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Alharbi BFH, Baker P, Pavey T, Alharbi MF. Investigating the beliefs of Saudi females regarding physical activity: a qualitative exploration. Int J Qual Stud Health Well-being 2024; 19:2296696. [PMID: 38127866 PMCID: PMC10763862 DOI: 10.1080/17482631.2023.2296696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Saudi women have been deprived of equal access to and opportunities for an active lifestyle due to sociocultural restrictions. Using the theory of planned behaviour, this elicitation study aimed to explore the salient beliefs of young Saudi women aged 18-35 regarding physical activity (PA). METHODS A descriptive qualitative methodology was utilized using a semi-structured interview. A total of 25 transcribed interviews were coded. Content analysis was used to identify the salient beliefs and to rank-order the beliefs using an adaptation of Burnard's model. FINDINGS Thirty-five salient beliefs were identified as dominant factors in the decision to engage in PA. The salient beliefs about PA are classified as positive (related to advantages, social approval, and enabling) and negative (related to disadvantages, social disapproval, and barriers). These included behavioural beliefs (concerning physical/psychological well-being and social opportunities), normative beliefs (concerning family, community, international and local media influencers' expectations), and control beliefs (concerning personal, social, natural, and built environment enablers as well as constraints). CONCLUSIONS Due to the elicited beliefs, young women may be able to adopt more active lifestyles and change their inactive behaviour. Addressing negative beliefs can help change their inactive behaviour. Strengthening positive beliefs and facilitators is also beneficial.
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Affiliation(s)
- Basmah Fehaid H Alharbi
- Basic Health Science Department, Qassim University, Applied Medical Science College, Al-Qassim Province, Kingdom of Saudi Arabia
| | - Philip Baker
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove
| | - Toby Pavey
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology
| | - Manal F. Alharbi
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Aljuraiban GS, Alharbi FJ, Aljohi AO, Almeshari AZ, Al-Musharraf SI, Aldhwayan MM, Alshaikh F, Abulmeaty M. Triglyceride-Glucose Index (TyG Index) in Association with Blood Pressure in Adults: A Retrospective Study. Int J Gen Med 2024; 17:3395-3402. [PMID: 39130487 PMCID: PMC11316482 DOI: 10.2147/ijgm.s469147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
Background High blood pressure (BP) is a major risk factor for cardiovascular disease. The triglyceride-glucose (TyG) index is a useful tool for identifying insulin resistance at an early stage and has been proposed as a cost-effective predictor for hypertension. However, available studies are limited. This study aims to investigate the association between the TyG index and BP. Methods Retrospective hospital data of a large cohort (n=1596) of adults aged ≥18 in Saudi Arabia were analyzed. The TyG index was calculated. Lipid markers, systolic BP (SBP), diastolic BP (DBP), and body mass index (BMI) were included. Results Across quartiles of the TyG index, SBP was significantly higher in those with higher vs lower TyG (p<0.03). No significant association was observed for DBP. A 2-SD higher SBP was significantly associated with a TyG difference of 1.7 (95% CI: 0.1, 3.3). In subgroup analysis, the relationship prevailed in females only [1.8 (95% CI: 0.3, 3.3)]. Across BMI categories (normal, overweight, obesity), the association between SBP and TyG was observed in participants with obesity only. Conclusions The TyG index may act as a cost-effective predictive marker for high blood pressure, especially among specific subgroups. Future prospective studies are needed to confirm this relationship.
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Affiliation(s)
- Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Fahad J Alharbi
- Department of Central Military Laboratory & Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali O Aljohi
- Department of Central Military Laboratory & Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Z Almeshari
- Department of Central Military Laboratory & Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sara Ibrahim Al-Musharraf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Madhawi M Aldhwayan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Fahdah Alshaikh
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11362, Saudi Arabia
| | - Mahmoud Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11362, Saudi Arabia
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Alsharif SN. High-Polyphenol Fruit and Vegetable Consumption and Cardiovascular Disease (CVD) Risk Factors Among Adults in Jeddah, Saudi Arabia. Cureus 2024; 16:e66863. [PMID: 39144417 PMCID: PMC11323877 DOI: 10.7759/cureus.66863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Polyphenols found in food is a potential modifiable factor in disease prevention, especially when it comes to cardiovascular diseases (CVDs). This study aimed to determine the total polyphenol intake from fruits and vegetables (FV) in patients at King of Abdulaziz University Hospital, Jeddah, Saudi Arabia, and its association with vascular risk biomarkers. METHODS A cross-sectional study was done on 151 adult patients with at least one CVD risk factor. Data about demographics, smoking status, physical activity, height and weight, waist-to-hip ratio (WHR), waist circumference (WC), disease history, current disease (CD), and amount of polyphenol intake (mg/100 g) from rich polyphenol FV sources were collected. RESULTS Of the participants, 127 (84.1%) were females, 49 (32.5%) had an age ranging from 45 to 54 years, and 110 (72.8%) were married. Of them, 54 (35.8%) had a bachelor's education, and 64 (42.4%) were employed. Moreover, 89 (59.3%) were physically inactive, 18 (11.9%) were smokers, 105 (69.5%) were obese, 116 (76.9%) had high WC, and 103 (68.2%), 109 (72.2%), and 90 (59.6%) had a family history of diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia, respectively. The mean total polyphenol consumption/gm was significantly higher among older and married participants, and patients with HTN had a significantly lower mean total polyphenol consumption/gm. A significant positive correlation was found between the total polyphenol consumption/gm and participants' age. CONCLUSION The consumption of polyphenols was associated with age, marital status, and blood pressure. Polyphenols from FV may have a preventive effect against cardiovascular illnesses. Including a range of foods high in polyphenols in a balanced diet is still a potential way to support cardiovascular health.
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Affiliation(s)
- Sarah N Alsharif
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
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4
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Al-Khlaiwi T, Habib SS, Bayoumy N, Al-Khliwi H, Meo SA. Identifying risk factors and mortality rate of premature coronary artery disease in young Saudi population. Sci Rep 2024; 14:12727. [PMID: 38830947 PMCID: PMC11148092 DOI: 10.1038/s41598-024-62970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
Coronary artery disease is a leading cause of morbidity and mortality worldwide. It occurs due to a combination of genetics, lifestyle, and environmental factors. Premature coronary artery disease (PCAD) is a neglected clinical entity despite the rising number of cases worldwide. This study aimed to investigate the risk factors of premature coronary artery disease. In this study, we searched articles that had studied the risk factors of premature coronary artery diseases from January 2000 to July 2022 in Saudi Arabia in Web of Science, Pub Med, Scopus, Springer, and Wiley databases. The final analysis is based on seven articles. The smoking prevalence was 39%, diabetes mellitus 41%, hypertension 33%, overweight and obesity 18%, family history of coronary artery disease (CAD) 19%, dyslipidemia 37%, and the prevalence range of low-density lipoprotein cholesterol was 33.8-55.0%. The results revealed a mortality prevalence of 4% ranging from 2 to 8% which is similar to the prevalence in older patients which was 2-10%. Smoking, diabetes mellitus, hypertension, family history of CAD, dyslipidemia, and overweight/obesity are significantly and positively associated with premature coronary artery diseases. The health authorities should design and implement an intensive and effective prophylactic plan to minimize the subsequent impact of PCAD on the young population. In addition, early diagnosis of PCAD has great value in providing timely treatment, managing the patients, and minimizing the burden of the disease.
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Affiliation(s)
- Thamir Al-Khlaiwi
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Syed Shahid Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nervana Bayoumy
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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El Omari N, Bakrim S, Khalid A, Abdalla AN, Iesa MAM, El Kadri K, Tang SY, Goh BH, Bouyahya A. Unveiling the molecular mechanisms: dietary phytosterols as guardians against cardiovascular diseases. NATURAL PRODUCTS AND BIOPROSPECTING 2024; 14:27. [PMID: 38722432 PMCID: PMC11082103 DOI: 10.1007/s13659-024-00451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
Until recently, the main pharmaceuticals used to control cholesterol and prevent cardiovascular disease (CVD) were statin-related drugs, known for their historical side effects. Therefore, there is growing interest in exploring alternatives, such as nutritional and dietary components, that could play a central role in CVD prevention. This review aims to provide a comprehensive understanding of how natural phytosterols found in various diets combat CVDs. We begin with a description of the overall approach, then we explore in detail the different direct and indirect mechanisms that contribute to reducing cardiovascular incidents. Phytosterols, including stigmasterol, β-sitosterol, ergosterol, and fucosterol, emerge as promising molecules within nutritional systems for protection against CVDs due to their beneficial effects at different levels through direct or indirect cellular, subcellular, and molecular mechanisms. Specifically, the mentioned phytosterols exhibit the ability to diminish the generation of various radicals, including hydroperoxides and hydrogen peroxide. They also promote the activation of antioxidant enzymes such as superoxide dismutase, catalase, and glutathione, while inhibiting lipid peroxidation through the activation of Nrf2 and Nrf2/heme oxygenase-1 (HO-1) signaling pathways. Additionally, they demonstrate a significant inhibitory capacity in the generation of pro-inflammatory cytokines, thus playing a crucial role in regulating the inflammatory/immune response by inhibiting the expression of proteins involved in cellular signaling pathways such as JAK3/STAT3 and NF-κB. Moreover, phytosterols play a key role in reducing cholesterol absorption and improving the lipid profile. These compounds can be used as dietary supplements or included in specific diets to aid control cholesterol levels, particularly in individuals suffering from hypercholesterolemia.
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Affiliation(s)
- Nasreddine El Omari
- High Institute of Nursing Professions and Health Techniques of Tetouan, Tetouan, Morocco
| | - Saad Bakrim
- Geo-Bio-Environment Engineering and Innovation Laboratory, Molecular Engineering, Biotechnology and Innovation Team, Polydisciplinary Faculty of Taroudant, Ibn Zohr University, 80000, Agadir, Morocco
| | - Asaad Khalid
- Substance Abuse and Toxicology Research Center, Jazan University, P.O. Box: 114, 45142, Jazan, Saudi Arabia.
- Medicinal and Aromatic Plants and Traditional Medicine Research Institute, National Center for Research, P. O. Box 2404, Khartoum, Sudan.
| | - Ashraf N Abdalla
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
| | - Mohamed A M Iesa
- Department of Physiology, Al Qunfudah Medical College, Umm Al Qura University, Mecca, Saudi Arabia
| | - Kawtar El Kadri
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, 10106, Rabat, Morocco
| | - Siah Ying Tang
- Department of Chemical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Bey Hing Goh
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Malaysia.
- Sunway Biofunctional Molecules Discovery Centre (SBMDC), School of Medical and Life Sciences, Sunway University, 47500, Sunway City, Malaysia.
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, 10106, Rabat, Morocco.
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Alothman SA, Al Baiz AA, Alzaben AS, Khan R, Alamri AF, Omer AB. Factors Associated with Lifestyle Behaviors among University Students-A Cross-Sectional Study. Healthcare (Basel) 2024; 12:154. [PMID: 38255042 PMCID: PMC10815065 DOI: 10.3390/healthcare12020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/05/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Lifestyle behaviors are daily habits influenced by social and environmental factors. This study examined lifestyle behaviors and their associations with sociodemographics, comorbidities, and pain in Saudi university students during the academic year 2021 and 2022. All students received the study invitation via university emails to complete an online questionnaire. The questionnaire included four sections (sociodemographics, health-related information, desired health promotion activities, and a lifestyle behavior assessment) via Health-Promoting Lifestyle Profile II (HPLP-II). The associations between study variables were assessed using Pearson's correlation and multiple linear regression. The study questionnaire was completed by 1112 students. No correlation was found between sociodemographics and lifestyle-behavior-related factors except for students in the College of Science who appeared to have good lifestyle behaviors (an increase in HPLP II total scores of 3.69). Students with mental health issues have poorer lifestyle behaviors and spend more time sitting (p < 0.00). Students without disabilities have lower scores in health responsibility, physical activity, nutrition, and stress management, while auditory disability specifically lowers health responsibility (p < 0.00). Pain was not associated with any assessed lifestyle behaviors. This study identified several significant correlations and differences between variables such as age, sedentary behavior, sleep duration, disability status, college major, and lifestyle behaviors among PNU students. These findings provide insights into the factors that influence students' health-promoting behaviors and can help guide interventions for promoting healthier lifestyles on campus. Targeted health promotion strategies at an early age could help in decreasing overall noncommunicable disease incidents later in life. The study results should be interpreted taking into consideration that the collected data were cross-sectional and self-reported. In conclusion, the findings of this study clearly demonstrate the need for specific lifestyle and health-promoting programs that are directed toward university students.
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Affiliation(s)
- Shaima A. Alothman
- Lifestyle and Health Research, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Alia Abdulaziz Al Baiz
- Department of Epidemiology and Biostatistics, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Abeer Salman Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ruqaiyah Khan
- Department of Basic Health Sciences, Deanship of Preparatory Year for Health Colleges, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ali Faris Alamri
- King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 13415, Saudi Arabia;
| | - Asma B. Omer
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
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Bashatah A, Syed W, Al-Rawi MBA. Knowledge of Cardiovascular Disease Risk Factors and Its Primary Prevention Practices Among the Saudi Public - A Questionnaire-Based Cross-Sectional Study. Int J Gen Med 2023; 16:4745-4756. [PMID: 37881476 PMCID: PMC10596219 DOI: 10.2147/ijgm.s433472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Background and Objectives In response to the aging population and rapid rise of chronic diseases, it is important to understand the knowledge about primary prevention. We aim to explore Saudi adults' knowledge of cardiovascular disease (CVD) risk factors and its primary prevention practices among the Saudi public. Methods This is a cross-sectional community-based study, conducted among people living in Saudi Arabia to assess the knowledge of CVD risk factors using a total of 24-item questionnaires divided into two sections using the Likert scale, true /False/I do not know. The data were analyzed using the statistical software SPSS v. 26.0 (SPSS Inc., Chicago, IL, USA). Results In this study, the 81.8% of participants (n=296) agreed that high blood pressure was a risk factor for CVD, while more than two-thirds (68.8%; n=249) believed that diabetes was a risk factor for CVD. Furthermore, about the same proportion of respondents ((79.8%; n=289) and (78.7%; n=285)) agreed that physical inactivity and smoking were risk factors for CVD. In addition, the vast majority of them (n=324; 89.5%) believed that regular exercise aids in the prevention of CVD. In contrast, 74.9% (n=271) of individuals agreed that quitting smoking helps prevent CVD. This study indicated that 55.8% (n=202) of respondents had strong knowledge of CVD, while 44.2% (n=160) had inadequate awareness of CVD risk factors and prevention methods. In terms of the association between socio-demographic factors and overall participants' knowledge of CVD risk factors and preventative measures, we discovered that age (p=0.000), gender (p=0.011), educational status (p=0.000), and the presence of chronic disease (p=0.000) were all significantly associated with CVD knowledge score levels. Conclusion Saudi adults have adequate knowledge of CVD risk factors and prevention interventions, but more effort is needed to raise continuous awareness to reduce the prevalence of CVD.
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Affiliation(s)
- Adel Bashatah
- Department of Nursing Administration & Education, College of Nursing, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Mohmood Basil A Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Wahabi H, Esmaeil S, Zeidan R, Jamal A, Fayed AA. Age and Gender-Specific Pattern of Cardiovascular Disease Risk Factors in Saudi Arabia: A Subgroup Analysis from the Heart Health Promotion Study. Healthcare (Basel) 2023; 11:1737. [PMID: 37372855 DOI: 10.3390/healthcare11121737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To investigate gender and age-specific distribution patterns of cardiovascular disease risk factors in the Saudi population for tailored health policies. METHODS From the heart health promotion study, 3063 adult Saudis were included in this study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years and ≥56 years). The prevalence of metabolic, socioeconomic, and cardiac risk was compared between the groups. Anthropometric and biochemical data were gathered using the World Health Organization stepwise approach to chronic disease risk factors. The cardiovascular risk (CVR) was determined using the Framingham Coronary Heart Risk Score. RESULTS The prevalence of CVR risk increased with age in both genders. Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits. The prevalence of tobacco smoking was significantly higher and from an early age in males compared to females (28% and 2.7%, respectively, at age 18-29 years). There is no significant difference in either the prevalence of diabetes, hypertension, or metabolic syndrome between men and women before the age of 60 years. Old Saudi females (≥60 years) have a higher prevalence of diabetes (50% vs. 38.7%) and metabolic syndrome (55.9% versus 43.5%). Obesity was more prevalent in females aged 40-49 years onwards (56.2% vs. 34.9% males), with 62.9% of females aged ≥60 years being obese compared to 37.9% of males. Dyslipidaemia prevalence increased with the progression of age, significantly more in males than females. Framingham high-risk scores showed that 30% of males were at high risk of cardiovascular diseases at the age group of 50-59 years, while only 3.7% of the females were considered as such. CONCLUSIONS Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits, with a marked increase in cardiovascular and metabolic risk factors with age. Gender differences exist in risk factor prevalence, with obesity as the main risk factor in women, while smoking and dyslipidaemia were the main risk factors in men.
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Affiliation(s)
- Hayfaa Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Samia Esmaeil
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Rasmieh Zeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Amr Jamal
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Amel A Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Tash AA, Al-Bawardy RF. Cardiovascular Disease in Saudi Arabia: Facts and the Way Forward. J Saudi Heart Assoc 2023; 35:148-162. [PMID: 37554144 PMCID: PMC10405907 DOI: 10.37616/2212-5043.1336] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/03/2023] [Accepted: 04/24/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiovascular diseases (CVDs) remain a major health concern globally. While some risk factors for CVDs are non-modifiable, other determinants like obesity, hypertension, type-2 diabetes and dyslipidemia can be mitigated by a wide plethora of measures to control CVD morbidity and mortality. Those determinants have been on the rise in Saudi Arabia, exacerbated by sedentary lifestyle. The Saudi Vision 2030 aims to reduce CVD clinical and economic burden and to scale up vitality and longevity; in a new era of comprehensive healthcare. From a health economics standpoint, CVDs entail a burden on healthcare systems directly through expenditure and indirectly through years living with the disease, low productivity, premature morbidity and mortality. This manuscript reviews current CV health and unmet needs in Saudi Arabia, discusses G20 countries' initiatives on primary prevention: public health measures, awareness programs; and proposes national registries and digital solutions to facilitate population-specific research, improve CV surveillance and alleviate CVD burden in Saudi Arabia.
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Affiliation(s)
- Adel A. Tash
- The National Heart Center at the Saudi Health Council, Riyadh,
Saudi Arabia
| | - Rasha F. Al-Bawardy
- King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Science, Jeddah,
Saudi Arabia
- King Abdullah International Medical Research Center,
Saudi Arabia
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Habib SS, Al-khlaiwi T, Butt MA, Habib SM, Al-khliwi H, Al-Regaiey K. Novel Adiponectin-Resistin Indices and Ratios Predict Increased Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus. J Saudi Heart Assoc 2023; 35:59-65. [PMID: 37260739 PMCID: PMC10229130 DOI: 10.37616/2212-5043.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/02/2023] Open
Abstract
Objectives Adiponectin and resistin are adipokines involved in insulin resistance, glucometabolic control and adiposity. There is evidence that hypoadiponectinemia and hyperresistinemia are associated with cardiovascular disease. Whether the ratio of Adiponectin-Resistin (AR) and Insulin Resistance Adiponectin-Resistin (IRAR) indices can be used as non-invasive biomarker of cardiovascular disease needs more attention. Therefore, the aim of this study was to assess the relationships of AR and IRAR indices with adiposity, glucometabolic control and cardiovascular risk incurred by high-sensitivity C-reactive protein (hsCRP) in healthy subjects and patients with Type 2 Diabetes Mellitus. Methods This observational case control study was conducted in the Department of Physiology and Medicine, King Saud University, Riyadh. A total of 191 (control = 84 and diabetic = 107) subjects were recruited. Body composition was assessed by bioelectrical impendence analyzer (BIA). Fasting blood samples were analyzed for glucose, glycosylated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hsCRP), lipid profile, adiponectin, and resistin levels. The AR and IRAR indices were determined by formulas. Results Serum adiponectin levels were significantly lower in diabetics compared to control (95.45 ± 39.27 ng/ml vs 146.64 ± 56.36 ng/ml, p < .001) while serum resistin was significantly higher in diabetic when compared to control (2.94 ± 1.30 ng/ml vs 2.40 ± 1.09 ng/ml, p = .003). Furthermore, AR and IRAR indices were significantly increased in diabetic subjects when compared to control (.82 ± .29 vs .48 ± .35, p < .001) and (.30 ± .10 vs .17 ± .12, p < .001) respectively. ROC analysis revealed that these indices predicted increased cardiovascular risk with area under the curve (AUC) for adiponectin = .717 ( p = .001), resistin = .635 ( p = .002), AR index = .740 ( p < .001), and IRAR index = .737 ( p < .001) respectively. AR index correlated positively with Triglycerides (r = .354, p < .01), hsCRP (r = .264, p < .01), HbA1c (r = .425, p < .01), fat mass (r = .164, p < .05), Waist/Hip Ratio (WHR) (r = .248, p < .01), and negatively with high density lipoprotein (r=-.327, p < .01). Furthermore, IRAR index more strongly correlated with Triglycerides (r = .409, p < .01), hsCRP (r = .268, p < .01), HbA1c (r = .508, p < .01), fat mass (r = .152, p < .05), WHR (r = .256, p < .01), and negatively with high density lipoprotein (r = -.340, p < .01). Conclusions AR and IRAR indices correlate significantly with adiposity, glucometabolic control and cardiovascular risk in type 2 diabetic patients and non-diabetic individuals. They may prove to be useful integrated biomarkers to predict metabolic dysregulation and cardiovascular risk.
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Affiliation(s)
- Syed S. Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
| | - Thamir Al-khlaiwi
- Department of Physiology, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
| | - Muhammad A. Butt
- Department of Family Medicine, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
| | - Syed M. Habib
- Sulaiman Alrajhi University Al Bukayriah,
Saudi Arabia
| | - Huthayfah Al-khliwi
- Department of Physiology, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
| | - Khalid Al-Regaiey
- Department of Physiology, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
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Almetairi KN, Alasmari SZ, Makkawi MH, Shaikh AA. Prevalence, hematological parameters, and coagulation profiles: Cardiovascular diseases statistics in the Asir region, Saudi Arabia. Saudi Med J 2023; 44:385-393. [PMID: 37062554 PMCID: PMC10153605 DOI: 10.15537/smj.2023.44.4.20220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To determine the prevalence of cardiovascular disease (CVD) types in the Asir region of Saudi Arabia and the importance of hematological testing for CVD patients in the context of disease management. METHODS This retrospective study comprised 416 CVD patients, and samples were divided based the type of CVD. The Mann Whitney U test was used to compare patients' hematological markers and coagulation profiles to those of healthy controls. RESULTS The rate of ischemic heart disease (IHD) was 80.7% that of other CVDs, and the rate of ST-elevation myocardial infarction (STEMI) was 37.3% the rate of CVD. Significant differences were observed in the hematological and coagulation parameters of CVD patients compared to the control group. White blood cells (WBC) were significantly higher in STEMI, non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and heart failure (HF) groups. Red blood cells (RBC) were significantly lower in STEMI, NSTEMI, UA, chronic coronary syndrome (CCS), HF, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Red distribution width (RDW) was significantly greater in the HF, DCM, and ICM groups. Prothrombin time (PT) was significantly higher in the STEMI, HF, and DCM groups. CONCLUSION ST-elevation myocardial infarction has a higher prevalence rate among CVD patients in the Asir region. Both coagulation and hematological indicators have high potential utility as CVD diagnostic and prognostic markers.
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Affiliation(s)
- Kholoud N. Almetairi
- From the Department of Clinical Laboratory Sciences (Kholoud, Sultan, Mohammed, Ahmed), Faculty of Applied Medical Sciences, King Khalid University, Abha; from Department of Laboratory (Kholoud), Prince Faisal bin Khalid Cardiac Center, Abha, Kingdom of Saudi Arabia.
| | - Sultan Z. Alasmari
- From the Department of Clinical Laboratory Sciences (Kholoud, Sultan, Mohammed, Ahmed), Faculty of Applied Medical Sciences, King Khalid University, Abha; from Department of Laboratory (Kholoud), Prince Faisal bin Khalid Cardiac Center, Abha, Kingdom of Saudi Arabia.
| | - Mohammed H. Makkawi
- From the Department of Clinical Laboratory Sciences (Kholoud, Sultan, Mohammed, Ahmed), Faculty of Applied Medical Sciences, King Khalid University, Abha; from Department of Laboratory (Kholoud), Prince Faisal bin Khalid Cardiac Center, Abha, Kingdom of Saudi Arabia.
| | - Ahmad A. Shaikh
- From the Department of Clinical Laboratory Sciences (Kholoud, Sultan, Mohammed, Ahmed), Faculty of Applied Medical Sciences, King Khalid University, Abha; from Department of Laboratory (Kholoud), Prince Faisal bin Khalid Cardiac Center, Abha, Kingdom of Saudi Arabia.
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Grant WB, Al Anouti F, Boucher BJ, Fakhoury HMA, Moukayed M, Pilz S, Al-Daghri NM. Evidence That Increasing Serum 25(OH)D Concentrations to 30 ng/mL in the Kingdom of Saudi Arabia and the United Arab Emirates Could Greatly Improve Health Outcomes. Biomedicines 2023; 11:biomedicines11040994. [PMID: 37189612 DOI: 10.3390/biomedicines11040994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Accumulating evidence supports the potential protective effects of vitamin D against chronic diseases such as Alzheimer’s disease, autoimmune diseases, cancers, cardiovascular disease (ischaemic heart disease and stroke), type 2 diabetes, hypertension, chronic kidney disease, stroke, and infectious diseases such as acute respiratory tract diseases, COVID-19, influenza, and pneumonia, as well as adverse pregnancy outcomes. The respective evidence is based on ecological and observational studies, randomized controlled trials, mechanistic studies, and Mendelian randomization studies. However, randomized controlled trials on vitamin D supplementation have largely failed to show benefits, probably due to poor design and analysis. In this work, we aim to use the best available evidence on the potential beneficial effects of vitamin D to estimate the expected reduction in incidence and mortality rates of vitamin D-related diseases in the Kingdom of Saudi Arabia and the United Arab Emirates if minimum serum 25(OH)D concentrations were to be raised to 30 ng/mL. Estimated reductions by 25% for myocardial infarction incidence, 35% for stroke incidence, 20 to 35% for cardiovascular disease mortality, and 35% for cancer mortality rates depicted a promising potential for raising serum 25(OH)D. Methods to increase serum 25(OH)D concentrations at the population level could include food fortification with vitamin D3, vitamin D supplementation, improved dietary vitamin D intake, and sensible sun exposure.
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Patterns and Associations of Physical Activity, Screen Time, Sleep, and Dietary Habits among Saudi Females Participating in Fitness Centers. Healthcare (Basel) 2022; 10:healthcare10060958. [PMID: 35742017 PMCID: PMC9222570 DOI: 10.3390/healthcare10060958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/30/2022] Open
Abstract
This study was designed to investigate the level and associations of physical activity, sedentary behavior, sleep, and dietary habits among Saudi women attending fitness centers in Riyadh. A descriptive cross-sectional study was carried out from 12 fitness centers in Riyadh, Saudi Arabia. A total of 460 participants answered a two-part survey self-administered questionnaire, which included information about the demographic characteristics and lifestyle. The analysis found significant differences between the two groups in terms of age, weight, BMI, and combined prevalence of being overweight and obese. Compared with less active females, high active females showed significantly more favorable dietary habits (p < 0.05). Significantly higher values were observed for the total physical activity energy expenditure in METs-min/week (p = 0.028). Moreover, females with high screen time (>3 h per day) were younger, less active, slept longer, and had higher intakes of fast foods and chocolates/candy intake (p = 0.001). Overall, the participants were highly active, exceeding the recommended physical activity needed to enhance health. The analysis also showed sufficient sleep duration (>7 h/night) was significantly associated with the diet and nutrition of the participants. Health education programs are needed to reduce the risks of sedentary behavior, sleep problems, and dietary habits.
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Al-Badr A, Saleem Z, Kaddour O, Almosaieed B, Dawood A, Al-Tannir M, AlTurki F, Alharbi R, Alsanea N. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Womens Health 2022; 22:27. [PMID: 35120501 PMCID: PMC8815131 DOI: 10.1186/s12905-022-01609-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/27/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pelvic Floor Dysfunction (PFD) is a global health problem affecting millions of women worldwide and comprises a broad range of clinical dysfunctions such as urinary incontinence (UI), fecal incontinence (FI), pelvic organ prolapse (POP) vaginal laxity (VL), vaginal wind (VW), and overactive bladder (OAB). This study aims to estimate the prevalence of PFD among Saudi women attending primary health care centers (PHCCs) across 13 regions of Saudi Arabia and their characteristics along with associated factors. METHODS A cross-sectional study was conducted on 2,289 non-pregnant women. The probability population proportional sampling technique was employed followed by a convenient sampling technique to recruit eligible women. Types of PFD were assessed using a self-administered electronic questionnaire. Pelvic Floor Distress Index (PFDI-20) was used to assess the primary study outcomes (FI, VL, POP, VW, and OAB). A multivariate logistic regression model was used to identify independent associated factors for PFD. RESULTS The findings showed that 830 women (36.3%) had any type of UI. Stress UI affected726 (31.7%) women, whilst 525 women (22.9%) had urge UI. VL occurred in 505 women (22.1%), whilst POP occurred in 536 women (23.4%). VW occurred in 733 participants and (32%) 1238 women (54.1%) had OAB. The multivariate analysis suggested that region, location, parity, and assisted birth were significantly associated with UI, VL, FI and PFD (P < 0.001). CONCLUSION PFD is a common condition among Saudi women. UI, VL, VW, OAB, POP and FI increased consistently among urban women with increased age, greater parity, assisted birth, and post-menopausal status.
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Affiliation(s)
- Ahmed Al-Badr
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Zarqa Saleem
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Ouhoud Kaddour
- Prince Naif Healthcare Research Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Bader Almosaieed
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Ashraf Dawood
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Mohamad Al-Tannir
- Applied Clinical Research Administration, Research Center, King Fahad Medical City Saudi Arabia, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Faisal AlTurki
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Reem Alharbi
- College of Medicine, King Abdullah Bin Abdul Aziz Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Nasser Alsanea
- College of Medicine, Al Faisal University, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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15
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Asi YM. Freedom of Movement as a Determinant of Women's Health: Global Analysis and Commentary. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Qasem Surrati AM, Mohammedsaeed W, Shikieri ABE. Cardiovascular Risk Awareness and Calculated 10-Year Risk Among Female Employees at Taibah University 2019. Front Public Health 2021; 9:658243. [PMID: 34671586 PMCID: PMC8520983 DOI: 10.3389/fpubh.2021.658243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases (CVD) are the most common cause of death and disability worldwide. Saudi Arabia, one of the middle-income countries has a proportional CVD mortality rate of 37%. Knowledge about CVD and its modifiable risk factors is a vital pre-requisite to change the health attitudes, behaviors, and lifestyle practices of individuals. Therefore, we intended to assess the employee knowledge about risk of CVD, symptoms of heart attacks, and stroke, and to calculate their future 10-years CVD risk. An epidemiological, cross-sectional, community-facility based study was conducted. The women aged ≥40 years who are employees of Taibah University, Al-Madinah Al-Munawarah were recruited. A screening self-administrative questionnaire was distributed to the women to exclude those who are not eligible. In total, 222 women met the inclusion criteria and were invited for the next step for the determination of CVD risk factors by using WHO STEPS questionnaire: It is used for the surveillance of non-communicable disease risk factor, such as CVD. In addition, the anthropometric measurements and biochemical measurements were done. Based on the identified atherosclerotic cardiovascular disease (ASCVD) risk factors and laboratory testing results, risk calculated used the Framingham Study Cardiovascular Disease (10-year) Risk Assessment. Data were analyzed using GraphPad Prism 7 software (GraphPad Software, CA, USA). The result showed the mean age of study sample was 55.6 ± 9.0 years. There was elevated percentage of obesity and rise in abdominal circumference among the women. Hypertension (HTN) was a considerable chronic disease among the participants where more than half of the sample had it, i.e., 53%. According to the ASCVD risk estimator, the study participants were distributed into four groups: 63.1% at low risk, 20.2% at borderline risk, 13.5% at intermediate risk, and 3.2% at high risk. A comparison between these categories based on the CVD 10-year risk estimator indicated that there were significant variations between the low-risk group and the intermediate and high-risk groups (P = 0.02 and P = 0.001, respectively). The multivariate analysis detected factors related to CVD risk for women who have an intermediate or high risk of CVD, such as age, smoking, body mass index (BMI), unhealthy diet, blood pressure (BP) measurements, and family history of CVD (P < 0.05). The present study reports limited knowledge and awareness of CVD was 8.6 that is considered as low knowledge. In conclusion, the present study among the university sample in Madinah reported limited knowledge and awareness of CVD risk. These findings support the need for an educational program to enhance the awareness of risk factors and prevention of CVD.
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Affiliation(s)
- Amal M Qasem Surrati
- Family and Community Medicine Department, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Walaa Mohammedsaeed
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Ahlam B El Shikieri
- Clinical Nutrition Department, College of Applied Medical Science, Taibah University, Medina, Saudi Arabia
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AbuAlUla NA, Elshatarat RA, Yacoub MI, Elhefnawy KA, Aljohani MS, Saleh ZT, Abu Raddaha AH. Relationship between Physiological Health Status, Lifestyle Behaviors, and Cardiovascular Disease Among Adults in Two Arab Countries. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
Identify the relationships among participants’ lifestyle and their perceptions toward physiological health status.
Methods:
This is a cross-sectional research study. A convenience sampling was used to recruit 480 adult clients from Jordan and Saudi Arabia.
Results:
The majority of the participants (48.8%) rated their physiological health status as sub-optimal health. Significant positive associations were found between participants’ perceptions about physiological health status as ‘healthy’ and their positive lifestyle and low-risk behaviors for Cardiovascular Disease (CVD). Specifically, the associations were between not being smoker (χ2 = 4.17, p = 0.04), practicing physical activity (χ2 = 60.9, p < 0.001), eating ≥ 5 cups of fruits and vegetables daily (χ2 = 8.33, p = 0.004), and being normal/under-weight (χ2 = 65.5, p < 0.001).
Conclusion:
Perception about poor/sub-optimal physical health status is associated with many CVD risk factors. Using a brief screening tool to assess physical health status is recommended at each clinic visit. In addition, periodic physical assessment, full check-up, and follow-up with healthcare providers are highly suggested for those who perceived their physical health status as “poor” to prevent further CVD. Health education is pressingly recommended to improve the awareness of these Arab communities toward the prevention of CVD risk factors and enhancement of positive lifestyle behaviors.
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18
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Jalloun RA, Alfadhli EM. Breakfast Location Effect on Breakfast Quality and Obesity Risk in Saudi Female College Students. CURRENT NUTRITION & FOOD SCIENCE 2021. [DOI: 10.2174/1573401316999201023152539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
There is a lack of data regarding breakfast consumption and quality
among college students in the Kingdom of Saudi Arabia.
Objective:
The objective of this study was to assess the prevalence of breakfast consumption and
examine the effect of breakfast location on breakfast nutritional quality and obesity risk among female
college students at Taibah University.
Methods:
A total of 658 students participated in this cross-sectional study. Based on the Child and Adult Care Food
Program (CACFP) recommendations, breakfast quality scores were computed by summing the individual food
components and categorizing participants according to tertiles of the breakfast score distribution. Mixed-effects repeatedmeasures models were used to examine BMI categories with increasing tertiles of breakfast quality scores, stratified by
breakfast location.
Results and Discussion:
Approximately 68% of the participants reported having breakfast regularly.
The mean breakfast quality score was determined for students who had breakfast at home (12.5
± 0.11), at college (10.41± 0.06), and in other places (8.19± 0.48). Obesity was associated with lower
average breakfast quality scores based on breakfast location [mean quintile 3 compared with 1
difference: home 13.6 (P < 0.001), college 9.1 (P < 0.001), other 8.6 (P < 0.001)].
Conclusion:
The findings presented here indicated that a high percentage of students consume
breakfast regularly. Students who had breakfast at home had high scores, which indicated good
breakfast quality and a decreased risk of obesity. Further research on breakfast quality is needed in
this area, as it affects the nutritional status and quality of life of the younger population.
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Affiliation(s)
- Rola A. Jalloun
- Nutrition and Food Science Department, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Eman M. Alfadhli
- Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Saudi Arabia
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Arredouani A. Greater and More Focused Measures Are Needed to Tackle Diabetes and Obesity Epidemics in the Nations of the Gulf Cooperation Council. Int J Endocrinol 2021; 2021:6661346. [PMID: 33833799 PMCID: PMC8018843 DOI: 10.1155/2021/6661346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Beyond the suffering of the affected subjects, type 2 diabetes (T2D) and obesity epidemics gripping the Gulf Cooperation Council (GCC) states are expected to seriously jeopardize these nations' economies and development due to productivity losses. Available data show that healthcare budgets in GCC nations are under tremendous pressure because of diabetes- and obesity-linked comorbidities. Furthermore, T2D, once an over-forties disease, risks becoming a whole-adult-life condition because of obesity-associated early-onset T2D and prediabetes. The incidence of T2D is set to worsen unless efficient actions are taken to fight obesity and prevent the conversion of prediabetes to T2D. There is a consensus that the concomitant increase in obesity rates drives T2D rates upward. Fighting obesity at all levels should, therefore, take center stage for the GCC nations. The battle against obesity and T2D is a long-term and complex one. Therefore, only through concerted efforts between several public and private actors, including health, economic, and urbanization agencies, food producers and retailers, schools, families, youth organizations, sports clubs, and voluntary organizations, can this battle be won. The present review tries to assess the current status of diabetes and obesity epidemics in the GCC context and take stock of some of the policies and initiatives that have been, or need to be, implemented to address their growing burden.
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Affiliation(s)
- Abdelilah Arredouani
- Diabetes Research Center; Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Khouja JH, Al Jasir B, Bargawi AA, Kutbi M. Lifestyle Intervention for Cardiovascular Disease Risk Factors in Jeddah, Saudi Arabia. Cureus 2020; 12:e11791. [PMID: 33282602 PMCID: PMC7716383 DOI: 10.7759/cureus.11791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/29/2020] [Indexed: 01/03/2023] Open
Abstract
Background Cardiovascular disease (CVD) remains the major cause of global mortality. Applying a comprehensive interventional program may reduce the incidence of cardiovascular disease and its complications. Objective This study compared the effects of a three-month intervention involving lifestyle modification and physical activity with standard care in women ≥30 years having a moderate to high risk of CVD, with respect to improving physical activity and cardiovascular disease risk factors at the National Guard Residential City in Jeddah, Saudi Arabia, in 2015. Methods The effects of this community-based lifestyle program were assessed through a randomized controlled trial from January 1st to September 6th, 2015. Women in the intervention group (n = 31) received health education, exercise training, and diet counselling as individuals and in groups according to the participant's risk. Women in the control group (n = 28) received one health education session at the screening site. The primary outcome was the proportion of women with moderate Framingham risk scores (FRS) reducing their risk by 10% and the proportion of women with high FRS reducing their risk by 25%. The secondary outcome was the proportion of women reducing their risk by ≥1 risk category. Results The mean participant age was 42 ± 8 years. At three-month's follow-up, reductions were greater in the intervention group and the difference between groups was statistically significant (p < 0.05). Lifestyle intervention program significantly reduced systolic blood pressure (-9.2 mmHg), blood glucose (-45 mg/dL) and Framingham risk score (-13.6). Linear regression analysis revealed a significant improvement in the Framingham risk score (p < 0.01). Conclusion In a population of women with moderate-to-high risk of CVD, a personalized lifestyle modification program showed positive association in improving the 10-year cardiovascular Framingham risk score after three months.
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Affiliation(s)
- Jumana H Khouja
- Preventive Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Badr Al Jasir
- Preventive Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amina A Bargawi
- Preventive Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Kutbi
- Preventive Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
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Mohammed Alkreathy H, Mohammed Eid Alsayyid K, Alaama JY, Al Ghalayini K, Karim S, Esmat A, Damanhouri ZA. Bisoprolol responses (PK/PD) in hypertensive patients: A cytochrome P450 (CYP) 2D6 targeted polymorphism study. Saudi J Biol Sci 2020; 27:2727-2732. [PMID: 32994732 PMCID: PMC7499297 DOI: 10.1016/j.sjbs.2020.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Bisoprolol is an effective β1-adrenergic blocker, an inter-individual genetic variability was recorded in its response. This study aimed at investigating the association of CYP2D6*2A (rs1080985) and CYP2D6*10 (rs1065852) single-nucleotide polymorphism (SNP) with Bisoprolol response in cardiac patients attending King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. PATIENTS AND METHODS In the study, 107 patients were enrolled. Five mL of venous blood was collected from each patient and genotyping for CYP2D6*2A and CYP2D6*10 using Vivid® CYP2D6 Green Screening Kit (Life Technologies, USA). Response to Bisoprolol was evaluated through assessment of diastolic and systolic blood pressure and by measuring Bisoprolol plasma level using triple quad mass spectrometer (TQ-MS). RESULTS All patients were found to carry homozygous wild type CYP2D6*10 (GG) and none were carrying heterozygous (GA) or mutant homozygous (AA) genotype. CYP2D6*2A allele was detected in the homozygous wild type (GG) in 70 out of 107 patients, the heterozygous (GC) in 19 patients, and the homozygous mutant (CC) in 18 patients with minor allele frequency (MAF) of 25.7%. The plasma concentrations of Bisoprolol in CC carriers were significantly lower than those in GG & CC carriers by 25%, and 51%; respectively. Higher systolic and diastolic blood pressures were also observed in CC carriers than GG and CC carriers. CONCLUSION There is a possible association of CYP2D6*2A genotype with plasma concentration of bisoprolol. This could provide a helpful tool to choose the optimum dose for bisoprolol, depending on the patient's genotyping, in order to increase effectiveness and ameliorate its toxicity.
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Affiliation(s)
- Huda Mohammed Alkreathy
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Jumana Y. Alaama
- Department of Medical Genetics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah 21413, Saudi Arabia
| | - Kamal Al Ghalayini
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahid Karim
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Esmat
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Zoheir A. Damanhouri
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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22
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Abdullah RI, Allah AA, Mubarak AS, Abdullah RI, Alzhrani SH, Alsufyani MH, Alharthi SJA, Althomali ROH. Prevalence and predictors of using complementary and alternative medicine among diabetic patients in Taif city, Saudi Arabia. J Family Med Prim Care 2020; 9:2092-2098. [PMID: 32670971 PMCID: PMC7346901 DOI: 10.4103/jfmpc.jfmpc_1222_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 12/30/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Saudi Arabia has the second-highest rate of diabetes in the Middle East. Herbal treatment is the most used complementary and alternative therapy among Saudi diabetic patients. Little is known about the use of complementary and alternative medicine among diabetic patients who reside in Taif city. Method: This study evaluated the magnitude and correlates of complementary and alternative medicine (CAM) use among diabetic patients attending diabetic clinics and primary healthcare in two governmental hospitals, namely, Prince Mansour Military Hospital (PMMH) and National Gourd Hospital (NGH) in Taif city. Results: CAM prevalence was 33.7%, of whom 87.3% did not consult a doctor before use and 43.2% had more than one source of information while 62.7% used more than one CAM method. Around 49.2% reported that it is very useful, and 72.9% did not notice any side effect from its use. In addition, 47.5% would recommend CAM to other diabetic patients. All (100%) reported using bitter apple, 66.1% reported using cinnamon, 55.1% used ginger, 35.6% took fenugreek, and 21.2% reported using Garlic as an only CAM. Female gender, family history, diabetic complications, and longer duration of diabetes were associated with the increased use of CAM. Discussion and Conclusion: CAM use by diabetic patients in Taif is prevalent. Health education and the safe use of CAM is much needed. Appropriate efforts from the government to integrate CAM into conventional diabetes treatment should be considered.
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Affiliation(s)
- Rehab I Abdullah
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Ahmad Aman Allah
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Ali S Mubarak
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Rayan I Abdullah
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Sarah H Alzhrani
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Maram H Alsufyani
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Salman J A Alharthi
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| | - Reham O H Althomali
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
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AlGhofili HH, Aljasser AA, Alyahya IA, Almohsen HA, Alwabel SA, Alhumaid AA, Iqbal K, Altuwaijri TA, Altoijry A. Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience. Semin Vasc Surg 2020; 32:89-93. [DOI: 10.1053/j.semvascsurg.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ghamri RA, Alzahrani NS, Alharthi AM, Gadah HJ, Badoghaish BG, Alzahrani AA. Cardiovascular risk factors among high-risk individuals attending the general practice at king Abdulaziz University hospital: a cross-sectional study. BMC Cardiovasc Disord 2019; 19:268. [PMID: 31775642 PMCID: PMC6882018 DOI: 10.1186/s12872-019-1261-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/15/2019] [Indexed: 02/10/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the primary cause of death worldwide, accounting for 31.0% of all deaths and more than 18 million deaths annually. The 2008 World Health Report indicated that 144 (35%) of the 413 deaths per 100,000 in 2002 in the Kingdom of Saudi Arabia (KSA) were due to CVD. Primary prevention is an important focus of most of the cardiovascular prevention guidelines around the world. In this study, we aimed to describe the prevalence of extrinsic risk factors for CVDs in a high-risk population attending general practice in Jeddah, KSA. Methods We conducted a cross-sectional survey at King Abdulaziz University Hospital in Jeddah. Patients started on lipid-lowering and/or antihypertensive and/or antidiabetes treatments without a history of established cardiovascular disease were interviewed. The questionnaire was adopted from the EUROASPIRE III study. Results Two hundred and fifty high-risk individuals (80.0% female) were interviewed. Overall, 72% of the patients had been diagnosed with hypertension, 61.2% of patients had dyslipidemia, and approximately two-thirds of patients had diabetes mellitus. Most of the patients (88%) were non-smokers. The mean waist circumference of patients was 101.6 ± 14.1 cm, which suggests most were clinically obese. About 54.8% of the patients followed an unhealthy diet and 52.0% were physically inactive. There were significant differences between women and men in relation to dyslipidemia (p = 0.007), unhealthy diet (p = 0.034), being overweight (p = 0.018), and high blood cholesterol (p = 0.002). We observed significantly greater prevalence of hypertension (p = 0.073), unhealthy diet (p = 0.015), being overweight (p = 0.018), and high blood cholesterol (p = 0.000) in those patients with dyslipidemia. Conclusion Our study presents novel findings in the KSA. Women were more likely to have high-risk CVD risk factors compared with their male counterparts in this sample. Gender-specific prevention programs in the KSA should be considered to more appropriately target at-risk individuals, to reduce preventable morbidity and mortality associated with CVDs.
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Affiliation(s)
- Ranya A Ghamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia.
| | - Nada S Alzahrani
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Amal M Alharthi
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Hana J Gadah
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Bayan G Badoghaish
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Azzah A Alzahrani
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
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Bahari G, Scafide K, Krall J, Mallinson RK, Weinstein AA. Mediating role of self-efficacy in the relationship between family social support and hypertension self-care behaviours: A cross-sectional study of Saudi men with hypertension. Int J Nurs Pract 2019; 25:e12785. [PMID: 31524326 DOI: 10.1111/ijn.12785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Self-efficacy and family social support are significantly associated with hypertension self-care behaviours. However, little is known about their mechanism in Saudi Arabia. This cross-sectional study aimed to examine the relationships among family social support, self-efficacy, and self-care behaviours among men with hypertension in Saudi Arabia. METHODS Data were collected from May to August of 2018. The Hypertension Self-Care Profile and the Perceived Social Support from Friends and Family scales were used to measure the study variables. Multiple linear regression was used to analyse the relationships between the variables, and the Baron and Kenny test was used to assess if self-efficacy mediated the relationship between family social support and hypertension self-care behaviours. RESULTS Respondents (N = 158) from the Jizan and Al-Sharqia regions of Saudi Arabia completed the survey. Family social support and self-efficacy were significantly associated with hypertension self-care behaviours. In regression, self-efficacy was the only variable significantly associated with hypertension self-care behaviours. Self-efficacy fully mediated the relationship between family social support and hypertension self-care behaviours. CONCLUSIONS Interventions to enhance hypertension self-care behaviours among Saudi men could focus on increasing individual's self-confidence to perform specific healthy behaviours. Family support can also contribute to the performance of hypertension self-care behaviours.
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Affiliation(s)
- Ghareeb Bahari
- Department of Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia.,Epsilon Zeta Chapter, School of Nursing, George Mason University, Fairfax, Virginia
| | | | - Jenna Krall
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | | | - Ali A Weinstein
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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Dar-Odeh N, Borzangy S, Babkair H, Farghal L, Shahin G, Fadhlalmawla S, Alhazmi W, Taher S, Abu-Hammad O. Association of Dental Caries, Retained Roots, and Missing Teeth with Physical Status, Diabetes Mellitus and Hypertension in Women of the Reproductive Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2565. [PMID: 31323793 PMCID: PMC6678296 DOI: 10.3390/ijerph16142565] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate in women of reproductive age a possible association between particular dental diseases-dental caries, retained roots, and missing teeth-with some systemic conditions-physical status score- ASA (American Society for Anesthesiologists), diabetes mellitus, and hypertension. METHODS Dental and medical history were retrieved from the electronic files of dental patients. Statistical analysis was performed using cross tabulation with the Chi-square test to explore the significance of an association between variables pertaining to dental diseases and the investigated systemic conditions. Logistic regression was further used to explore the significance of the above dental diseases as predictors for systemic conditions. RESULTS A total of 1768 female patients in the age range 18-55 were included, with a mean age of 31.2 ± 10.13 years. A total of 228 (12.9%) patients had a chronic systemic disease within the ASA II category, 66 (3.7%) were diabetic, and 76 (4.3%) were hypertensive. Missing teeth were significantly associated with the ASA II category, diabetes mellitus, and hypertension (p < 0.001, p = 0.009, p = 0.005 respectively), while retained roots were significantly associated with the ASA II category only (p = 0.023). Logistic regression showed a low predictive capacity of models describing the three systemic conditions. CONCLUSIONS Diabetes mellitus and hypertension were the most common systemic diseases among the study sample. While carious teeth had no significant association with the investigated systemic conditions, retained roots were significantly associated with the ASA II category only, and missing teeth were significantly associated with all investigated systemic conditions. However, oral diseases expressed a low predictive power of these systemic conditions.
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Affiliation(s)
- Najla Dar-Odeh
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia.
- School of Dentistry, University of Jordan, Amman 11942, Jordan.
| | - Sary Borzangy
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Hamzah Babkair
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Lamis Farghal
- Private Sector, Al Madinah Al Munawara 42313, Saudi Arabia
| | - Ghufran Shahin
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Sawsan Fadhlalmawla
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Walaa Alhazmi
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Sarah Taher
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
| | - Osama Abu-Hammad
- College of Dentistry, Taibah University, Al Madinah Al Munawara 43353, Saudi Arabia
- School of Dentistry, University of Jordan, Amman 11942, Jordan
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Postpartum Weight Retention and Cardiometabolic Risk among Saudi Women: A Follow-Up Study of RAHMA Subcohort. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2957429. [PMID: 31355253 PMCID: PMC6634075 DOI: 10.1155/2019/2957429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
Objectives This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum. Methods This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants' cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated. Results A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01. Conclusion Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy.
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Demographic risk factors for extra-pulmonary tuberculosis among adolescents and adults in Saudi Arabia. PLoS One 2019; 14:e0213846. [PMID: 30917151 PMCID: PMC6436801 DOI: 10.1371/journal.pone.0213846] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/02/2019] [Indexed: 12/18/2022] Open
Abstract
Despite low infectious potential of extrapulmonary tuberculosis (EPTB), it poses significant clinical challenges in terms of diagnosis and treatment monitoring. Understanding the main demographical risk factors for disease characteristics of EPTB plays a crucial role in speeding up diagnosis process and improving overall clinical experience. The aim of this study was to investigate the main demographical and clinical risk factors for EPTB among adults and adolescents for the first time in Saudi Arabia. A cross-sectional multicenter study was carried out on a collection of 902 extrapulmonary Mycobacterium tuberculosis complex (MTBC) isolates with demographical and clinical data. All isolates were subjected to spoligotyping and 24-loci based MIRU-VNTR typing. The association between two potential variables was assessed using odd ratios (OR) calculations. Independent risk factors for EPTB and diseases characteristics of EPTB were identified using multivariate regression model analyses. Gender was found to be significantly associated with lymph node, gastrointestinal, central nervous system and urogenital TB. Lymph node TB showed statistical association to age group below 25 years, non-Saudis and South East Asian ethnicity. While gastrointestinal TB demonstrated an association with patients above 60 years old, and Saudis. Multivariate analysis showed that gender is an independent risk factor to urogenital TB (p 0.03) and lymph node TB (p 0.005). On the other hands, South Asian (p 0.01) and South East Asian (p 0.03) ethnicities were both identified as independent risk factors significantly associated with EPTB. MTBC lineages, site of infections, gender, HIV and smear positivity showed no significant association. Nationwide qualitative-studies are highly warranted in the future to further understand the main demographic risk factors for disease characteristics of EPTB.
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Birk R, Heifetz EM. Variations in biochemical values for common laboratory tests: a comparison among multi-ethnic Israeli women cohort. Ir J Med Sci 2019; 188:249-258. [PMID: 29705948 DOI: 10.1007/s11845-018-1825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Biochemical laboratory values are an essential tool in medical diagnosis, treatment, and follow-up; however, they are known to vary between populations. Establishment of ethnicity-adjusted reference values is recommended by health organizations. AIM To investigate the ethnicity element in biochemical lab values studying women of different ethnic groups. METHODS Biochemical lab values (n = 27) of 503 adult Israeli women of three ethnicities (Jewish Ashkenazi, Jewish Sephardic, and Bedouin Arab) attending a single medical center were analyzed. Biochemical data were extracted from medical center records. Ethnic differences of laboratory biochemicals were studied using ANCOVA to analyze the center of the distribution as well as quartile regression analysis to analyze the upper and lower limits, both done with an adjustment for age. RESULTS Significant ethnic differences were found in almost half (n = 12) of the biochemical laboratory tests. Ashkenazi Jews exhibited significantly higher mean values compared to Bedouins in most of the biochemical tests, including albumin, alkaline phosphatase, calcium, cholesterol, cholesterol LDL and HDL, cholesterol LDL calc., folic acid, globulin, and iron saturation, while the Bedouins exhibited the highest mean values in the creatinine and triglycerides. For most of these tests, Sephardic Jews exhibited biochemical mean levels in between the two other groups. Compared to Ashkenazi Jews, Sephardic Jews had a significant shift to lower values in cholesterol LDL. CONCLUSIONS Ethnic subpopulations have distinct distributions in biochemical laboratory test values, which should be taken into consideration in medical practice enabling precision medicine.
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Affiliation(s)
- Ruth Birk
- Department of Nutrition, Faculty of Health Sciences, Ariel University, 40700, Ariel, Israel.
| | - Eliyahu M Heifetz
- Faculty of Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
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Alanzi T. mHealth for diabetes self-management in the Kingdom of Saudi Arabia: barriers and solutions. J Multidiscip Healthc 2018; 11:535-546. [PMID: 30349285 PMCID: PMC6183657 DOI: 10.2147/jmdh.s174198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In this paper I present a perspective of mobile health (mHealth) technologies for diabetes in conjunction with an overview of the current status of mHealth technologies for diabetes self-management and the clinical evidence in the Kingdom of Saudi Arabia. In addition, a small survey to identify the barriers to mHealth for diabetes care in the Kingdom and the relevant solutions are discussed. PARTICIPANTS AND METHODS In order to study the relevant obstacles for adopting mHealth solutions for diabetes care and to suggest appropriate solutions, a small survey study was conducted with a specific questionnaire deployed to >40 anonymous leading health care professionals and decision-makers of the Kingdom. The survey was distributed by means of a link to the target population through a WhatsApp group. The data were collected during 1 month, and three reminders were sent to the group to complete the survey. Basic descriptive statistics were used to analyze the survey data. RESULTS The high percentages of agreement among the participants suggest that mHealth expertise and human shortage; funding and infrastructure investments; legal, privacy standardization and regulatory obstacles; and health care organizational and bureaucracy impediments are barriers to the implementation of mHealth technologies in the self-management of diabetes in this region. However, most of these barriers can be mitigated by the creation of the appropriate leadership and clinical environment in the current health care system. CONCLUSION The mHealth technologies for diabetes self-management have not yet been translated successfully in the Kingdom of Saudi Arabia as it was detected in the literature review carried out in this work. Among other possibilities, the causes of this situation are the existence of human, organizational, funding, bureaucracy, and legal barriers, as shown by the results of the survey conducted among decision-makers and senior clinicians of the Kingdom of Saudi Arabia.
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Affiliation(s)
- Turki Alanzi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia,
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Al-Amodi HS, Abdelbasit NA, Fatani SH, Babakr AT, Mukhtar MM. The effect of obesity and components of metabolic syndrome on leptin levels in Saudi women. Diabetes Metab Syndr 2018; 12:357-364. [PMID: 29307577 DOI: 10.1016/j.dsx.2017.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Leptin levels are reported to be increased with excessive body fat and is a potential determinant of obesity and its complications. Our Objective is to evaluate the relationship between leptin levels and BMI, waist circumference and metabolic syndrome components in normal and obese females classified according to their BMI. SUBJECTS AND METHODS A total of 136 female subjects aged between 20 and 60 years were recruited for the current study. Anthropometric measures included body mass index and waist circumference. The blood samples were used for estimation of plasma fasting blood glucose and serum was used for estimation of triglycerides, total cholesterol, low and high density lipoproteins, and total leptin. RESULTS Correlation between glucose and lipids profile with waist circumference among the whole study group (obese and non-obese) is reflecting that a strong positive correlation between BMI and blood glucose, serum TGs, cholesterol and LDL, a negative correlation was reported between BMI and serum HDL. Mean of leptin concentrations in two groups were found to be 5.77 ng/ml (±1.00) in non-obese and 28.89 ng/ml (±4.91) in the obese with metabolic syndrome. Leptin had a positive correlations with triglycerides (r = 0.84, p < 0.001), total cholesterol (r = 0.77, p < 0.001), LDL (r = 0.83, p < 0.001), waist circumference (r = 0.86, p < 0.001) and BMI (r = 0.72, p < 0.001) in the test group. a negative correlation was reported between BMI and serum HDL (r = -0.48, p < 0.001). CONCLUSION Leptin levels were high in Saudi women with high BMI and waist circumference. There was a significant correlation between leptin levels and Obesity.
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Affiliation(s)
- Hiba S Al-Amodi
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Nazik Altayeb Abdelbasit
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Samir H Fatani
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Abdullatif Taha Babakr
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
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Al-Ajlan A, Al-Musharaf S, Fouda MA, Krishnaswamy S, Wani K, Aljohani NJ, Al-Serehi A, Sheshah E, Alshingetti NM, Turkistani IZ, Afrah Alharbi A, Alraqebah BA, Ali AM, Al-Saeed G, Al-Daghri NM. Lower vitamin D levels in Saudi pregnant women are associated with higher risk of developing GDM. BMC Pregnancy Childbirth 2018; 18:86. [PMID: 29631547 PMCID: PMC5891955 DOI: 10.1186/s12884-018-1723-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 03/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has serious consequences such as increased risks of preeclampsia, macrosomia and cesarean delivery. Even though the mechanistic basis of GDM has not been completely understood, several risk factors have been identified and one of these is vitamin D. However, the link between vitamin D deficiency and development of GDM is yet to be proven with certainty. METHODS This study aimed to investigate the link between the incidence of GDM and serum vitamin D level in pregnant women of Saudi Arabia. 515 Saudi women (ages 18-46) in their 24-28th week of pregnancy, visiting various hospitals of Riyadh, participated in this study. Serum vitamin D and various biochemical and anthropometric parameters were determined in the first trimester and the recruits were screened for GDM by OGTT according to IADPSG criteria in their 2nd trimester. The association between vitamin D deficiency and development of GDM was calculated based on odds ratio of the incidence of GDM among vitamin D deficient and normal women. RESULTS In this study cohort of 515 pregnant women, in the first trimester vitamin D deficiency (< 50 nmol/l) was detected in 425 (82.5%). On their 2nd visit (2nd trimester), 116 (27.7%) were diagnosed with GDM out of 419 with OGTT, according to IADPSG criteria. GDM risk was significantly higher among vitamin D deficient than non-deficient women (Odds Ratio: 2.87; Confidence Interval: 1.32-6.25; P = 0.008) even after adjusting for season, sun exposure and vitamin D intake (OR: 2.9; CI: 1.07-7.89). Of the various anthropometric and biochemical parameters, the GDM women differed significantly from non-GDM women with respect to serum levels of triglycerides (in mmol/l) (1.3 ± 0.6; 1.5 ± 0.6, p = 0.018) and fasting glucose (in mmol/l) [4.7 (4.3-5.2); 5.1 (4.6-5.6), p < 0.01]. Also, fasting glucose level in the 2nd trimester correlated inversely to serum vitamin D level determined during the 1st trimester (r = - 0.121; p = 0.014). CONCLUSIONS Results of our study reveal a significantly higher risk of development of GDM among pregnant women having deficient vitamin D status.
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Affiliation(s)
- Abdulrahman Al-Ajlan
- Department of Clinical Lab Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Sara Al-Musharaf
- Division of Metabolic and Vascular Health, University of Warwick, CV47AL, Coventry, UK
| | - Mona A Fouda
- Department of Medicine, Endocrinology Division, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Soundararajan Krishnaswamy
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia
| | - Kaiser Wani
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia
| | - Naji J Aljohani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Amal Al-Serehi
- Maternal-Fetal Medicine Department, King Fahad Medical City, Riyadh, 59406, Saudi Arabia
| | - Eman Sheshah
- Obstetrics and Gynaecology Department, King Salman Bin Abdulaziz Hospital, Riyadh, 11564, Saudi Arabia
| | - Naemah M Alshingetti
- Department of Medicine, Endocrinology Division, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Iqbah Z Turkistani
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - A Afrah Alharbi
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia.,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Buthaynah A Alraqebah
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia.,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Aisha Mansoor Ali
- Diabetes Care Center, King Salman Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gawaher Al-Saeed
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Nasser M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia. .,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia.
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Fatani SH, Abdelbasit NA, Al-Amodi HS, Mukhtar MM, Babakr AT. Testosterone, obesity, and waist circumference as determinants of metabolic syndrome in Saudi women. Diabetes Metab Syndr Obes 2018; 11:175-181. [PMID: 29750045 PMCID: PMC5935187 DOI: 10.2147/dmso.s156021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND High serum total testosterone is associated with metabolic syndrome (MS). This study aimed to identify possible alterations in total testosterone and their relationship with plasma glucose, blood pressure, and serum lipid profile. METHODS One hundred forty-two female subjects were selected to participate in this study, and they were recruited by consultant physicians from the Clinic and Medical Out-Patient, King Abdulaziz Hospital, Kingdom of Saudi Arabia. The anthropometric characteristics were obtained from questionnaires by using standard methods. Blood samples were obtained for the determination of glucose, triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein by using enzymatic methods. Total testosterone was determined by enzyme-linked immunosorbent assay for the quantitative measurement of testosterone in human serum. RESULTS Significantly higher concentrations of total testosterone, low-density lipoprotein, and glucose, but lower concentrations of high-density lipoprotein, were observed in subjects with MS compared with women without MS (P<0.05). CONCLUSION This study suggests that high levels of total testosterone and disturbance in lipid profile were associated with MS in Saudi women.
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Affiliation(s)
- Sameer H Fatani
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Nazik Altayeb Abdelbasit
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Hiba S Al-Amodi
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Maowia Mohamed Mukhtar
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Medical Campus, Khartoum, Sudan
| | - Abdullatif Taha Babakr
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
- Correspondence: Abdullatif Taha Babakr, Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, PO Box 7607 Abdia, Makkah 21955, Kingdom of Saudi Arabia, Tel +966 12 2527 0000 extn 4322, Fax +966 12 2527 0000 extn 4319, Email
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Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
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Affiliation(s)
- Karam Turk-Adawi
- Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ibtihal Fadhil
- Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt
| | - Kathryn Taubert
- International Science and Health Strategies, American Heart Association, Aeschengraben 14, Basel 4051, Switzerland
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, Georgia 30303, USA
| | - Nigel S Tan
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada
| | - Sherry L Grace
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada.,School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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Alshaikh MK, Filippidis FT, Al-Omar HA, Rawaf S, Majeed A, Salmasi AM. The ticking time bomb in lifestyle-related diseases among women in the Gulf Cooperation Council countries; review of systematic reviews. BMC Public Health 2017; 17:536. [PMID: 28578688 PMCID: PMC5455090 DOI: 10.1186/s12889-017-4331-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/27/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aims to review all published systematic reviews on the prevalence of modifiable cardiovascular disease risk factors among women from the Gulf Cooperation Council countries (GCC). This is the first review of other systematic reviews that concentrates on lifestyle related diseases among women in GCC countries only. METHOD Literature searches were carried out in three electronic databases for all published systematic reviews on the prevalence of cardiovascular disease risk factors in the GCC countries between January 2000 and February 2016. RESULTS Eleven systematic reviews were identified and selected for our review. Common reported risk factors for cardiovascular disease were obesity, physical inactivity, diabetes, metabolic syndrome and hypertension. In GCC countries, obesity among the female population ranges from 29 to 45.7%, which is one of the highest rates globally, and it is linked with physical inactivity, ranging from 45 to 98.7%. The prevalence of diabetes is listed as one of the top ten factors globally, and was reported with an average of 21%. Hypertension ranged from 20.9 to 53%. CONCLUSIONS The high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social and political changes. These findings highlight the need for comprehensive work among the GCC to strengthen the regulatory framework to decrease and control the prevalence of these factors.
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Affiliation(s)
- Mashael K Alshaikh
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, 3rd Floor, Reynolds Building, London, W6 8RP, UK.
- Pharmacy Department, King Saud University, Medical City, Riyadh, Saudi Arabia.
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, 3rd Floor, Reynolds Building, London, W6 8RP, UK
| | - Hussain A Al-Omar
- Pharmacy Department, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - Salman Rawaf
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, 3rd Floor, Reynolds Building, London, W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, 3rd Floor, Reynolds Building, London, W6 8RP, UK
| | - Abdul-Majeed Salmasi
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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