy for WHO and Saudi Arabia 2006–2011. 2006. Available from: http://www.who.int/countryfocus/cooperation_strategy/ccs_sau_ en.pdf Accessed 20 May, 2021.
[29]
Al-Kaabba AF, Al-Hamdan NA, El Tahir A, Abdalla AM, Saeed AA, Hamza MA. Prevalence and correlates of dyslipidemia among adults in Saudi Arabia: Results from a National Survey. 2: 89–97. OJEMD 2012; 2: 89-97.
[http://dx.doi.org/10.4236/ojemd.2012.24014]
[30]
Gehani AA, Al-Hinai AT, Zubaid M, et al. Association of risk factors with acute myocardial infarction in Middle Eastern countries: The INTERHEART Middle East study. Eur J Prev Cardiol 2014; 21(4): 400-10.
[http://dx.doi.org/10.1177/2047487312465525] [PMID: 23125402]
[31]
Al-Shamsi S, Regmi D, Govender RD. Incidence of cardiovascular disease and its associated risk factors in at-risk men and women in the United Arab Emirates: A 9-year retrospective cohort study. BMC Cardiovasc Disord 2019; 19(1): 148.
[http://dx.doi.org/10.1186/s12872-019-1131-2] [PMID: 31208354]
[32]
Baynouna LM, Revel AD, Nagelkerke NJ, et al. High prevalence of the cardiovascular risk factors in Al-Ain, United Arab Emirates. An emerging health care priority. Saudi Med J 2008; 29(8): 1173-8.
[PMID: 18690314]
[33]
Yusufali A, Bazargani N, Muhammed K, et al. Opportunistic screening for CVD risk factors: The Dubai shopping for cardiovascular risk study (DISCOVERY). Glob Heart 2015; 10(4): 265-72.
[http://dx.doi.org/10.1016/j.gheart.2015.04.008] [PMID: 26271552]
[34]
Loney T, Aw TC, Handysides DG, et al. An analysis of the health status of the United Arab Emirates: The 'Big 4′ public health issues. Glob Health Action 2013; 6: 20100.
[http://dx.doi.org/10.3402/gha.v6i0.20100]
[35]
Statistics Centre Abu Dhabi. Population and demographic estimates for the Emirate of Abu Dhabi. 2017. Available from: https://www.scad.ae/Release%20Documents/SYB_2017_EN.PDF (Accessed on: January, 2021).
[36]
Ministry of Health and Prevention. United Arab Emirates. Available from https://mohap.gov.ae/EN/HOME 2015 Report
[37]
Bayés de Luna A, Tse TF, de Figueiredo MB, et al. World Heart Day: A World Heart Federation enterprise promoting the prevention of heart disease and stroke across the world. Circulation 2003; 108(9): 1038-40.
[http://dx.doi.org/10.1161/01.CIR.0000089504.27796.2C] [PMID: 12952824]
[38]
World Health Organization. Prevention of cardiovascular disease. World Health Organization 2007. Available from: https://apps.who.int/iris/handle/10665/43685 (Accessed on: 21 April 2021).
[39]
Giles TD, Materson BJ, Cohn JN, Kostis JB. Definition and classification of hypertension: An update. J Clin Hypertens (Greenwich) 2009; 11(11): 611-4.
[http://dx.doi.org/10.1111/j.1751-7176.2009.00179.x] [PMID: 19878368]
[40]
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (Suppl. 1): S62-7.
[http://dx.doi.org/10.2337/dc09-S062] [PMID: 19118289]
[41]
Wyer JT, Melanson KJ, Sriprachy-anunt U, et al. Dietary Treatment of Obesity Endotext. South Dartmouth (MA): MDText.com, Inc. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278991/table/diet-treatment-obes.table4clas/ (Accessed on: 5 February 2021).
[42]
Sampson M, Ling C, Sun Q, et al. A new equation for calculation of low-density lipoprotein cholesterol in patients with normolipidemia and/or hypertriglyceridemia. JAMA Cardiol 2020; 5(5): 540-8.
[http://dx.doi.org/10.1001/jamacardio.2020.0013] [PMID: 32101259]
[43]
Oulhaj A, Bakir S, Aziz F, et al. Agreement between cardiovascular disease risk assessment tools: An application to the United Arab Emirates population. PLoS One 2020; 15(1)e0228031
[http://dx.doi.org/10.1371/journal.pone.0228031] [PMID: 31978187]
[44]
Nasir K, Michos ED, Blumenthal RS, Raggi P. Detection of high-risk young adults and women by coronary calcium and National Cholesterol Education Program Panel III guidelines. J Am Coll Cardiol 2005; 46(10): 1931-6.
[http://dx.doi.org/10.1016/j.jacc.2005.07.052] [PMID: 16286182]
[45]
D’Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: The framingham heart study. Circulation 2008; 117(6): 743-53.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.699579] [PMID: 18212285]
[46]
CV risk calculator. American Heart Association. Dallas, TX.: Prevention Guidelines Tools 2013. Available from: http://my.americanheart.org/cvriskcalculator (Accessed on: May, 2021).
[47]
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: The Reynolds Risk Score. JAMA 2007; 297(6): 611-9.
[http://dx.doi.org/10.1001/jama.297.6.611] [PMID: 17299196]
[48]
Levenson JW, Skerrett PJ, Gaziano JM. Reducing the global burden of cardiovascular disease: The role of risk factors. Prev Cardiol 2002; 5(4): 188-99.
[http://dx.doi.org/10.1111/j.1520-037X.2002.00564.x] [PMID: 12417828]
[49]
World Health Organization. Cardiovascular Diseases (CVDs). Fact Sheet N 317 2017. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/index.html [Last accessed on 2017 May 22].
[50]
Lewington S, Whitlock G, Clarke R, et al. Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370(9602): 1829-39.
[http://dx.doi.org/10.1016/S0140-6736(07)61778-4] [PMID: 18061058]
[51]
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies C. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360(9349): 1903-13.
[http://dx.doi.org/10.1016/S0140-6736(02)11911-8] [PMID: 12493255]
[52]
Jackson R, Lawes CM, Bennett DA, Milne RJ, Rodgers A. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 2005; 365(9457): 434-41.
[http://dx.doi.org/10.1016/S0140-6736(05)70240-3] [PMID: 15680460]
[53]
Chamnan P, Simmons RK, Jackson R, Khaw KT, Wareham NJ, Griffin SJ. Non-diabetic hyperglycaemia and cardiovascular risk: Moving beyond categorisation to individual interpretation of absolute risk. Diabetologia 2011; 54(2): 291-9.
[http://dx.doi.org/10.1007/s00125-010-1914-6] [PMID: 20859613]
[54]
El-Menyar A, Zubaid M, Shehab A, et al. Prevalence and impact of cardiovascular risk factors among patients presenting with acute coronary syndrome in the middle East. Clin Cardiol 2011; 34(1): 51-8.
[http://dx.doi.org/10.1002/clc.20873] [PMID: 21259279]
[55]
World Health Organization. ( 2017) . Tackling NCDs: 'best buys' and other recommended interventions for the prevention and control of noncommunicable diseases. World Health Organization. 2017. Available from: https://apps.who.int/iris/handle/10665/259232 (Accessed on: 9 April 2021).
[56]
Mahmoud I, Sulaiman N. Dyslipidaemia prevalence and associated risk factors in the United Arab Emirates: A population-based study. BMJ Open 2019; 9(11)e031969
[http://dx.doi.org/10.1136/bmjopen-2019-031969]
[57]
Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study. Lancet 2020; 395(10226): 795-808.
[http://dx.doi.org/10.1016/S0140-6736(19)32008-2] [PMID: 31492503]
[58]
Malik P. The axiom of Rose. Can J Cardiol 2006; 22(9): 735.
[http://dx.doi.org/10.1016/S0828-282X(06)70297-5] [PMID: 16835666]
[59]
Khaw RGK-T, Marmot M. The Strategy of Preventive Medicine. Oxford: Oxford University Press 2008.
[http://dx.doi.org/10.1093/acprof:oso/9780192630971.001.0001]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy