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Alhuneafat L, Ta'ani OA, Jabri A, Tarawneh T, ElHamdan A, Naser A, Al-Bitar F, Alrifai N, Ghanem F, Alaswad K, Alqarqaz M, Van't Hof JR, Adabag S, Virani SS. Cardiovascular disease burden in the Middle East and North Africa region. Curr Probl Cardiol 2024; 49:102341. [PMID: 38103814 DOI: 10.1016/j.cpcardiol.2023.102341] [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: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) remains the leading cause of death globally, including the Middle East and North Africa (MENA) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors in the MENA. METHODS We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 21 MENA countries. Prevalence and mortality were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and risk factors were evaluated under the GBD's comparative risk assessment framework. RESULTS Between 1990 and 2019, CVD raw accounts in the MENA increased by 140.9%, while age standardized prevalence slightly decreased (-1.3%). CVD raw mortality counts rose by 78.3%, but age standardized death rates fell by 28%. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of CVA. Age standardized DALYs decreased by 32.54%. DALY rates varied across countries and were consistently higher in males. Leading risk factors included hypertension, high LDL-C, dietary risks, and elevated BMI. The countries with the three highest DALYs in 2019 were Afghanistan, Egypt, and Yemen. CONCLUSIONS While strides have been made in lessening the CVD burden in the MENA region, the toll on mortality and morbidity, particularly from ischemic heart disease, remains significant. Country-specific variations call for tailored interventions addressing socio-economic factors, healthcare infrastructure, and political stability.
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Affiliation(s)
- Laith Alhuneafat
- Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, United States.
| | - Omar Al Ta'ani
- Department of Medicine, Allegheny Health Network, PA, United States
| | - Ahmad Jabri
- Department of Cardiovascular disease, Henry Ford, MI, United States
| | - Tala Tarawneh
- Department of Medicine, Marshall University, Huntington, WV, United States
| | - Adee ElHamdan
- Department of cardiovascular medicine, Marshall University, WV, United States
| | - Abdallah Naser
- Department of Medicine, Allegheny Health Network, PA, United States
| | - Farah Al-Bitar
- Department of pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nada Alrifai
- Department of Rheumatology, Cooper University, NJ, United States
| | - Fares Ghanem
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | - Khaldoon Alaswad
- Department of Cardiovascular disease, Henry Ford, MI, United States
| | | | - Jeremy R Van't Hof
- Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, United States
| | - Selcuk Adabag
- Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, United States
| | - Salim S Virani
- Department of Cardiology, Aga Khan University, Karachi, Pakistan; Department of Cardiovascular medicine, Texas Heart Institute and Baylor College of Medicine, Houston, TX, United States
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Aminorroaya A, Saeedi Moghaddam S, Tavolinejad H, Aryan Z, Heidari B, Ebrahimi H, Naderian M, Shobeiri P, Ghanbari A, Rezaei N, Malekpour MR, Haghshenas R, Rezaei N, Larijani B, Farzadfar F. Burden of Ischemic Heart Disease and Its Attributable Risk Factors in North Africa and the Middle East, 1990 to 2019: Results From the GBD Study 2019. J Am Heart Assoc 2024; 13:e030165. [PMID: 37956220 PMCID: PMC10926818 DOI: 10.1161/jaha.123.030165] [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: 05/01/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The North Africa and Middle East (NAME) region has one of the highest burdens of ischemic heart disease (IHD) worldwide. This study reports the contemporary epidemiology of IHD in NAME. METHODS AND RESULTS We estimated the incidence, prevalence, deaths, years of life lost, years lived with disability, disability-adjusted life years (DALYs), and premature mortality of IHD, and its attributable risk factors in NAME from 1990 to 2019 using the results of the GBD (Global Burden of Disease study 2019). In 2019, 0.8 million lives and 18.0 million DALYs were lost due to IHD in NAME. From 1990 to 2019, the age-standardized DALY rate of IHD significantly decreased by 33.3%, mostly due to the reduction of years of life lost rather than years lived with disability. In 2019, the proportion of premature death attributable to IHD was higher in NAME compared with global measures: 26.8% versus 16.9% for women and 18.4% versus 14.8% for men, respectively. The age-standardized DALY rate of IHD attributed to metabolic risks, behavioral risks, and environmental/occupational risks significantly decreased by 28.7%, 37.8%, and 36.4%, respectively. Dietary risk factors, high systolic blood pressure, and high low-density lipoprotein cholesterol were the top 3 risks contributing to the IHD burden in most countries of NAME in 2019. CONCLUSIONS In 2019, IHD was the leading cause of death and lost DALYs in NAME, where premature death due to IHD was greater than the global average. Despite the great reduction in the age-standardized DALYs of IHD in NAME from 1990 to 2019, this region still had the second-highest burden of IHD in 2019 globally.
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Affiliation(s)
- Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT USA
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Kiel Institute for the World Economy Kiel Germany
| | - Hamed Tavolinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran
| | - Zahra Aryan
- Department of Medicine Rutgers New Jersey Medical School Newark NJ USA
| | - Behnam Heidari
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Hedyeh Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
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Manla Y, Almahmeed W. The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:543-557. [PMID: 37615785 PMCID: PMC10471667 DOI: 10.1007/s11883-023-01126-x] [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] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.
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Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Dugani SB, Zubaid M, Rashed W, Girardo ME, Balayah Z, Mora S, Alsheikh-Ali AA. Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome. Mayo Clin Proc Innov Qual Outcomes 2023; 7:153-164. [PMID: 37152409 PMCID: PMC10160579 DOI: 10.1016/j.mayocpiqo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Objective To describe and compare the determinants of 1-year mortality after premature vs non-premature acute coronary syndrome (ACS). Patients and Methods Participants presenting with ACS were enrolled in a prospective registry of 29 hospitals in 4 countries, from January 22, 2012 to January 22, 2013, with 1-year of follow-up data. The primary outcome was all-cause 1-year mortality after premature ACS (men aged <55 years and women aged <65 years) and non-premature ACS (men aged ≥55 years and women aged ≥65 years). The associations between the baseline patient characteristics and 1-year mortality were analyzed in models adjusting for the Global Registry of Acute Coronary Events (GRACE) score and reported as adjusted odds ratio (aOR) (95% CI). Results Of the 3868 patients, 43.3% presented with premature ACS that was associated with lower 1-year mortality (5.7%) than those with non-premature ACS. In adjusted models, women experienced higher mortality than men after premature (aOR, 2.14 [1.37-3.41]) vs non-premature ACS (aOR, 1.28 [0.99-1.65]) (P interaction=.047). Patients lacking formal education vs any education had higher mortality after both premature (aOR, 2.92 [1.87-4.61]) and non-premature ACS (aOR, 1.78 [1.36-2.34]) (P interaction=.06). Lack of employment vs any employment was associated with approximately 3-fold higher mortality after premature and non-premature ACS (P interaction=.72). Using stepwise logistic regression to predict 1-year mortality, a model with GRACE risk score and 4 characteristics (education, employment, body mass index [kg/m2], and statin use within 24 hours after admission) had higher discrimination than the GRACE risk score alone (area under the curve, 0.800 vs 0.773; P comparison=.003). Conclusion In this study, women, compared with men, had higher 1-year mortality after premature ACS. The social determinants of health (no formal education or employment) were strongly associated with higher 1-year mortality after premature and non-premature ACS, improved mortality prediction, and should be routinely considered in risk assessment after ACS.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine and Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Wafa Rashed
- Division of Cardiology, Mubarak Al Kabeer Hospital, Kuwait University, Kuwait
| | | | - Zuhur Balayah
- Bayes Business School, Centre for Health Care Innovation Research, University of London, UK
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Al-Shamsi S. Development and validation of a novel 10-year cardiovascular risk prediction nomogram for the United Arab Emirates national population. BMJ Open 2022; 12:e064502. [PMID: 36581433 PMCID: PMC9806017 DOI: 10.1136/bmjopen-2022-064502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality among United Arab Emirates (UAE) nationals. Recent studies have shown that current tools are poor in predicting the risk of incident ASCVD in Emiratis. To improve ASCVD risk prediction in this high-risk population, this study sought to develop and validate a novel and practical 10-year ASCVD risk nomogram using risk factors known to be significant in UAE nationals. DESIGN A 10-year retrospective cohort study. SETTING Outpatient clinics at a large public tertiary care hospital in Al-Ain, UAE. PARTICIPANTS Emiratis aged ≥18 years without prior cardiovascular disease (CVD) who had presented to Tawam Hospital's clinics between 1 April 2008 and 31 December 2008, were included. Patients' data were collected retrospectively until 31 January 2020. EXPOSURE Cox proportional hazards models were developed to estimate the 10-year ASCVD risk. PRIMARY OUTCOME MEASURE Model discrimination and calibration were assessed using the Harrell C-statistic and the Greenwood-Nam-D'Agostino (GND) χ2 test, respectively. Receiver operating characteristic curve analysis was used to determine the optimal cut-off point of the nomogram for elevated ASCVD risk. RESULTS The study included 1245 patients, of whom 117 developed ASCVD within 10 years. The ASCVD risk nomogram comprised age, sex, family history of CVD, hypertension treatment, systolic blood pressure, total cholesterol, glycosylated haemoglobin A1c and estimated glomerular filtration rate. The Harrell C-statistic was 0.826 and the GND χ2 was 2.83 (p=0.830), which indicated good discrimination and calibration of the nomogram model, respectively. The optimal cut-off point was determined to be 10% (sensitivity=79%; specificity=77%). The nomogram can be freely accessed as an online calculator at (https://ascvdriskuae.shinyapps.io/ASCVDrisk/). CONCLUSIONS The developed nomogram provides an accurate prognostic tool for 10-year ASCVD risk prediction in UAE nationals. These findings may help guide future research on CVD prevention in this high-risk population.
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Affiliation(s)
- Saif Al-Shamsi
- Department of Internal Medicine, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
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Association between obesity grade and the age of the first acute coronary syndrome: A cross-sectional observational study. Int J Cardiol 2021; 351:93-99. [PMID: 34864079 DOI: 10.1016/j.ijcard.2021.11.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The study evaluates how obesity grade is associated with age during the first acute coronary syndrome (ACS) and examines the effect of cardiovascular (CV) risk factors and the age of first ACS in patients with severe obesity. METHODS We enrolled consecutive patients diagnosed with first episode of ACS between 2014 and 2019, and categorized them by body mass indices (BMI). Severe obesity was defined as BMI ≥35 kg/m2. Independent variables affecting the age of first ACS were examined by linear regression analysis. RESULTS A total of 1005 patients (mean age, 57.5 ± 12.3 years; 19.3% female) were included. Approximately 6% and 12% of obese patients and normal weight patients had no other risk factors. Patients with ACS with severe obesity were younger than those with ACS in the grade-I obesity, overweight, and normal-weight groups (52.8 ± 9.9 vs. 55.3 ± 10.9, 56.8 ± 11.4, and 61.4 ± 14.2, respectively, p < 0.001). BMI had a strong, inverse linear relationship with earlier age of first ACS. The number of patients with no risk factors was significantly high in normal-weight individuals compared with patients with severe obesity (11.6% vs 5.6%, p = 0.037). After adjusting for CV risk factors, patients with overweight, grade-I obesity, and severe obesity may experience first ACS sooner than those with normal-weight by 3.9, 6.1, and 7.7 years, respectively (p < 0.001). However, males and females with severe obesity without CV risk factors experienced the first ACS episode 16 and 22 years later than those with the highest number of risk factors, respectively. CONCLUSION Patients with severe obesity experience first ACS episode 7.7 years earlier than those with normal-weight. Absence of CV risk factors in people with obesity can improve the potential negative effect of obesity on the ACS age. TRIAL REGISTRATION NCT04578964, 08 October 2020.
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Rahimi M, Khanahmad H, Gharipour M, Roohafza H, Dianatkhah M, Khosravi E, Sadeghian L, Sadeghi M. Polymorphisms of LPA gene, rs1801693 and rs7765781, are not associated with premature myocardial infarction in the Iranian population. ARYA ATHEROSCLEROSIS 2021; 17:1-8. [PMID: 35686243 PMCID: PMC9137221 DOI: 10.22122/arya.v17i0.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is one of the leading causes of mortality globally. Although it is most prevalent in the elderly, it may occur in young adults (men ≤ 55 years or women ≤ 65 years) as premature MI (PMI). As awareness of genetic risks may lead to effective prevention of PMI, we aim to investigate the association of two susceptible single nucleotide polymorphisms (SNPs) in the LPA gene with PMI in the Iranian population, rs1801693 and rs7765781, identified in previous genome-wide association studies (GWAS). METHODS A total number of 85 patients with PMI and 85 healthy controls were recruited from December 2015 to March 2016 from Isfahan, Iran. Peripheral blood samples were collected from all individuals. Deoxyribonucleic acid (DNA) was extracted and genotyped at rs1181693 and rs7765781 polymorphisms, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results were statistically analyzed to find any possible association of the two polymorphisms with PMI by SPSS software and P-values less than 0.05 were considered to be statistically significant. RESULTS Statistical analysis displayed no significant difference between rs1801693 (P = 0.815)/rs7765781 (P = 0.746) alleles in patients with PMI and healthy control subjects. CONCLUSION There is no meaningful association between rs1801693/rs7765781 and PMI incidence in the Iranian population.
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Affiliation(s)
- Mahsa Rahimi
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Khanahmad
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Gharipour
- Department of Genetics and Epigenetics, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Minoo Dianatkhah
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Khosravi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ladan Sadeghian
- Department of Genetics and Epigenetics, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Masoumeh Sadeghi; Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran;
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Allabadi H, Alkaiyat A, Zahdeh T, Assadi A, Ghanayim A, Hasan S, Abu Al Haj D, Allabadi L, Haj-Yahia S, Schindler C, Kwiatkowski M, Zemp E, Probst-Hensch N. Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine. PLoS One 2021; 16:e0255077. [PMID: 34314470 PMCID: PMC8315523 DOI: 10.1371/journal.pone.0255077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors. Discussion Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.
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Affiliation(s)
- Hala Allabadi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdulsalam Alkaiyat
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Tamer Zahdeh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaa Assadi
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Aya Ghanayim
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Shaden Hasan
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Dalia Abu Al Haj
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Liana Allabadi
- Faculty of Graduate Studies, Arab American University, Ramallah, Palestine
| | - Salim Haj-Yahia
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- Institute of Cardiovascular and Medical Sciences, Glasgow University, 126 University Place, Glasgow, United Kingdom
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Risk Factors for Premature Myocardial Infarction: A Systematic Review and Meta-analysis of 77 Studies. Mayo Clin Proc Innov Qual Outcomes 2021; 5:783-794. [PMID: 34401655 PMCID: PMC8358212 DOI: 10.1016/j.mayocpiqo.2021.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the magnitude of the association between risk factors and premature myocardial infarction (MI) (men aged 18-55 years; women aged 18-65 years). Patients and Methods We searched MEDLINE and other databases from inception through April 30, 2020, as well as bibliography of articles selected for data extraction. We selected observational studies reporting the magnitude of the association of at least 1 risk factor (demographic characteristics, lifestyle factors, clinical risk factors, or biomarkers) with premature MI and a control group. Pooled risk estimates (random effects) from all studies unadjusted and adjusted for risk factors were reported as summary odds ratios (ORs) with 95% CIs. Results From 35,320 articles of 12.7 million participants, we extracted data on 19 risk factors from 77 studies across 58 countries. Men had a higher risk of premature MI (OR, 2.39; 95% CI, 1.71 to 3.35) than did women. Family history of cardiac disease was associated with a higher risk of premature MI (OR, 2.67; 95% CI, 2.29 to 3.27). Major modifiable risk factors associated with higher risk were current smoking (OR, 4.34; 95% CI, 3.68 to 5.12 vs no/former), diabetes mellitus (OR, 3.54; 95% CI, 2.69 to 4.65), dyslipidemia (OR, 2.94; 95% CI, 1.76 to 4.91), and hypertension (OR, 2.85; 95% CI, 2.48 to 3.27). Higher body mass index carried higher risk (OR, 1.46; 95% CI, 1.24 to 1.71 for ≥25 kg/m2 vs <25 kg/m2). Biomarkers associated with 2- to 3-fold higher risk were total cholesterol levels greater than 200 mg/dL, triglyceride levels higher than 150 mg/dL, and high-density lipoprotein cholesterol levels less than 60 mg/dL (to convert to mmol/L, multiply by 0.0259). Conclusion Major risk factors for premature MI are mostly amenable to patient, population, and policy level interventions. Mild elevations in body mass index and triglyceride levels were associated with higher risk, which has implications for the growing worldwide epidemic of cardiometabolic diseases.
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Dugani SB, Fabbri M, Chamberlain AM, Bielinski SJ, Weston SA, Manemann SM, Jiang R, Roger VL. Premature Myocardial Infarction: A Community Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:413-422. [PMID: 33997637 PMCID: PMC8105506 DOI: 10.1016/j.mayocpiqo.2021.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective To evaluate the trends in incident premature myocardial infarction (MI) and prevalence of cardiac risk factors in a population-based cohort. Methods We studied a population-based cohort of incident premature MIs among residents (MI in men aged 18-55 years and women aged 18-65 years) in Olmsted County, Minnesota, during a 26-year period from January 1, 1987 through December 31, 2012. Recurrent MI and death after incident premature MI were enumerated through September 30, 2018. Results Of 3276 MI cases, 850 were premature events (37.9% [322/850] women). Age-adjusted premature MI incidence rates (2012 vs 1987) declined by 39% in men (rate ratio, 0.61; 95% CI, 0.46 to 0.81]) and 61% in women (rate ratio, 0.39; 95% CI, 0.27 to 0.57). Among men with premature MI, the prevalence of hypertension, diabetes, and hyperlipidemia increased over time, whereas in women, only the prevalence of hyperlipidemia increased. During a mean follow-up of 13.3 years, there was no temporal decline in recurrent MI in men and women. Women showed 66% decreased risk for mortality (hazard ratio, 0.34; 95% CI, 0.17 to 0.68) over time, whereas men showed no change. Conclusion The incidence of premature MI declined over a 26-year period for both men and women. The risk factor profile of persons presenting with MI worsened over time, especially in men. Death following incident MI declined only in women. These results underscore the importance of primary prevention in young adults and of sex-specific approaches.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Correspondence: Address to Sagar B. Dugani, MD, PhD, Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Matteo Fabbri
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
- Departments of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Susan A. Weston
- Departments of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Ruoxiang Jiang
- Departments of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Véronique L. Roger
- Departments of Health Sciences Research, Mayo Clinic, Rochester, MN
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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11
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Reda A, Bendary A, Elbahry A, Farag E, Mostafa T, Khamis H, Wadie M, Bendary M, Abdoul Azeem B, Salah R. Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndrome: final data of the nationwide cross-sectional 'CardioRisk' project. J Public Health Afr 2021; 11:1368. [PMID: 33623654 PMCID: PMC7893316 DOI: 10.4081/jphia.2020.1368] [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: 02/23/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. Results The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants. Conclusion Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
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Affiliation(s)
- Ashraf Reda
- Cardiology Department, Faculty of Medicine, Menofia University
| | - Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University
| | | | - Elsayed Farag
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Tamer Mostafa
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Hazem Khamis
- Cardiology Department, Faculty of Medicine, October University
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University
| | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University
| | | | - Rehab Salah
- Faculty of Medicine, Benha University, Egypt
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12
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An F, Liu C, Wang X, Li T, Fu H, Bao B, Cong H, Zhao J. Effect of ABCA1 promoter methylation on premature coronary artery disease and its relationship with inflammation. BMC Cardiovasc Disord 2021; 21:78. [PMID: 33557767 PMCID: PMC7869242 DOI: 10.1186/s12872-021-01894-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND ATP-binding cassette transporter A1 (ABCA1) plays a major role in high-density lipoprotein (HDL) metabolism and reverse cholesterol transport (RCT) and exerts anti-inflammatory effects. Increased ABCA1 promoter methylation level may result in the progression of coronary artery disease. Thus, the present study investigated the association between promoter methylation status of ABCA1 and inflammation in the development of premature coronary artery disease (pCAD). METHODS PCAD patients and healthy individuals (n = 90 each) were recruited from the Characteristic Medical Center of the Chinese People's Armed Police Force from June to December 2019. Using pyrosequencing, the levels of ABCA1 promoter methylation in their blood samples were evaluated. Serum concentrations of lipids, interleukin 1β (IL-1β), C-reactive protein (CRP), and circulating free DNA/Neutrophil extracellular traps (cfDNA/NETs) were also routinely measured and compared between the two groups. P values < 0.05 were considered statistically significant. RESULTS The mean ABCA1 promoter methylation levels were significantly higher in the pCAD group than in the control group (44.24% ± 3.66 vs. 36.05% ± 2.99, P < 0.001). Based on binary logistic regression analysis, ABCA1 promoter methylation level was identified as an independent risk factor for pCAD development (odds ratio = 2.878, 95% confidence interval: 1.802-4.594, P < 0.001). Furthermore, ABCA1 promoter methylation levels were negatively correlated with HDL levels (r = - 0.488, P < 0.001) and positively correlated with the levels of CRP, cfDNA/NETs, and IL-1β (r = 0.389, 0.404, 0.385, respectively; P < 0.001). Multiple regression analysis showed that the serum levels of CRP, IL-1β, and cfDNA/NETs independently affect ABCA1 promoter methylation. CONCLUSIONS Our findings indicate that high methylation levels at the ABCA1 promoter are associated with low HDL cholesterol levels and an increased risk of pCAD. Inflammatory factors and NETs may be involved in the progression of pCAD by affecting ABCA1 promoter methylation levels.
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Affiliation(s)
- Fang An
- Graduate School, Tianjin Medical University, Tianjin, 300070, China.,Department of Military General Medicine, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Chao Liu
- Institute of Cardiovascular disease, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Xiujuan Wang
- Institute of Cardiovascular Disease, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Tan Li
- Department of Pathogen Biology, Logistics University of Chinese People's Armed Police Force, Tianjin, 300309, China
| | - Hao Fu
- Department of Military General Medicine, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Buhe Bao
- Department of Clinical Laboratory, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Hongliang Cong
- Institute of Cardiovascular disease, Tianjin Chest Hospital, Tianjin, 300222, China. .,Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, China.
| | - Jihong Zhao
- Department of Military General Medicine, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China.
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13
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Cheng K, Alhumood K, El Shaer F, De Silva R. The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region. Adv Ther 2021; 38:925-948. [PMID: 33351175 PMCID: PMC7889547 DOI: 10.1007/s12325-020-01582-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022]
Abstract
Chronic coronary syndromes (CCS) and stable angina are a growing clinical burden worldwide. This is of particular concern in the Gulf region given its high prevalence of cardiovascular risk factors, especially diabetes mellitus and smoking. Despite recommendations on the use of first- and second-line anti-anginal medication, management challenges remain. Current guidelines for pharmacologic treatment are not determined by the range of pathophysiological mechanisms of ischaemia and consequent angina, which may occur either in isolation or co-exist. In this article, we highlight the need to improve knowledge of the epidemiology of chronic coronary syndromes in the Middle East and Gulf region, and the need for studies of stratified pharmacologic approaches to improve symptomatic angina and quality of life in the large and growing number of patients with coronary artery disease from this region. We discuss the role of nicorandil, currently recommended as a second-line anti-anginal drug in CCS patients, and suggest that this may be a particularly useful add-on therapy for patients in the Gulf region.
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Affiliation(s)
- Kevin Cheng
- Specialist Angina Service, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Vascular Science Department, National Heart and Lung Institute, London, UK
| | | | - Fayez El Shaer
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- National Heart Institute, Cairo, Egypt
| | - Ranil De Silva
- Specialist Angina Service, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
- Vascular Science Department, National Heart and Lung Institute, London, UK.
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