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Sabbour H, Al-Humood K, Al Taha Z, Romany I, Haddadin H, Mohty D. Corrigendum: A wolf in sheep's clothing-aortic stenosis and cardiac amyloidosis: "RAISE"ing awareness in clinical practice. Front Cardiovasc Med 2024; 11:1418216. [PMID: 38737716 PMCID: PMC11082413 DOI: 10.3389/fcvm.2024.1418216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2024.1323023.].
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Affiliation(s)
- H. Sabbour
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - K. Al-Humood
- Advanced Heart Failure and Transplantation Unit, Chest Disease Hospital, Kuwait City, Kuwait
| | - Z. Al Taha
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - I. Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - H. Haddadin
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - D. Mohty
- Heart Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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Yogeswaran A, Gall H, Fünderich M, Wilkins MR, Howard L, Kiely DG, Lawrie A, Hassoun PM, Sirenklo Y, Torbas O, Sweatt AJ, Zamanian RT, Williams PG, Frauendorf M, Arvanitaki A, Giannakoulas G, Saleh K, Sabbour H, Cajigas HR, Frantz R, Al Ghouleh I, Chan SY, Brittain E, Annis JS, Pepe A, Ghio S, Orfanos S, Anthi A, Majeed RW, Wilhelm J, Ghofrani HA, Richter MJ, Grimminger F, Sahay S, Tello K, Seeger W. Comparison of Contemporary Risk Scores in All Groups of Pulmonary Hypertension: A Pulmonary Vascular Research Institute GoDeep Meta-Registry Analysis. Chest 2024:S0012-3692(24)00309-X. [PMID: 38508334 DOI: 10.1016/j.chest.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a heterogeneous disease with a poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). Although various risk models have been developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. RESEARCH QUESTION Are risk scores originally developed for PAH predictive in PH groups 1 through 4? STUDY DESIGN AND METHODS We conducted a comprehensive analysis of outcomes among patients with incident PH enrolled in the multicenter worldwide Pulmonary Vascular Research Institute GoDeep meta-registry. Analyses were performed across PH groups 1 through 4 and further subgroups to evaluate the predictive value of PAH risk scores, including REVEAL Lite 2, REVEAL 2.0, ESC/ERS 2022, COMPERA 3-strata, and COMPERA 4-strata. RESULTS Eight thousand five hundred sixty-five patients were included in the study, of whom 3,537 patients were assigned to group 1 PH, whereas 1,807 patients, 1,635 patients, and 1,586 patients were assigned to group 2 PH, group 3 PH, and group 4 PH, respectively. Pulmonary hemodynamics were impaired with median mean pulmonary arterial pressure of 42 mm Hg (33-52 mm Hg) and pulmonary vascular resistance of 7 WU (4-11 WU). All risk scores were prognostic in the entire PH population and in each of the PH groups 1 through 4. The REVEAL scores, when used as continuous prediction models, demonstrated the highest statistical prognostic power and granularity; the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Similar results were obtained when separately analyzing various subgroups (PH subgroups 1.1, 1.4.1, and 1.4.4; PH subgroups 3.1 and 3.2; group 2 with isolated postcapillary PH vs combined precapillary and postcapillary PH; patients of all groups with concomitant cardiac comorbidities; and severe [> 5 WU] vs nonsevere PH). INTERPRETATION This comprehensive study with real-world data from 15 PH centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common to the group or calculated separately for each PH group (1-4) and various subgroups.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Meike Fünderich
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London
| | - Luke Howard
- National Heart and Lung Institute, Imperial College London, London
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuriy Sirenklo
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Olena Torbas
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | | | | | - Alexandra Arvanitaki
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Khaled Saleh
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Frantz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | - Raphael W Majeed
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Jochen Wilhelm
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | | | - Khodr Tello
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany.
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Ahmad A, Sabbour H. Effectiveness and safety of the combination of sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies. Cardiovasc Diabetol 2024; 23:99. [PMID: 38500154 PMCID: PMC10949729 DOI: 10.1186/s12933-024-02192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Randomized controlled trials and real-world studies suggest that combination therapy with sodium-glucose transport protein 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with improvement in fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), body mass index (BMI), and total cholesterol levels. However, a systematic review of available real-world evidence may facilitate clinical decision-making in the real-world scenario. This meta-analysis assessed the safety and effectiveness of combinations of SGLT2is + GLP-1RAs with a focus on their cardioprotective effects along with glucose-lowering ability in patients with type 2 diabetes mellitus (T2DM) in a real-world setting. METHODS Electronic searches were performed in the PubMed/MEDLINE, PROQuest, Scopus, CINAHL, and Google Scholar databases. Qualitative analyses and meta-analyses were performed using the Joanna Briggs Institute SUMARI software package and Review Manager v5.4, respectively. RESULTS The initial database search yielded 1445 articles; of these, 13 were included in this study. The analyses indicated that SGLT2is + GLP-1RAs combinations were associated with significantly lower all-cause mortality when compared with individual therapies (odds ratio [95% confidence interval [CI] 0.49 [0.41, 0.60]; p < 0.00001). Significant reductions in BMI (- 1.71 [- 2.74, - 0.67]; p = 0.001), SBP (- 6.35 [- 10.17, - 2.53]; p = 0.001), HbA1c levels (- 1.48 [- 1.75, - 1.21]; p < 0.00001), and FPG (- 2.27 [- 2.78, - 1.76]; p < 0.00001) were associated with the simultaneous administration of the combination. Changes in total cholesterol levels and differences between simultaneous and sequential combination therapies for this outcome were not significant. CONCLUSION This systematic review and meta-analysis based on real-world data suggests that the combination of SGLT2is + GLP-1RAs is associated with lower all-cause mortality and favorable improvements in cardiovascular, renal, and glycemic measurements. The findings drive a call-to-action to incorporate this combination early and simultaneously in managing T2DM patients and achieve potential cardiovascular benefits and renal protection.
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Affiliation(s)
- Aftab Ahmad
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates.
- Department of Endocrinology, Khalifa Medical University, Abu Dhabi, United Arab Emirates.
| | - Hani Sabbour
- Department of Cardiology, Mediclinic Hospital, Abu Dhabi, United Arab Emirates
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Cardiology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
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Salih RM, Barajas-Gamboa JS, Del Gobbo GD, Abdallah M, Sun H, Lee-St John T, Kanwar O, Abril C, Pantoja JP, Raza J, Sabbour H, Rodriguez J, Kroh M, Corcelles R. Cardiovascular disease risk scores in patients with optimal vs suboptimal weight loss after bariatric surgery: Translating improvements into clinical practice. Am J Surg 2024:S0002-9610(24)00169-7. [PMID: 38494359 DOI: 10.1016/j.amjsurg.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/15/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate cardiovascular disease (CVD) risk modification in patients with optimal weight loss (OWL) versus suboptimal weight loss SWL following MBS. METHODS This was a retrospective analysis. The 10-year risk CVD was estimated before and after one year of surgery using the "Framingham Score". RESULTS 191 patients were included in our study. Mean baseline Framingham score was 7.2 ± 6.9%. According to the score, 54% of patients were classified as low risk (n = 104), 23% as moderate (n = 43), 20% moderately high (n = 39) and 3% as high risk (n = 5). One year after surgery, 91% of the patients showed reduction of their Framingham score. Mean CVD risk score decreased significantly to 4.1 ± 3.7% when compared to baseline (p-value is < 0.001); 80% of patients classified as low risk (n = 153), 13% as moderate (n = 25), 7% moderately high (n = 13) and 0% as high risk (n = 0). CONCLUSION Weight loss after bariatric surgery reduces CVD risk scores and the magnitude of effect correlates with the degree of weight loss.
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Affiliation(s)
- Rajaa Mohamed Salih
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan S Barajas-Gamboa
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Gabriel Diaz Del Gobbo
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Mohammed Abdallah
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Helen Sun
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Terrence Lee-St John
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Oshin Kanwar
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Juan Pablo Pantoja
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Javed Raza
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Department of Cardiology, Cleveland Clinic Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - John Rodriguez
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Ricard Corcelles
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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Sabbour H, Al-Humood K, Al Taha Z, Romany I, Haddadin H, Mohty D. A wolf in sheep's clothing-aortic stenosis and cardiac amyloidosis: "RAISE"ing awareness in clinical practice. Front Cardiovasc Med 2024; 11:1323023. [PMID: 38464842 PMCID: PMC10921426 DOI: 10.3389/fcvm.2024.1323023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/15/2024] [Indexed: 03/12/2024] Open
Abstract
Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.
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Affiliation(s)
- H. Sabbour
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - K. Al-Humood
- Advanced Heart Failure and Transplantation Unit, Chest Disease Hospital, Kuwait City, Kuwait
| | - Z. Al Taha
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - I. Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - H. Haddadin
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - D. Mohty
- Heart Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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Sabbour H, Bhatt DL, Elhenawi Y, Aljaberi A, Bennani L, Fiad T, Hasan K, Hashmani S, Hijazi RA, Khan Z, Shantouf R. A Practical Approach to the Management of Residual Cardiovascular Risk: United Arab Emirates Expert Consensus Panel on the Evidence for Icosapent Ethyl and Omega-3 Fatty Acids. Cardiovasc Drugs Ther 2024:10.1007/s10557-023-07519-z. [PMID: 38363478 DOI: 10.1007/s10557-023-07519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE Patients with hyperlipidemia treated with statins remain at a residual cardiovascular (CV) risk. Omega-3 polyunsaturated fatty acids hold the potential to mitigate the residual CV risk in statin-treated patients, with persistently elevated triglyceride (TG) levels. METHOD We reviewed the current evidence on the use of icosapent ethyl (IPE), an omega-3 fatty acid yielding a pure form of eicosapentaenoic acid. RESULTS REDUCE-IT reported a significant 25% reduction in CV events, including the need for coronary revascularization, the risk of fatal/nonfatal myocardial infarction, stroke, hospitalization for unstable angina, and CV death in patients on IPE, unseen with other omega-3 fatty acids treatments. IPE was effective in all patients regardless of baseline CV risk enhancers (TG levels, type-2 diabetes status, weight status, prior revascularization, or renal function). Adverse events (atrial fibrillation/flutter) related to IPE have occurred mostly in patients with prior atrial fibrillation. Yet, the net clinical benefit largely exceeded potential risks. The combination with other omega-3 polyunsaturated fatty acids, in particular DHA, eliminated the effect of EPA alone, as reported in the STRENGTH and OMEMI trials. Adding IPE to statin treatment seems to be cost-effective, especially in the context of secondary prevention of CVD, decreasing CV event frequency and subsequently the use of healthcare resources. CONCLUSION Importantly, IPE has been endorsed by 20 international medical societies as a statin add-on treatment in patients with dyslipidemia and high CV risk. Robust medical evidence supports IPE as a pillar in the management of dyslipidemia.
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Affiliation(s)
- Hani Sabbour
- Warren Alpert School of Medicine, Brown University, RI USA, Mediclinic Hospital, Abu Dhabi, United Arab Emirates.
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Yaser Elhenawi
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Asma Aljaberi
- Endocrine Division, Department of Medicine, Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Layal Bennani
- Medical Affairs, Biologix, Dubai, United Arab Emirates
| | - Tarek Fiad
- Centre Abu Dhabi, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khwaja Hasan
- Packer Hospital Guthrie, Sayre, Pennsylvania, USA
| | - Shahrukh Hashmani
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Rabih A Hijazi
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Zafar Khan
- Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ronney Shantouf
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
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Kinsara AJ, Sabbour H. Flash'O real-world evidence programme - Attitude and practices toward the use of omega-3 FA by physicians from Middle East Countries. Medicine (Baltimore) 2023; 102:e35416. [PMID: 37800826 PMCID: PMC10553087 DOI: 10.1097/md.0000000000035416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
The Flash'O project was designed to provide insights into the current use of prescription omega-3 and their perceived benefits by physicians in real-world clinical practice, in Russia, Saudi Arabia, Thailand, and Gulf countries, and to determine the adherence of physicians to dyslipidemia management guidelines. The present study focuses on Flash'O's process and results in Middle East countries. A total of 338 physicians and specialists completed the online questionnaire. Most responding physicians were male (91.7%), general practitioners (42.6%) with more than 5 years of seniority (80.4%) and saw more than 50 patients a week (71.5%). Most surveyed physicians (64.2%) reported using guidelines in their daily practice for the management of their patients with dyslipidemia. They mostly followed national guidelines (68.6%). American or European ones were less commonly used. Responding physicians thought that omega-3 supplementation could be more beneficial in all types of dyslipidemia, except high non- hight density lipoproteins, and for patients suffering from obesity, type 2 diabetes mellitus, acute coronary syndrome with ST-segment elevation myocardial infarction and high cardiovascular diseases risk (score ≥ 5% and < 10%), but less beneficial in chronic kidney disease. Respondents recommended omega-3 to their patients mainly after statin treatment in patients with dyslipidemia and for the treatment of dyslipidemia. This survey confirmed that omega-3 fatty acids are at the heart of the cardiovascular medical strategy.
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Affiliation(s)
- Abdulhalim Jamal Kinsara
- Ministry of National Guard health affairs, King Saud bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Research center, Riyadh, Saudi Arabia
| | - Hani Sabbour
- Heart and Vascular Institute, AL Maryah Island, Abu Dhabi Global Market Square, Abu Dhabi, United Arab Emirates
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Al Taha Z, Alibazoglu D, Sabbour H, Romany I, Alibazoglu H, Bokhari S. Attacking the Achilles heel of cardiac amyloid nuclear scintigraphy: How to reduce equivocal and false positive studies. J Nucl Cardiol 2023; 30:1922-1934. [PMID: 36859593 PMCID: PMC10558365 DOI: 10.1007/s12350-023-03214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/22/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Planar and single-photon emission computed tomography (SPECT) nuclear imaging techniques with bone seeking radiotracers have been increasingly adopted for diagnosis of ATTR cardiac amyloidosis. However, inherent limitations of these techniques due to lack of anatomical landmarks have been recognized, with consequent high numbers of equivocal or false positive cases. SPECT/computed tomography (CT) fusion imaging offers a significant advantage to overcome these limitations by substantially reducing inaccurate interpretations. The authors present the results of a 3-year imaging quality improvement project that focused on reducing the high number of equivocal studies that were noted in the first two years of the amyloidosis program, comparing SPECT only to SPECT/CT fusion technique. METHODS A retrospective, systematic analysis of 176 patient records was performed to test the premise that SPECT/CT fusion imaging has the potential to reduce equivocal and false positive results. RESULTS Of a total of 176 patients, 35 equivocal (19.8%), 32 (18.18%) strongly suggestive, and 109 (61.93%) not suggestive cases were identified. Recognizing that this was not consistent with the international data, the authors set out on a comprehensive quality assessment project to reduce the number of equivocal and false positive cases. In patients who initially underwent SPECT only (Group A; n = 78), the addition of SPECT/CT fusion resulted in the net reclassification of 73% of cases: 100% of equivocal cases (n = 35) were reclassified to not suggestive (n = 34) or strongly suggestive (n = 1). 73% of strongly suggestive cases (n = 30) were reclassified to not suggestive (n = 22) while 8 strongly suggestive cases were confirmed as true positives. 13 not suggestive cases remained negative after SPECT/CT fusion. In cases where SPECT/CT fusion was utilized from the beginning (Group B; n = 98), there were no reclassification of any of the cases when these cases were reprocessed as a control group. CONCLUSION Addition of SPECT/CT imaging reduces the false positive or equivocal studies and increases the diagnostic accuracy of the test. All false positive and equivocal studies were eliminated using the fusion technique. Utilizing the fusion imaging technique increases the spatial resolution, with the ability to localize myocardial uptake and accurately differentiate from blood pool, which is a major source of error.
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Affiliation(s)
- Zainab Al Taha
- Sheikh Shakhboot Medical City, Abu Dhabi, United Arab Emirates
| | | | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Ingy Romany
- Pfizer Gulf FZ-LLC, Dubai, United Arab Emirates
| | | | - Sabahat Bokhari
- Robert Wood Johnson Medical School - Rutgers University, New Brunswick, NJ, USA
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Abdelhamid M, Al Ghalayini K, Al‐Humood K, Altun B, Arafah M, Bader F, Ibrahim M, Sabbour H, Shawky Elserafy A, Skouri H, Yilmaz MB. Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey. ESC Heart Fail 2023; 10:2773-2787. [PMID: 37530028 PMCID: PMC10567674 DOI: 10.1002/ehf2.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co-morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5-16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co-morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium-glucose co-transporter-2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co-morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.
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Affiliation(s)
| | | | | | - Bülent Altun
- Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Feras Bader
- Cleveland ClinicAbu DhabiUnited Arab Emirates
| | | | | | | | - Hadi Skouri
- Sheikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
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Verma S, Alamuddin N, Alawadi F, Alkandari H, Al Mahmeed W, Assaad-Khalil SH, Haddad J, Husemoen LLN, Lombard L, Malik RA, Mashaki Ceyhan E, Sabbour H, Tombak G, Yadav G, Salek S. Prevalence of Diabetes and Cardiovascular Risk in the Middle East and Africa: Primary Results of the PACT-MEA Study. Circulation 2023; 147:1251-1255. [PMID: 36877670 PMCID: PMC10101130 DOI: 10.1161/circulationaha.123.064345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Subodh Verma
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Naji Alamuddin
- Royal College of Surgeons in Ireland Bahrain, King Hamad University Hospital, Bahrain
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority (DHA), United Arab Emirates
| | - Hessa Alkandari
- Department of Pediatrics, Farwaniya Hospital; Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Wael Al Mahmeed
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samir H Assaad-Khalil
- Unit of Diabetes, Lipidology & Metabolism; Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jihad Haddad
- Endocrinology Section, Bader Medical Complex, Amman, Jordan, JORDAN
| | | | - Landman Lombard
- Principal Investigator, Cape Town Medical Research Centre, Cape Town South Africa
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
| | | | - Hani Sabbour
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Gourav Yadav
- Novo Nordisk Saglik Urunleri Tic. Ltd. Sti. Istanbul, Turkey
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, and Institute of Medicines Development, United Kingdom
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Verma S, Alamuddin N, Alawadi F, Alkandari H, Almahmeed WA, Assaad-Khalil S, Haddad J, Husemoen LLN, Lombard L, Malik RA, Ceyhan EM, Sabbour H, Yadav G, Verma S. PREVALENCE OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASES IN PATIENTS WITH TYPE 2 DIABETES ACROSS MIDDLE EAST AND AFRICA: PRIMARY RESULTS OF THE PACT-MEA STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Verma S, Sabbour H, Alamuddin N, Alawadi F, Alkandari H, Almahmeed W, Assaad-Khalil SH, Haddad J, Lombard L, Malik RA, Mashaki Ceyhan E, Prasad P, Tombak G, Salek S. A cross-sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa (PACT-MEA): Study design and rationale. Diabetes Obes Metab 2023; 25:1444-1452. [PMID: 36775980 DOI: 10.1111/dom.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/14/2023]
Abstract
AIM To investigate the epidemiology and clinical management of patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (eASCVD) or high/very high ASCVD risk, defined by the 2021 European Society of Cardiology Guidelines, in seven countries in the Middle East and Africa (PACT-MEA; NCT05317845), and to assess physicians' attitudes and the basis for their decision-making in the management of these patients. MATERIALS AND METHODS PACT-MEA is a cross-sectional, observational study undertaken in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa and the United Arab Emirates based on a medical chart review of approximately 3700 patients with T2D in primary and secondary care settings, and a survey of approximately 400 physicians treating patients with T2D. RESULTS The primary and secondary objectives are to determine the prevalence of eASCVD and high/very high ASCVD risk in patients with T2D. Current treatment with cardioprotective antidiabetic medication, the proportion of patients meeting the treatment criteria for reimbursement in the study countries where there is an applicable reimbursement guideline, and physician-reported factors in clinical decision-making in T2D management, will also be assessed. CONCLUSIONS This large cross-sectional study will establish the estimated prevalence and management of eASCVD and high/very high ASCVD risk in patients with type 2 diabetes across the Middle East and Africa.
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Affiliation(s)
- Subodh Verma
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hani Sabbour
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Naji Alamuddin
- Royal College of Surgeons in Ireland-Bahrain, King Hamad University Hospital, Adliya, Bahrain
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Hessa Alkandari
- Department of Pediatrics, Farwaniya Hospital, Kuwait City, Kuwait
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Wael Almahmeed
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samir H Assaad-Khalil
- Unit of Diabetes, Lipidology and Metabolism, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine/Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jihad Haddad
- Endocrinology Section, Bader Medical Complex, Amman, Jordan
| | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | | | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute for Medicines Development, Cardiff, UK
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Namas R, Elarabi M, Khan S, Mubashir A, Memisoglu E, El-Kaissi M, Joshi A, Chapman J, Jassim I, Khogali H, Hassan N, Sabbour H, Saleh K, Alnaqbi KA, Zayat AS, Diab S, Awir Z, Abu Taha N, Ginawi A, Al Ansari A, Rifaai H, Alrawi Z, Al Dhaheri A, Ibrahim G, Abogamal A, Al Shehhi W, Teir J, Khan T, Musgrave M, Hameed B, Khan B, Mosallam N, Hussien N, Hussein I, Abdulelhamid A, Ali A, Hannawi S, Al Izzi M, Badsha H, Al Saleh J. Comprehensive description of the prevalence, serological and clinical characteristics, and visceral involvement of systemic sclerosis (scleroderma) in a large cohort from the United Arab Emirates Systemic Sclerosis Registry. Journal of Scleroderma and Related Disorders 2023. [DOI: 10.1177/23971983221145788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Systemic sclerosis is an autoimmune condition characterized by a wide range of clinical presentations. Registries may serve to expand understanding about systemic sclerosis and aid in patient care and follow-up. The objective of this study was to analyze the prevalence of systemic sclerosis in a large cohort from the United Arab Emirates Systemic Sclerosis Registry and find the significant similarities and differences between the different subsets. All scleroderma patients in the United Arab Emirates were included in this multicenter national retrospective analysis. Data on demographics, comorbidities, serological characteristics, clinical aspects, and treatment were collected and analyzed, highlighting the most common traits identified. A total of 167 systemic scleroderma patients from diverse ethnic backgrounds were enrolled. Overall, 54.5% (91/167) of the patients were diagnosed with diffuse cutaneous systemic sclerosis, and 45.5% (76/167) with limited cutaneous systemic sclerosis. The prevalence of systemic sclerosis was 1.66 per 100,000 for the total registry and 7.78 per 100,000 for United Arab Emirates patients. Almost all patients in the diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis groups tested positive for the immunofluorescence antinuclear antibody. Antibodies against Scl-70 were significantly more associated with diffuse cutaneous systemic sclerosis, whereas anticentromere antibodies were significantly more associated with the limited cutaneous systemic sclerosis group ( p < 0.001). Sclerodactyly, shortness of breath, and digital ulcers were more common in diffuse cutaneous systemic sclerosis patients compared with the limited cutaneous systemic sclerosis subtype in terms of clinical symptoms and organ involvement. Telangiectasia was much more common in the limited cutaneous systemic sclerosis group. Furthermore, diffuse cutaneous systemic sclerosis patients had more lung fibrosis (interstitial lung disease) than limited cutaneous systemic sclerosis patients (70.5% vs 45.7%), and pulmonary arterial hypertension was twice as common in limited cutaneous systemic sclerosis patients as it was in diffuse cutaneous systemic sclerosis patients. Local registries are paramount to understanding the clinical/serological characteristics of scleroderma. This study emphasizes the importance of raising disease awareness and distinguishing between the various systemic sclerosis subsets to implement patient-tailored strategies for early detection, better management, and higher quality of care.
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Affiliation(s)
- Rajaie Namas
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mohamed Elarabi
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Saniya Khan
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Asia Mubashir
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Esat Memisoglu
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Abhay Joshi
- Division of Rheumatology, Burjeel Day Surgery Center, Abu Dhabi, UAE
| | - Jeffrey Chapman
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Imad Jassim
- Department of Rheumatology, Tawam Hospital, Al Ain, UAE
| | - Hiba Khogali
- Department of Rheumatology, Tawam Hospital, Al Ain, UAE
| | - Nada Hassan
- Department of Rheumatology, Mediclinic Parkview Hospital, Dubai, UAE
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Khaled Saleh
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Ahmed S Zayat
- Division of Rheumatology, University Hospital Sharjah, Sharjah, UAE
| | - Sehriban Diab
- Division of Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Zyiad Awir
- Department of Rheumatology, Yas Healthcare, Abu Dhabi, UAE
| | - Nehad Abu Taha
- Department of Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Amel Ginawi
- Division of Rheumatology, Mediclinic City Hospital, Dubai, UAE
| | - Atheer Al Ansari
- Division of Rheumatology, Mediclinic Airport Road Hospital, Abu Dhabi, UAE
| | - Hazem Rifaai
- Department of Rheumatology, Mediclinic Al Noor Hospital, Abu Dhabi, UAE
| | - Zaid Alrawi
- Department of Rheumatology, Clemenceau Medical Center Hospital, Dubai, UAE
| | | | - Gamal Ibrahim
- Department of Rheumatology, Dr. Sulaiman Al Habib Hospital, Dubai, UAE
| | - Ahmed Abogamal
- Department of Rheumatology, Dr. Sulaiman Al Habib Hospital, Dubai, UAE
| | | | - Jamal Teir
- Department of Rheumatology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Tahir Khan
- Department of Rheumatology,Yas Clinic Khalifa City, Abu Dhabi, UAE
| | - Maisam Musgrave
- Dubai, UAE Department of Rheumatology, Mediclinic City Hospital, Dubai, UAE
| | - Beena Hameed
- Department of Rheumatology, King’s College Hospital, Dubai, UAE
| | - Bhavna Khan
- Division of Rheumatology, King’s College Hospital, Dubai, UAE
| | - Nagwa Mosallam
- Department of Rheumatology, Burjeel Hospital, Abu Dhabi, UAE
| | - Nahla Hussien
- Department of Rheumatology, Medeor Hospital, Abu Dhabi, UAE
| | - Iman Hussein
- Department of Rheumatology,Yas Clinic Khalifa City, Abu Dhabi, UAE
| | | | - Ahmed Ali
- Department of Rheumatology, Ibrahim Bin Hamad Obaidullah Hospital, Ras Al Khaima, UAE
| | - Suad Hannawi
- Department of Rheumatology, Ministry of Health and Prevention Ibrahim Bin Hamad Obaidullah, Dubai, UAE
| | - Mustafa Al Izzi
- Department of Rheumatology, Mediclinic Welcare Hospital, Dubai, UAE
| | - Humeira Badsha
- Department of Rheumatology, Dr. Humeira Badsha Medical Center, Dubai, UAE
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Sabbour H, Ahmad A. Management of Heart Failure in Patients With Diabetes Mellitus in the UAE: A Call to Action. J Cardiovasc Pharmacol Ther 2023; 28:10742484231162248. [PMID: 37067056 DOI: 10.1177/10742484231162248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Heart failure (HF) is an important adverse outcome of diabetes mellitus (DM) with high rates of mortality and HF-related hospitalizations. The risk of HF is 2 times higher in patients with DM compared to those without DM. Due to under-recognition and underdiagnoses, HF is often a neglected outcome in the diabetic population. There is a dearth of data regarding the true prevalence of HF and the management protocols for diabetic patients at risk of HF in the UAE and the Middle East. This lacuna in the information has led to the inception of this "call to action" paper, which identifies the gaps in the true prevalence of HF and describes the importance of early diagnosis and appropriate management of HF in the Middle East. METHODOLOGY An advisory board meeting was convened and a group of key opinion leaders and experts in cardiology and endocrinology assembled to describe the prevalence, diagnosis, and management of HF in diabetes patients and to present a "call to action" in the UAE and Middle East scenario. After the group discussion, key expert opinions were formulated and "call to action" recommendations were proposed. CONCLUSION This "call to action" is mainly based on the available evidence from the literature and the experts' clinical experience. Based on the new evidence from various cardiovascular outcome trials, the "call to action" highlights a series of collaborative learning regarding the role of newer antidiabetic therapies like sodium-glucose cotransporter-2 inhibitors in the prevention and management of HF. This "call to action" intends to serve as a guide for physicians, including primary healthcare providers, in their management of diabetic patients with HF.
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Affiliation(s)
- Hani Sabbour
- Department of Cardiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Cardiology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Aftab Ahmad
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
- Department of Endocrinology, Khalifa Medical University, Abu Dhabi, United Arab Emirates
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Shehab A, Bakir S, Sabbour H, Elnour AA, Mahmeed WA, Salam AM, Kholy DE. Prevalence of Cardiovascular Risk Factors and 10-Years Risk for Coronary Heart Disease in the United Arab Emirates. Curr Diabetes Rev 2023; 19:38-48. [PMID: 35593359 DOI: 10.2174/1573399818666220421113607] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. AIM The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. OBJECTIVE The main objective was to report the 10-years risk for CHD in a sample of the UAE population. METHODS We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). RESULTS 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. CONCLUSION The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.
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Affiliation(s)
- Abdulla Shehab
- Department of Cardiology, Burjeel Royal Hospital, Al-Ain, UAE
| | - Sherif Bakir
- Department of Cardiology, Kids, and Adult Heart Centers Dubai and Abu Dhabi, Dhabi, UAE
| | - Hani Sabbour
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Asim A Elnour
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi Campus, Abu Dhabi, UAE
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, UAE
| | - Wael Al Mahmeed
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Amar M Salam
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Doaa El Kholy
- Department of Cardiology, Mediclinic Al Ain Hospital, Al Ain, UAE
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Abstract
It is well known that diabetes is a prominent risk factor for cardiovascular (CV) events. The level of CV risk depends on the type and duration of diabetes, age and additional co-morbidities. Diabetes is an independent risk factor for atrial fibrillation (AF) and is frequently observed in patients with AF, which further increases their risk of stroke associated with this cardiac arrhythmia. Nearly one third of patients with diabetes globally have CV disease (CVD). Additionally, co-morbid AF and coronary artery disease are more frequently observed in patients with diabetes than the general population, further increasing the already high CV risk of these patients. To protect against thromboembolic events in patients with diabetes and AF or established CVD, guidelines recommend optimal CV risk factor control, including oral anticoagulation treatment. However, patients with diabetes exist in a prothrombotic and inflammatory state. Greater clinical benefit may therefore be seen with the use of stronger antithrombotic agents or innovative drug combinations in high-risk patients with diabetes, such as those who have concomitant AF or established CVD. In this review, we discuss CV risk management strategies in patients with diabetes and concomitant vascular disease, stroke prevention regimens in patients with diabetes and AF and how worsening renal function in these patients may complicate these approaches. Accumulating evidence from clinical trials and real-world evidence show a benefit to the administration of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with diabetes and AF.
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Affiliation(s)
- A John Camm
- Division of Cardiac and Vascular Sciences, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, Cranmer Terrace, SW17 0RE, UK.
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Warren Alpert School of Medicine, Brown University, Rhode Island, USA
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Neuherberg, Munich, Germany
| | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Saleh K, Khan N, Ghorab A, El-Kaissi M, Mubashir A, Elarabi M, Sabbour H, Namas R. AB0652 Prevalence of Interstitial lung disease and pulmonary arterial hypertension in systemic sclerosis patients cohort at a rheumatology referral centre in the United Arab Emirates. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundScleroderma, also known as Systemic Sclerosis (SSc), is a connective tissue disease that affects multiple organ systems, including the cardiovascular and respiratory systems, namely, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) as the leading causes of death in this patient population.ObjectivesThe purpose of this study is to determine the prevalence of PAH and ILD in a cohort of patients diagnosed with SSc.MethodsWe performed a retrospective chart review of clinical characteristics of all patients diagnosed with SSc Cleveland Clinic Abu Dhabi between April 2015 and April 2020. PAH was estimated by echocardiographic findings and diagnosed based on right heart catheterization (RHC) using 2019 World Symposium on Pulmonary Hypertension. The CT scan of the chest was read by a board-certified radiologist in chest radiology.ResultsFifty individuals were diagnosed with SSc, with 46% having diffuse cutaneous systemic sclerosis and 54% having limited cutaneous systemic sclerosis. The majority of the patients (88%) were female, with a mean age of 41 ±13 years. The average period from presentation to diagnosis was 5 ±5.4 years. The majority of the cohort (86%) were from the United Arab Emirates. The average BMI was 26.0 kg/m2. Patients’ most prevalent symptoms are fatigue (80%), gastrointestinal symptoms (72%) followed by shortness of breath (58%) and cough (50%). Twenty-six out of fifty patients (52%) underwent a CT chest scan, with 19 (38%) having ILD. Eight patients had more than 30% fibrotic alterations, four patients had 10-30% fibrotic changes, and seven patients had less than 10% fibrotic abnormalities. Patients with more than 10% fibrotic changes were more likely to have usual interstitial pneumonia, whereas those with less than 10% fibrotic changes were more likely to have none specific fibrosis. The majority of patients (92%) had echocardiogram. All except one patient had a normal ejection fraction, and five had grade 1 left ventricular diastolic dysfunction. Five patients were described as having mild, 1 moderate and 2 severe PAH. Only 4 patients underwent RHC. One patient had group II PAH based on elevated wedge pressure. One had group 1 PAH with systemic sclerosis as the only cause for her PAH and two patients had group III PAH due to having more than 30 % pulmonary fibrosis and severe restrictive defect on spirometry. Therefore, the precapillary PAH prevalence was 6% (3/50).ConclusionWhile the prevalence of pulmonary fibrosis in our SSc patients reflects what has been reported in the literature, the prevalence of PAH is significantly lower than the reported 15-20%.1 This is likely due to underdiagnosis of PAH considering the number of years of systemic sclerosis diagnosis on presentation to our clinic. A systematic approach is needed to assess for the presence and severity of PAH using tools as in Detect algorithm which has been validated and commonly used in Europe and North America to screen for PAH.2 Validation of such algorithm is likely needed in middle eastern population before it is universally adopted.References[1]Screening for pulmonary arterial hypertension in an unselected prospective systemic sclerosis cohort. Vandecasteele E, Eur Respir J. 2017;49(5) Epub 2017 May 11.[2]Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study, Coghlan et al. Ann Rheum Dis 2014;73:1340–1349. doi:10.1136/annrheumdis-2013-203301.Disclosure of InterestsNone declared
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Sonmez A, Sabbour H, Echtay A, Rahmah AM, Alhozali AM, al Sabaan FS, Haddad FH, Iraqi H, Elebrashy I, Assaad SN, Bayat Z, Osar Siva Z, Hassanein M. Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations. J Diabetes 2022; 14:315-333. [PMID: 35434900 PMCID: PMC9366572 DOI: 10.1111/1753-0407.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Hani Sabbour
- Heart & Vascular Institute Cleveland ClinicAbu DhabiUAE
- Brown University Warren Alpert School of MedicineProvidenceRhode IslandUSA
| | - Akram Echtay
- School of MedicineLebanese UniversityHadathLebanon
| | - Abbas Mahdi Rahmah
- National Centre for DiabetesCollege of Medicine, Al‐Mustansriya UniversityBaghdadIraq
| | | | | | - Fares H. Haddad
- Endocrine & Diabetes, Abdali Hospital/Endocrine & Diabetes ClinicAmmanJordan
| | - Hinde Iraqi
- Faculty of Medicine and PharmacyMohammed V UniversityRabatMorocco
| | | | | | - Zaheer Bayat
- Division of Endocrinology and Metabolism, Department of Internal MedicineHelen Joseph HospitalRossmore, JohannesburgSouth Africa
| | | | - Mohamed Hassanein
- Dubai Hospital, DHADubaiUAE
- Gulf Medical UniversityAjmanUAE
- Cardiff UniversityCardiffUK
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Al Sayed N, Almahmeed W, Alnouri F, Al Waili K, Sabbour H, Sulaiman K, Zubaid M, Ray KK, Al-Rasadi K. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East – 2021 update. Atherosclerosis 2021; 343:28-50. [DOI: 10.1016/j.atherosclerosis.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
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Vallejo-Vaz AJ, Stevens CA, Lyons AR, Dharmayat KI, Freiberger T, Hovingh GK, Mata P, Raal FJ, Santos RD, Soran H, Watts GF, Abifadel M, Aguilar-Salinas CA, Alhabib KF, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Al-Sarraf A, Al-Sayed N, Araujo F, Ashavaid TF, Banach M, Béliard S, Benn M, Binder CJ, Bogsrud MP, Bourbon M, Chlebus K, Corral P, Davletov K, Descamps OS, Durst R, Ezhov M, Gaita D, Genest J, Groselj U, Harada-Shiba M, Holven KB, Kayikcioglu M, Khovidhunkit W, Lalic K, Latkovskis G, Laufs U, Liberopoulos E, Lima-Martinez MM, Lin J, Maher V, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nordestgaard BG, Panayiotou AG, Paragh G, Petrulioniene Z, Pojskic B, Postadzhiyan A, Raslova K, Reda A, Reiner Ž, Sadiq F, Sadoh WE, Schunkert H, Shek AB, Stoll M, Stroes E, Su TC, Subramaniam T, Susekov AV, Tilney M, Tomlinson B, Truong TH, Tselepis AD, Tybjærg-Hansen A, Vázquez Cárdenas A, Viigimaa M, Wang L, Yamashita S, Kastelein JJ, Bruckert E, Vohnout B, Schreier L, Pang J, Ebenbichler C, Dieplinger H, Innerhofer R, Winhofer-Stöckl Y, Greber-Platzer S, Krychtiuk K, Speidl W, Toplak H, Widhalm K, Stulnig T, Huber K, Höllerl F, Rega-Kaun G, Kleemann L, Mäser M, Scholl-Bürgi S, Säly C, Mayer FJ, Sablon G, Tarantino E, Nzeyimana C, Pojskic L, Sisic I, Nalbantic AD, Jannes CE, Pereira AC, Krieger JE, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Baass A, Bergeron J, Bernard S, Brisson D, Brunham LR, Cermakova L, Couture P, Francis GA, Gaudet D, Hegele RA, Khoury E, Mancini GJ, McCrindle BW, Paquette M, Ruel I, Cuevas A, Asenjo S, Wang X, Meng K, Song X, Yong Q, Jiang T, Liu Z, Duan Y, Hong J, Ye P, Chen Y, Qi J, Liu Z, Li Y, Zhang C, Peng J, Yang Y, Yu W, Wang Q, Yuan H, Cheng S, Jiang L, Chong M, Jiao J, Wu Y, Wen W, Xu L, Zhang R, Qu Y, He J, Fan X, Wang Z, Chow E, Pećin I, Perica D, Symeonides P, Vrablik M, Ceska R, Soska V, Tichy L, Adamkova V, Franekova J, Cifkova R, Kraml P, Vonaskova K, Cepova J, Dusejovska M, Pavlickova L, Blaha V, Rosolova H, Nussbaumerova B, Cibulka R, Vaverkova H, Cibickova L, Krejsova Z, Rehouskova K, Malina P, Budikova M, Palanova V, Solcova L, Lubasova A, Podzimkova H, Bujdak J, Vesely J, Jordanova M, Salek T, Urbanek R, Zemek S, Lacko J, Halamkova H, Machacova S, Mala S, Cubova E, Valoskova K, Burda L, Bendary A, Daoud I, Emil S, Elbahry A, Rafla S, Sanad O, Kazamel G, Ashraf M, Sobhy M, El-Hadidy A, Shafy MA, Kamal S, Bendary M, Talviste G, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrie A, Charrieres S, Cottin Y, Di-Fillipo M, Ducluzeau PH, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, hankard R, Inamo J, Lemale J, Moulin P, Paillard F, Peretti N, Perrin A, Pradignac A, Rabes JP, Rigalleau V, Sultan A, Schiele F, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O, Haack IA, Schmidt N, Dressel A, Klein I, Christmann J, Sonntag A, Stumpp C, Boger D, Biedermann D, Usme MM, Beil FU, Klose G, König C, Gouni-Berthold I, Otte B, Böll G, Kirschbaum A, Merke J, Scholl J, Segiet T, Gebauer M, Predica F, Mayer M, Leistikow F, Füllgraf-Horst S, Müller C, Schüler M, Wiener J, Hein K, Baumgartner P, Kopf S, Busch R, Schömig M, Matthias S, Allendorf-Ostwald N, Fink B, Böhm D, Jäkel A, Koschker AC, Schweizer R, Vogt A, Parhofer K, König W, Reinhard W, Bäßler A, Stadelmann A, Schrader V, Katzmann J, Tarr A, Steinhagen-Thiessen E, Kassner U, Paulsen G, Homberger J, Zemmrich C, Seeger W, Biolik K, Deiss D, Richter C, Pantchechnikova E, Dorn E, Schatz U, Julius U, Spens A, Wiesner T, Scholl M, Rizos CV, Sakkas N, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Athyros V, Skalidis E, Kolovou G, Garoufi A, Bilianou E, Koutagiar I, Agapakis D, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Koutsogianni AD, Karányi Z, Harangi M, Bajnok L, Audikovszky M, Márk L, Benczúr B, Reiber I, Nagy G, Nagy A, Reddy LL, Shah SA, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Altaey M, Al-Jumaily K, Rasul D, Abdalsahib AF, Jabbar AA, Al-ageedi M, Agar R, Cohen H, Ellis A, Gavishv D, Harats D, Henkin Y, Knobler H, Leavit L, Leitersdorf E, Rubinstein A, Schurr D, Shpitzen S, Szalat A, Casula M, Zampoleri V, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Sabbà C, Bossi AC, Borghi C, Muntoni S, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Iannuzzi A, Iannuzzo G, Calabrò P, Averna M, Biasucci G, Zambon S, Roscini AR, Trenti C, Arca M, Federici M, Del Ben M, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Bonomo K, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Khodzhiboboev E, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Upena-RozeMicena A, Terauda E, Jambart S, Khoury PE, Elbitar S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Kasim NA, Nor NS, Ramli AS, Razak SA, Al-Khateeb A, Kadir SH, Muid SA, Rahman TA, Kasim SS, Radzi AB, Ibrahim KS, Razali S, Ismail Z, Ghani RA, Hafidz MI, Chua AL, Rosli MM, Annamalai M, Teh LK, Razali R, Chua YA, Rosman A, Sanusi AR, Murad NA, Jamal ARA, Nazli SA, Razman AZ, Rosman N, Rahmat R, Hamzan NS, Azzopardi C, Mehta R, Martagon AJ, Ramirez GA, Villa NE, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJ, Zazueta AR, Alvarado RM, Portano JD, Lopez HA, Sauque-Reyna L, Herrera LG, Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PA, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AY, Cazares HE, Gonzalez JR, Valencia CV, Padilla FG, Prado RM, De los Rios Ibarra MO, Villicaña RD, Rivera KJ, Carrera RA, Alvarez JA, Martinez JC, de los Reyes Barrera Bustillo M, Vargas GC, Chacon RC, Andrade MH, Ortega AF, Alcala HG, de Leon LE, Guzman BG, Garcia JJ, Cuellar JC, Cruz JR, Garcia AH, Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez AB, Oyervides JC, Vazquez DI, Rodriguez EA, Osorio ML, Saucedo JR, Tamayo MT, Talavera LA, Arroyo LE, Carrillo EA, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LS, Starostecka E, Konopka A, Lewek J, Bartłomiejczyk M, Gąsior M, Dyrbuś K, Jóźwiak J, Gruchała M, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Woś M, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Safarova M, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AH, Awan Z, Elamin OA, Altaradi H, Rajkovic N, Popovic L, Singh S, Stosic L, Rasulic I, Lalic NM, Lam C, Le TJ, Siang EL, Dissanayake S, I-Shing JT, Shyong TE, Jin TC, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Kovac J, Mlinaric M, Sustar U, Podkrajsek KT, Fras Z, Jug B, Cevc M, Pilcher GJ, Blom D, Wolmarans K, Brice B, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Lux A, Chang NT, Ganokroj P, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural IE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Hay DA, Luqman N, Elfatih A, Abdulrasheed A, Kwok S, Oca ND, Reyes X, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV, Abdullaeva GJ, Do DL, Nguyen MN, Kim NT, Le TT, Le HA, Tokgozoglu L, Catapano AL, Ray KK. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Lancet 2021; 398:1713-1725. [PMID: 34506743 DOI: 10.1016/s0140-6736(21)01122-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Sabbour H, Hasan KY, Al Badarin F, Alibazoglu H, Rivard AL, Romany I, Perlini S. From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis. Front Cardiovasc Med 2021; 8:644508. [PMID: 34262948 PMCID: PMC8274453 DOI: 10.3389/fcvm.2021.644508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/11/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic "red flags" associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis. A diagnostic algorithm centered around the use of non-invasive imaging and laboratory analysis is presented. The algorithm generates four differential diagnoses for patients presenting with signs and symptoms consistent with cardiac amyloidosis. Case examples are presented, representing the four potential outcomes of diagnosis using the algorithm. The review provides a guide on how to recognize the often-overlooked presentations of this disease in clinical practice. Non-invasive imaging techniques and diagnostic tools that do not require the involvement of a specialty center have allowed for the improved diagnosis of cardiac amyloidosis. Timely diagnosis of this life-threatening disease is essential for optimal management and it is imperative that clinicians have a high index of suspicion for patients presenting with "red flag" symptoms.
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Affiliation(s)
- Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | | | | | | | | | - Ingy Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - Stefano Perlini
- Emergency Department, Amyloid Research and Treatment Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo Foundation, Internal Medicine Department, University of Pavia, Pavia, Italy
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Alhabib KF, Al-Rasadi K, Almigbal TH, Batais MA, Al-Zakwani I, Al-Allaf FA, Al-Waili K, Zadjali F, Alghamdi M, Alnouri F, Awan Z, Kinsara AJ, AlQudaimi A, Almahmeed W, Sabbour H, Traina M, Atallah B, Al-Jarallah M, AlSarraf A, AlSayed N, Amin H, Altaradi H. Familial Hypercholesterolemia in the Arabian Gulf Region: Clinical results of the Gulf FH Registry. PLoS One 2021; 16:e0251560. [PMID: 34086694 PMCID: PMC8177652 DOI: 10.1371/journal.pone.0251560] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain). METHODS The multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up. RESULTS Among 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p <0.001; for both comparisons). CONCLUSIONS This snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a "call-to-action" for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.
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Affiliation(s)
- Khalid F. Alhabib
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al-Rasadi
- Medical Research Centre, Sultan Qaboos University, Muscat, Oman
- Department of Biochemistry, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Turky H. Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Alfarabi College of Medicine, Alfarabi Colleges, Riyadh, Saudi Arabia
| | - Mohammed A. Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- Gulf Health Research, Muscat, Oman
| | - Faisal A. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khalid Al-Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fahad Zadjali
- Department of Biochemistry, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Fahad Alnouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Zuhier Awan
- Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhalim J. Kinsara
- Ministry of National Guard Health Affair, COM-WR, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mahmoud Traina
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Bassam Atallah
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America
| | | | - Ahmad AlSarraf
- Department of Medicine, Sabah Al-Ahmed Cardiac Center, Kuwait
| | | | | | - Hani Altaradi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Hamour I, Ferrer R, Atallah B, Gabra G, Soliman M, Sabbour H, Bader F. Defying challenges: mid-term outcomes of international collaborations for a successful heart transplantation program in the middle east. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Heart transplantation (HTx) is a successful treatment strategy for advanced heart failure. Survival rates exceed those achieved by medical therapy alone. Lack of suitable donors and cultural perception remain obstacles for receiving this novel therapy.
Methods
Overcoming challenges we adopted a first-of-a-kind multicenter HTx program, collaborating between Cardiac Centers in India and the United Arab Emirates (UAE). Patients were worked up as part of our newly established HTx program in the UAE, then referred to India for successful HTx. All post HTx follow-up care was continued in the UAE thereafter.
Results
We assessed 10 HTx recipients, [90% male; mean age 34 yrs]. Five patients required inotropes while one LVAD support pre transplant. Our data outline short waiting-list time and excellent 3 years clinical outcomes.
All patients are maintained on Tacrolimus and Mycophenolate Mofetil. Two patient developed acute rejection (celluar and humoral) with graft dysfunction within 18 months.
Seventy percent had non-ischemic cardiomyopathy pre-transplant. Three acquired donor transmitted coronary vascular disease. One patient developed aggressive allograft vasculopathy requiring coronary artery bypass grafting. Acute kidney injury requiring renal replacement therapy occurred in 1 patient.
Conclusion
Defying logistic challenges, donor availability and long HTx waiting list times, we have established a successful multi-center new concept HTx program with excellent mid-term outcome result. Diverse genetic background is evident in the presence of early coronary vascular disease in young donor hearts, requiring extra care in donor screening. This international collaboration has a promising future for new programs in the Middle East.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I.M Hamour
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - R Ferrer
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - B Atallah
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - G Gabra
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - M Soliman
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - H Sabbour
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - F Bader
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
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Al-Rasadi K, Alhabib KF, Al-Allaf F, Al-Waili K, Al-Zakwani I, AlSarraf A, Almahmeed W, AlSayed N, Alghamdi M, Batais MA, Almigbal TH, Alnouri F, Kinsara A, Hammouda A, Awan Z, Kary H, Elamin OA, Zadjali F, Al-Jarallah M, Shehab A, Sabbour H, Amin H, Altaradi H. The Gulf Familial Hypercholesterolemia Registry (Gulf FH): Design, Rationale and Preliminary Results. Curr Vasc Pharmacol 2020; 18:57-64. [PMID: 30289081 PMCID: PMC7040511 DOI: 10.2174/1570161116666181005125459] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 01/05/2023]
Abstract
Aim: To determine the prevalence, genetic characteristics, current management and outcomes of familial hypercholesterolaemia (FH) in the Gulf region. Methods: Adult (18-70 years) FH patients were recruited from 9 hospitals and centres across 5 Arabian Gulf countries. The study was divided into 4 phases and included patients from 3 different categories. In phase 1, suspected FH patients (category 1) were collected according to the lipid profile and clinical data obtained through hospital record systems. In phase 2, patients from category 2 (patients with a previous clinical diagnosis of FH) and category 1 were stratified into definitive, probable and possible FH according to the Dutch Lipid Clinic Network criteria. In phase 3, 500 patients with definitive and probable FH from categories 1 and 2 will undergo genetic testing for 4 common FH genes. In phase 4, these 500 patients with another 100 patients from category 3 (patients with previous genetic diagnosis of FH) will be followed for 1 year to evaluate clinical management and cardiovascular outcomes. The Gulf FH cohort was screened from a total of 34,366 patients attending out-patient clinics. Results: The final Gulf FH cohort consisted of 3,317 patients (mean age: 47±12 years, 54% females). The number of patients with definitive FH is 203. In this initial phase of the study, the prevalence of (probable and definite) FH is 1/232. Conclusion: The prevalence of FH in the adult population of the Arabian Gulf region is high. The Gulf FH registry, a first-of-a-kind multi-national study in the Middle East region, will help in improving underdiagnosis and undertreatment of FH in the region.
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Affiliation(s)
- Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makka, Saudi Arabia
| | - Khalid Al-Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.,Gulf Health Research, Muscat, Oman
| | - Ahmad AlSarraf
- Department of Medical Biochemistry, Ministry of Health, Kuwait City, Safat, Kuwait
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alnouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Abdulhalim Kinsara
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | | | - Zuhier Awan
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Heba Kary
- King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Omer A Elamin
- King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Fahad Zadjali
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Abdullah Shehab
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE; University, Al Ain, United Arab Emirates
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Hani Altaradi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Abstract
Background
Approved dose adjustment criteria for apixaban are based on the clinical trial. Adjustments require presence of 2 of 3 criteria. In the ARISTOTLE trial, 4.7% of patients met those criteria. Real world data show much higher utilization of the lower dose. Accurate statistics on the prevalence and predictors of such dosing in the Middle East Gulf region are lacking.
Purpose
We sought to explore the appropriateness of apixaban dosing and to predict the factors influencing physician dosing strategies at a tertiary care center in our United .
Methods
We performed a retrospective chart review of patients receiving apixaban for atrial fibrillation from our hospital-based outpatient pharmacy between April 1, 2015 and October 1, 2018. Patients with missing data or on apixaban for other indications were excluded.
Results
A total of 232 patients were included with a mean follow-up of 400 ± 271 days. The mean age was 66.0 ± 13.2 years, 45.5% female, mean weight 82.4 ± 44.7 kg, mean serum creatinine 1.0 ± 0.4 mg/dL, CHA2DS2VASc 3.7 ± 1.8, and 30.1% were on at least 1 concomitant antiplatelet drug. Seventy three patients (31.3%) received a reduced apixaban dose of 2.5 mg twice daily. Deviation from recommended criteria was seen in a total of 62 patients (26.6%), most being under-dosed (93.5%). The significant predictors of underdosing in our model were older age (risk of under-dosing increases by 7.2% for each additional year of age) and eGFR 30 to 60 mL/min/1.73 m2.
Conclusion
Under-dosing of apixaban is prevalent in the Middle East Gulf region. Advancing age and eGFR are the main predictors of under-dosing. More education is needed to optimize dosing of apixaban for stroke prevention in AF.
Table 1 % Change in Odds Ratio Variables coef. std. error p expected min max Intercept -1.563 0.223 0.000 Age 0.069 0.022 0.002 7.2% 2.5% 12.1% eGFR (30-60 relative to >60) 1.583 0.625 0.011 386.9% 39.6% 1597.8% Table 1. Stepwise logistic regression model for predictors of apixaban underdosing. Adjusted for serum creatinine, weight, BMI, gender, CHADS2-VASc score, concomitant antiplatelets, and eGFR < 30 or > 60 mL/min/m2
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Affiliation(s)
- B Atallah
- Cleveland Clinic Abu Dhabi, Pharmacy Services, Abnu Dhabi, United Arab Emirates
| | - S Alsolh
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - W El Nekidy
- Cleveland Clinic Abu Dhabi, Pharmacy Services, Abnu Dhabi, United Arab Emirates
| | - H Sabbour
- Cleveland Clinic Abu Dhabi, Cardiovascular Medicine, Abu Dhabi, United Arab Emirates
| | - W Almahmeed
- Cleveland Clinic Abu Dhabi, Cardiovascular Medicine, Abu Dhabi, United Arab Emirates
| | - K Almuti
- Cleveland Clinic Abu Dhabi, Cardiovascular Medicine, Abu Dhabi, United Arab Emirates
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Dougherty KAD, Elkaissi M, Sabbour H, Farha S. Incidental finding of pulmonary artery aneurysm revealing a congenital heart defect. BMJ Case Rep 2019; 12:12/6/e230477. [PMID: 31229979 DOI: 10.1136/bcr-2019-230477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Mahmoud Elkaissi
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samar Farha
- Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Bashier A, Bin Hussain A, Abdelgadir E, Alawadi F, Sabbour H, Chilton R. Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases. Diabetol Metab Syndr 2019; 11:80. [PMID: 31572499 PMCID: PMC6761728 DOI: 10.1186/s13098-019-0476-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 02/12/2023] Open
Abstract
The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium-glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.
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Affiliation(s)
- Alaaeldin Bashier
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Azza Bin Hussain
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Elamin Abdelgadir
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, Abu Dhabi, UAE
| | - Robert Chilton
- Division of Cardiology, University of Texas Health Science Center, Audie L Murphy VA Hospital, San Antonio, TX USA
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Hersi AS, Alhebaishi YS, Hamoui O, Hassan T, Khalifa Hamad A, Magdy M, Sabbour H, Shaheen S. Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa. J Saudi Heart Assoc 2018; 30:122-139. [PMID: 29910583 PMCID: PMC6000886 DOI: 10.1016/j.jsha.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/17/2017] [Accepted: 05/26/2017] [Indexed: 01/18/2023] Open
Abstract
Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across the MENA region. The incidence of stroke secondary to atrial fibrillation in patients across the MENA region is higher than rates reported globally, and this might be attributed to a higher incidence of vascular risk factors and underuse of anticoagulants in patients in the MENA. The available evidence supports the established role of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of stroke in patients with NVAF. There is a consistent body of clinical trial and real-world evidence supporting their efficacy for stroke prevention in NVAF, with more favorable bleeding risk profiles relative to vitamin K antagonists, such that guidelines now recommend the use of NOACs in preference over vitamin K antagonists. There are important opportunities to improve the management of NVAF outcomes for patients with NVAF by applying evidence-based guidelines for stroke prevention. Growing experience with NOACs in the MENA region will help guide patient selection and elucidate optimal dosing strategies to maximize the clinical benefits of the NOACs.
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Affiliation(s)
- Ahmad S. Hersi
- King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Taher Hassan
- Cardiology Clinics, Al Badriyah Tower, Jeddah, Saudi Arabia
| | - Adel Khalifa Hamad
- Mohammed bin Khalifa Al Khalifa Cardiac Centre, Bahrain Defense Force Hospital, Riffa, Bahrain
| | - Mohamed Magdy
- Critical Care Cardiology and Electrophysiology Departments, Cairo University, Cairo, Egypt
- Electrophysiology Department, Alqassimi Cardiac Center, Sharjah, United Arab Emirates
| | - Hani Sabbour
- Cardiology & Electrophysiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cardiology Department, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Sameh Shaheen
- Cardiology Department, Ain-shams University, Cairo, Egypt
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Ferrer R, Atallah B, Sadik ZG, Khalil ME, Sabbour H, Stapleton J, Bader F. The Impact of Post Discharge Telephone Follow-up in an Advanced Heart Failure Program in the Middle-East Gulf Region. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Ferrer R, Nasef R, Atallah B, Sadik ZG, Khalil ME, Sabbour H, Stapleton J, Bader F. Impact of a Multidisciplinary Heart Failure Inpatient Service on 30-day Readmission at a Tertiary Care Center in a Developing Country. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Huisman MV, Rothman KJ, Paquette M, Teutsch C, Diener HC, Dubner SJ, Halperin JL, Ma CS, Zint K, Elsaesser A, Bartels DB, Lip GY, Abban D, Abdul N, Abelson M, Ackermann A, Adams F, Adams L, Adragão P, Ageno W, Aggarwal R, Agosti S, Marin JA, Aguilar F, Aguilar Linares JA, Aguinaga L, Ahmad Z, Ainsworth P, Al Ghalayini K, Al Ismail S, Alasfar A, Alawwa A, Al-Dallow R, Alderson L, Alexopoulos D, Ali A, Ali M, Aliyar P, Al-Joundi T, Al Mahameed S, Almassi H, Almuti K, Al-Obaidi M, Alshehri M, Altmann U, Alves AR, Al-Zoebi A, Amara W, Amelot M, Amjadi N, Ammirati F, Andrawis N, Angoulvant D, Annoni G, Ansalone G, Antonescu SA, Ariani M, Arias JC, Armero S, Arora R, Arora C, Ashcraft W, Aslam MS, Astesiano A, Audouin P, Augenbraun C, Aydin S, Azar R, Azim A, Aziz S, Backes LM, Baig M, Bains S, Bakbak A, Baker S, Bakhtiar K, Bala R, Banayan J, Bandh S, Bando S, Banerjee S, Bank A, Barbarash O, Barón G, Barr C, Barrera C, Barton J, Kes VB, Baula G, Bayeh H, Bazargani N, Behrens S, Bell A, Benezet-Mazuecos J, Benhalima B, Berdagué P, Berg van den B, Bergen van P, Berngard E, Bernstein R, Yao J, Yarlagadda C, Yeh KH, Yotov Y, Yvorra S, Zahn R, Zamorano J, Zanini R, Zarich S, Zebrack J, Berrospi P, Zenin S, Zeuthen EL, Zhang X, Zhang Q, Zhang D, Zhang D, Zhang H, Zhao S, Zhao X, Zheng Y, Berti S, Zheng Q, Zhou J, Zhou J, Zimmermann SL, Zimmermann R, Zukerman LS, Zwaan van der C, Bertomeu V, Berz A, Bettencourt P, Betzu R, Beyer-Westendorf J, Bhagwat R, Black T, Blanco Ibaceta JH, Bloom S, Blumberg E, Bo M, Bockisch V, Bøhmer E, Bongiorni MG, Boriani G, Bosch R, Boswijk D, Bott J, Bottacchi E, Kalan MB, Brandes A, Bratland B, Brautigam D, Breton N, Brouwers P, Browne K, Bruguera J, Brunehaut M, Brunschwig C, Buathier H, Buhl A, Bullinga J, Butcher K, Cabrera Honorio JW, Caccavo A, Cadinot D, Cai S, Calvi V, Camm J, Candeias R, Capo J, Capucci A, Cardoso JN, Duarte Vera YC, Carlson B, Carvalho P, Cary S, Casanova R, Casu G, Cattan S, Cavallini C, Cayla G, Cha TJ, Cha KS, Chaaban S, Chae JK, Challappa K, Chand S, Chandrashekar H, Chang M, Charbel P, Chartier L, Chatterjee K, Cheema A, Chen SA, Chevallereau P, Chiang FT, Chiarella F, Chih-Chan L, Cho YK, Choi DJ, Chouinard G, Danny, Chow HF, Chrysos D, Chumakova G, José Roberto Chuquiure Valenzuela EJ, Cieza-Lara T, Nica VC, Ciobotaru V, Cislowski D, Citerne O, Claus M, Clay A, Clifford P, Cohen S, Cohen A, Colivicchi F, Collins R, Compton S, Connors S, Conti A, Buenostro GC, Coodley G, Cooper M, Corbett L, Corey O, Coronel J, Corrigan J, Cotrina Pereyra RY, Cottin Y, Coutu B, Cracan A, Crean P, Crenshaw J, Crijns H, Crump C, Cucher F, Cudmore D, Cui L, Culp J, Darius H, Dary P, Dascotte O, Dauber I, Davee T, Davies R, Davis G, Davy JM, Dayer M, De La Briolle A, de Mora M, De Teresa E, De Wolf L, Decoulx E, Deepak S, Defaye P, Del-Carpio Munoz F, Brkljacic DD, Deluche L, Destrac S, Deumite N, Di Legge S, Dibon O, Diemberger I, Dillinger J, Dionísio P, Naydenov S, Dotani I, Dotcheva E, D'Souza A, Dubrey S, Ducrocq X, Dupljakov D, DuThinh V, Dutra OP, Dutta D, Duvilla N, Dy J, Dziewas R, Eaton C, Eaves W, Ebinger M, Eck van J, Edwards T, Egocheaga I, Ehrlich C, Eisenberg S, El Hallak A, El Jabali A, El Mahmoud R, El Shahawy M, Eldadah Z, Elghelbazouri F, Elhag O, El-Hamdani M, Elias D, Ellery A, El-Sayed H, Elvan A, Erickson B, Espaliat E, Essandoh L, Everington T, Evonich R, Ezhov A, Fácila L, Farsad R, Fayard M, Fedele F, Gomes Ferreira LG, Ferreira D, Santos JF, Ferrier A, Finsen A, First B, Fisher R, Floyd J, Folk T, Fonseca C, Fonseca L, Forman S, Forsgren M, Foster M, Foster N, Frais M, Frandsen B, Frappé T, Freixa R, French W, Freydlin M, Frickel S, Fruntelata AG, Fujii S, Fujino Y, Fukunaga H, Furukawa Y, Gabelmann M, Gabris M, Gadsbøll N, Galin P, Galinier M, Ganim R, Garcia R, Quintana AG, Gartenlaub O, Genz C, Georger F, Georges JL, Georgeson S, Ghanbasha A, Giedrimas E, Gierba M, Gillespie E, Giniger A, Gkotsis A, Gmehling J, Gniot J, Goethals P, Goldberg R, Goldmann B, Goldscher D, Golitsyn S, Gomez Lopez EA, Gomez Mesa JE, Gonzalez E, Cocina EG, Juanatey CG, Gorbunov V, Gordon B, Gorka H, Gornick C, Gorog D, Goss F, Götte A, Goube P, Goudevenos I, Goulden D, Graham B, Grande A, Greco C, Green M, Greer G, Gremmler U, Grena P, Grinshstein Y, Grond M, Gronda E, Grondin F, Grönefeld G, Groot de J, Guardigli G, Guarnieri T, Caiedo CG, Guignier A, Gulizia M, Gumbley M, Gupta D, Hack T, Haerer W, Hakas J, Hall C, Hampsey J, Hananis G, Hanbali B, Handel F, Hargrove J, Hargroves D, Harris K, Hartley D, Haruna T, Hata Y, Hayek E, Healey J, Hearne S, Heggelund G, Hemels M, Hemery Y, Henein S, Henz B, Her SH, Hermany P, Hernandes ME, Higashino Y, Hill M, Hisadome T, Hishida E, Hitchcock J, Hoffer E, Hoghton M, Holmes C, Hong SK, Houppe Nousse MP, Howard V, Hsu LF, Huang CH, Huckins D, Huehnergarth K, Huizenga A, Huntley R, Hussein G, Hwang GS, Igbokidi O, Iglesias I, Ikpoh M, Imberti D, Ince H, Indolfi C, Ionova T, Ip J, Irles D, Iseki H, Ismail Y, Israel N, Isserman S, Iteld B, Ivanchura G, Iyer R, Iyer V, Iza Villanueva RO, Jackson-Voyzey E, Jaffrani N, Jäger F, Jain M, James M, Jamon Y, Jang SW, Pereira Jardim CA, Jarmukli N, Jeanfreau R, Jenkins R, Jiang X, Jiang H, Jiang T, Jiang N, Jimenez J, Jobe R, Joffe I, Johansson B, Jones N, Moura Jorge JC, Jouve B, Jundi M, Jung W, Jung BC, Jung KT, Kabbani S, Kabour A, Kafkala C, Kajiwara K, Kalinina L, Kampus P, Kanda J, Kapadia S, Karim A, Karolyi L, Kashou H, Kastrup A, Katsivas A, Kaufman E, Kawai K, Kawajiri K, Kazmierski J, Keeling P, Kerfes GA, Kerr Saraiva JF, Ketova G, Khaira A, Khalid M, Khludeeva E, Khripun A, Kim DI, Kim DK, Kim NH, Kim KS, Kim YH, Kim JB, Kim JS, Kim JS, Kinova E, Klein A, Kleinschnitz C, Kmetzo J, Kneller GL, Knezevic A, Koch S, Koenig K, Angela Koh SM, Köhrmann M, Koons J, Korabathina R, Korennova O, Koschutnik M, Kosinski E, Kovacic D, Kowalczyk J, Koziolova N, Kragten J, Krause LU, Kreidieh I, Krenning B, Krishnaswamy K, Krysiak W, Kuck KH, Kumar S, Kümler T, Kuniss M, Kuo JY, Küppers A, Kurrelmeyer K, Kwan T, Kyo E, Labovitz A, Lacroix A, Lam A, Lanas Zanetti FT, Landau C, Landini G, Lang W, Larsen TB, Laske V, Lavandier K, Law N, Lee MH, Lee D, Leitão A, Lejay D, Lelonek M, Lenarczyk R, Leprince P, Lequeux B, Leschke M, Ley N, Li Z, Li Y, Li X, Li Z, Li W, Liang J, Lieber I, Lillestol M, Limon Rodriguez RH, Lin H, Lip G, Litchfield J, Liu Z, Liu X, Liu Y, Liu F, Liu W, Llamas Esperon GA, Llisterri JL, Lo T, Lo E, Lobos JM, Lodde BP, Loiselet P, López-Sendón J, Lorga Filho AM, Lori I, Luo M, Lupovitch S, Lyrer P, Zuhairy HM, Ma C, Ma G, Ma H, Madariaga I, Maeno K, Magnin D, Mahmood S, Mahood K, Maid G, Mainigi S, Makaritsis K, Maldonado Villalon JA, Malhotra R, Malik A, Mallecourt C, Mallik R, Manning R, Manolis A, Mantas I, Manzur Jattin FG, Marcionni N, Marín F, Santana AM, Martinez J, Martinez L, Maskova P, Hernández NM, Matskeplishvili S, Matsuda K, Mavri A, May E, Mayer N, Mazon P, McClure J, McCormack T, McGarity W, McGuire M, McIntyre H, McLaughlin P, McLaurin B, Medina Palomino FA, Mehta P, Mehzad R, Meinel A, Melandri F, Mena A, Meno H, Menzies D, Metcalf K, Meyer B, Miarka J, Mibach F, Michalski D, Michel P, Chreih RM, Mikdadi G, Mikhail M, Mikus M, Milicic D, Militaru C, Miller G, Milonas C, Minescu B, Mintale I, Miralles A, Mirault T, Mistry D, Mitchell G, Miu NV, Miyamoto N, Moccetti T, Mohammed A, Nor AM, Molina de Salazar DI, Molon G, Molony D, Mondillo S, Mont L, Moodley R, Moore R, Ribeiro Moreira DA, Mori K, Moriarty A, Morka J, Moschos N, Mota Gomes MA, Mousallem N, Moya A, Mügge A, Mulhearn T, Muller JJ, Muresan CM, Muse D, Musial W, Musumeci F, Nadar V, Nageh T, Nair P, Nakagawa H, Nakamura Y, Nakayama T, Nam KB, Napalkov D, Natarajan I, Nayak H, Nechvatal L, Neiman J, Nerheim P, Neuenschwander FC, Nishida K, Nizov A, Novikova T, Novo S, Nowalany-Kozielska E, Nsah E, Nunez Fragoso JC, Nyvad O, de Los Rios Ibarra MO, O'Donnell M, O'Donnell P, Oh DJ, Oh YS, Daniel Oh CT, O'Hara G, Oikonomou K, Olalla JJ, Olivari Z, Oliver R, Olympios C, Osborne J, Osca J, Osman R, Osunkoya A, Padanilam B, Panchenko E, Pandey AS, Vicenzo de Paola AA, Paraschos A, Pardell H, Park HW, Park JS, Parkash R, Parker I, Parrens E, Parris R, Passamonti E, Patel J, Patel R, Pentz WH, Persic V, Perticone F, Peters P, Petkar S, Pezo LF, Pham D, Cao Phai GP, Phlaum S, Pineau J, Pineda-Velez A, Pini R, Pinter A, Pinto F, Pirelli S, Pivac N, Pizzini AM, Pocanic D, Calin Podoleanu CG, Polanczyk CA, Polasek P, Poljakovic Z, Pollock S, Polo J, Poock J, Poppert H, Porro Y, Pose A, Poulain F, Poulard JE, Pouzar J, Povolny P, Pozzer D, Pras A, Prasad N, Prevot S, Protasov K, Prunier L, Puleo J, Pye M, Qaddoura F, Quedillac JM, Raev D, Rahimi S, Raisaro A, Rama B, Ranadive N, Randall K, Ranjith N, Raposo N, Rashid H, Raters C, Rauch-Kroehnert U, Rebane T, Regner S, Renzi M, Reyes Rocha MA, Reza S, Ria L, Richter D, Rickli H, Rickner K, Rieker W, Rigo F, Ripoll T, Fonteles Ritt LE, Roberts D, Pascual CR, Briones IR, Reyes HR, Roelke M, Roman M, Romeo F, Ronner E, Ronziere T, Rooyer F, Rosenbaum D, Roth S, Rozkova N, Rubacek M, Rubalcava F, Rubanenko O, Rubin A, Borret MR, Rybak K, Sabbour H, Morales OS, Sakai T, Salacata A, Salecker I, Salem A, Salfity M, Salguero R, Salvioni A, Samson M, Sanchez G, Sandesara C, Saporito WF, Sasaoka T, Sattar P, Savard D, Scala PJ, Scemama J, Schaupp T, Schellinger P, Scherr C, Schmitz KH, Schmitz B, Schmitz L, Schnitzler R, Schnupp S, Schoeniger P, Schön N, Schuster S, Schwimmbeck P, Seamark C, Seebass R, Seidl KH, Seidman B, Sek J, Sekaran L, Seko Y, Sepulveda Varela PA, Sevilla B, Shah V, Shah A, Shah N, Shah A, Shanes J, Sharareh A, Sharma VK, Shaw L, Shimizu Y, Shimomura H, Shin DG, Shin ES, Shite J, Shoukfeh M, Shoultz C, Silver F, Sime I, Simmers T, Singal D, Singh N, Siostrzonek P, Sirajuddin M, Skeppholm M, Smadja D, Smith R, Smith D, Soda H, Sofley CW, Sokal A, Sotolongo R, de Souza OF, Sparby JA, Spinar J, Sprigings D, Spyropoulos A, Stakos D, Steinberg A, Steinwender C, Stergiou G, Stites HW, Stoikov A, Strasser R, Streb W, Styliadis I, Su G, Su X, Suarez RM, Sudnik W, Sueyoshi A, Sukles K, Sun L, Suneja R, Svensson P, Ziekenhuis A, Szavits-Nossan J, Taggeselle J, Takagi Y, Takhar A, Tallet J, Tamm A, Tanaka S, Tanaka K, Tang A, Tang S, Tassinari T, Tayama S, Tayebjee M, Tebbe U, Teixeira J, Tesloianu DN, Tessier P, The S, Thevenin J, Thomas H, Timsit S, Topkis R, Torosoff M, Touze E, Traissac T, Trendafilova E, Troyan B, Tsai WK, Tse HF, Tsutsui H, Tsutsui T, Tuininga Y, Turakhia M, Turk S, Turner W, Tveit A, Twiddy S, Tytus R, Ukrainski G, Valdovinos Chavez SB, Van De Graaff E, Vanacker P, Vardas P, Vargas M, Vassilikos V, Vazquez J, Venkataraman A, Verdecchia P, Vester EG, Vial H, Vinereanu D, Vlastaris A, Vogel C, vom Dahl J, von Mering M, Vora K, Wakefield P, Walia J, Walter T, Wang M, Wang N, Wang F, Wang X, Wang Z, Wang KY, Watanabe K, Wei J, Weimar C, Weinrich R, Wen MS, Wheelan K, Wicke J, Wiemer M, Wild B, Wilke A, Willems S, Williams M, Williams D, Winkler A, Wirtz JH, Witzenbichler B, Wong DH, Lawrence Wong KS, Wong B, Wozakowska-Kaplon B, Wu Z, Wu S, Wyatt N, Xu Y, Xu X, Yamada A, Yamamoto K, Yamanoue H, Yamashita T, Bryan Yan PY, Yang Y, Yang T. The Changing Landscape for Stroke Prevention in AF. J Am Coll Cardiol 2017; 69:777-785. [DOI: 10.1016/j.jacc.2016.11.061] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022]
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Al Sayed N, Al Waili K, Alawadi F, Al-Ghamdi S, Al Mahmeed W, Al-Nouri F, Al Rukhaimi M, Al-Rasadi K, Awan Z, Farghaly M, Hassanein M, Sabbour H, Zubaid M, Barter P. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East. Int J Cardiol 2016; 225:268-283. [PMID: 27741487 DOI: 10.1016/j.ijcard.2016.09.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. METHODS A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. RESULTS The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. CONCLUSIONS These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.
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Affiliation(s)
- Nasreen Al Sayed
- Gulf Diabetes Specialist Center, P.O. Box 21686, Manama, Bahrain.
| | - Khalid Al Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Saeed Al-Ghamdi
- Department of Medicine, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| | - Fahad Al-Nouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Mona Al Rukhaimi
- Dubai Medical College, P.O. Box 22331, Dubai, United Arab Emirates.
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Zuhier Awan
- King Abdulaziz University, Jeddah 22254, Saudi Arabia.
| | | | | | - Hani Sabbour
- Shaikh Khalifa Medical City, Cardiac Sciences Institute, Abu Dhabi, United Arab Emirates.
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
| | - Philip Barter
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Al-Ashwal A, Alnouri F, Sabbour H, Al-Mahfouz A, Al-Sayed N, Razzaghy-Azar M, Al-Allaf F, Al-Waili K, Banerjee Y, Genest J, Santos RD, Al-Rasadi K. Identification and Treatment of Patients with Homozygous Familial Hypercholesterolaemia: Information and Recommendations from a Middle East Advisory Panel. Curr Vasc Pharmacol 2016; 13:759-70. [PMID: 26311574 PMCID: PMC4997916 DOI: 10.2174/1570161113666150827125040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/15/2015] [Accepted: 07/09/2015] [Indexed: 01/06/2023]
Abstract
We present clinical practice guidelines for the diagnosis and treatment of homozygous familial hypercholesterolaemia (HoFH) in the Middle East region. While guidelines are broadly applicable in Europe, in the Middle East we experience a range of confounding factors that complicate disease management to a point whereby the European guidance cannot be applied without significant modification. Specifically, for disease prevalence, the Middle East region has an established epidemic of diabetes and metabolic syndrome that can complicate treatment and mask a clinical diagnosis of HoFH. We have also a high incidence of consanguineous marriages, which increase the risk of transmission of recessive and homozygous genetic disorders. This risk is further augmented in autosomal dominant disorders such as familial
hypercholesterolaemia (FH), in which a range of defective genes can be transmitted, all of which contribute to the phenotypic expression of the disease. In terms of treatment, we do not have access to lipoprotein apheresis on the same scale as in Europe, and there remains a significant reliance on statins, ezetimibe and the older plasma exchange methods. Additionally, we do not have widespread access to anti-apolipoprotein B therapies and microsomal transfer protein inhibitors. In order to adapt existing global guidance documents on HoFH to the Middle East region, we convened a panel of experts from Oman, Saudi Arabia, UAE, Iran and Bahrain to draft a regional guidance document for HoFH. We also included selected experts from outside the region. This panel statement will form the foundation of a detailed appraisal of the current FH management in the Middle Eastern population and thereby provide a suitable set of guidelines tailored for the region.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
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Alsheikh-Ali AA, Hersi AS, Hamad AKS, Al Fagih AR, Al-Samadi FM, Almusaad AM, Bokhari FA, Al-Kandari F, Al-Ghamdi BS, Al Rawahi N, Asaad N, Alkaabi S, Daoulah A, Zaky HA, Elhag O, Al Hebaishi YS, Sweidan R, Alanazi H, Chase D, Sabbour H, Al Meheiri M, Al Abri I, Amin M, Dagriri K, Ahmed AO, Shafquat A, Khan SH. The Gulf Implantable Cardioverter-defibrillator Registry: Rationale, Methodology, and Implementation. Heart Views 2016; 16:125-30. [PMID: 26900416 PMCID: PMC4738492 DOI: 10.4103/1995-705x.172193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Results: Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute <30% of implants in the majority of centers. Enrollment started in December 2013, and accrual rate increased as more centers entered the study reaching an average of 98 patients per month. Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region.
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Affiliation(s)
- Alawi A Alsheikh-Ali
- Division of Adult Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Adel K S Hamad
- Mohammed Bin Khalifa Bin Sulman AlKhalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
| | - Ahmed R Al Fagih
- Prince Sultan Cardiac Center, King Fahd Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Faisal M Al-Samadi
- King Salman Heart Center, King Fahd Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmohsen M Almusaad
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fayez A Bokhari
- Division of Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, KSA
| | - Fawzia Al-Kandari
- Division of Adult Cardiology, Chest Hospital, Kuwait Cardiac Center and Dabbous Cardiac Center, Kuwait City, Kuwait
| | - Bandar S Al-Ghamdi
- Heart Center, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Nidal Asaad
- Division of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salem Alkaabi
- Division of Adult Cardiology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Amin Daoulah
- Division of Adult Cardiology, King Faisal Specialist Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Hosam A Zaky
- Division of Adult Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Omer Elhag
- Division of Adult Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Yahya S Al Hebaishi
- Prince Sultan Cardiac Center, King Fahd Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Raed Sweidan
- Division of Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, KSA
| | - Haitham Alanazi
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - David Chase
- Division of Adult Cardiology, Royal Hospital, Muscat, Oman
| | - Hani Sabbour
- Division of Adult Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mohammad Al Meheiri
- Division of Adult Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ismail Al Abri
- Division of Adult Cardiology, Royal Hospital, Muscat, Oman
| | - Mohammad Amin
- Mohammed Bin Khalifa Bin Sulman AlKhalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
| | - Khaled Dagriri
- Prince Sultan Cardiac Center, King Fahd Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Adil O Ahmed
- Prince Sultan Cardiac Center, King Fahd Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Azam Shafquat
- Heart Center, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Shahul Hameed Khan
- Division of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Khan MD, Tofeig M, Talo H, Kiraly L, El Badaoui H, Tamas C, Jha N, Salustri A, Aljabbari S, Elhag O, Sabbour H, Ghori M, Mora B, Khan J, Almahmeed W, Alzubaidi A, Alsheikh-Ali AA. APSC2015-1327 Cardiac Catheterization for Adults With Congenital Heart Disease in the United Arab Emirates: A Large Referral Center Experience. Glob Heart 2015. [DOI: 10.1016/j.gheart.2015.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alkaabi S, Elhag O, Sabbour H, Alsheikh-Ali AA. Requirements for Achieving and Maintaining Competency in the Implantation and Management of Cardiac Implantable Electrical Devices: A clinical competency statement by the Emirates Cardiac Society. Heart Views 2013; 14:97-100. [PMID: 24696754 PMCID: PMC3969631 DOI: 10.4103/1995-705x.125921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Salem Alkaabi
- Department of Cardiology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Omer Elhag
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Alawi A. Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Abstract
2-Octyl Cyanoacrylate (2-OCA) is a tissue adhesive developed for skin laceration closure that has not been previously evaluated for cardiac device implant wound closure. We reviewed 460 consecutive device implants with 475 incisions between November 1993 and May 2001. From November 1993 to December 1998, all patients (n 335) had a 3-layer reabsorbable suture closure with the application of topical bacitracin and dressing material. They were advised to avoid exposure to moisture for 10 days. From January 1999 to May 2001, the superficial suture layer was replaced with 2-OCA (n=125). No topical bacitracin or dressing was applied and patients were allowed to shower within 72 hours. The two groups did not differ significantly with respect to age (69 +/- 12 vs 70 +/- 13 years, P=NS), sex (59% vs 62% male, p=NS) or device type (77% vs 68% pacemakers/loop recorders, p=NS). All incisions were evaluated at 24 hours, 7-14 days, and 6-12 weeks postprocedure. The 2-OCA and suture groups did not differ significantly with respect to allergic reaction (0% vs 1.4%, P=NS), cellulitis (0% vs 0.9%, P=NS), and infection requiring explant (0.8% vs 0.3%, P=NS), respectively. Total adverse events occurred in 1 of 125 (0.8%) of the 2-OCA group versus 9 of 350 (2.6%) of the suture group (P=NS). In cardiac device implant closure 2-OCA obviated the need for topical antibiotics and dressing materials while facilitating wound care without increased complications.
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Reddy VY, Jongnarangsin K, Albert CM, Sabbour H, Keane D, Mela T, McGovern B, Ruskin JN. Para-Hisian Entrainment: A Novel Pacing Maneuver to Differentiate Orthodromic Atrioventricular Reentrant Tachycardia from Atrioventricular Nodal Reentrant Tachycardia. J Cardiovasc Electrophysiol 2003; 14:1321-8. [PMID: 14678108 DOI: 10.1046/j.1540-8167.2003.03239.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Para-Hisian pacing during sinus rhythm can help to identify the presence of an accessory pathway (AP). In this maneuver, the retrograde activation time and pattern are compared during capture and loss-of-capture of the His bundle while pacing from a para-Hisian position. However, identification of a retrograde AP does not necessitate that it is operative during the tachycardia of interest; conversely, slowly conducting or "distant" bypass tracts may not be identified. We evaluated the utility of entrainment or resetting of tachycardias from the para-Hisian position to help distinguish atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular tachycardia (AVRT). METHODS AND RESULTS Para-Hisian entrainment/resetting was evaluated in 50 patients: 33 with AVNRT and 17 with AVRT. The maneuvers were performed using a standard quadripolar catheter placed at the His position: low output for right ventricular (RV) capture and high output for both RV and His capture. The retrograde atrial activation sequence, SA interval (interval from stimulus to earliest retrograde atrial activation), and "local" VA interval (interval between the ventricular and atrial electrograms at the site of earliest retrograde atrial activation) were compared between His and His/RV capture. The DeltaSA was > 40 ms in patients with AVNRT and was < 40 ms in all but one patient with AVRT. In concert with the DeltaSA interval, the DeltaVA interval was able to fully define the mechanism of the tachycardia in all patients studied. CONCLUSION Para-Hisian entrainment/resetting can determine the course of retrograde conduction operative during narrow complex tachycardias. It is a useful diagnostic maneuver in differentiating AVNRT and orthodromic AVRT.
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Affiliation(s)
- Vivek Y Reddy
- Massachusetts General Hospital--Harvard Medical School, Boston, Massachusetts 02114, USA.
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