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Prevalence and risk factors of cardiovascular disease in the United Arab Emirates

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Review Article
1 1
2 2
3
4 Prevalence and Risk Factors of Cardiovascular Disease in the 3
4
5
6
United Arab Emirates 5
6
7 7
Hira Abdul Razzak, Alya Harbi, Wael Shelpai, Ahmad Qawas
8 8
Statistics and Research Center, Ministry of Health and Prevention, Dubai, United Arab Emirates
9 9
10 10
11 Abstract 11
12 12
13 Noncommunicable diseases are a cause of great concern in developing countries, particularly cardiovascular disease (CVD). CVD is most 13
14 commonly attributable to risk factors such as obesity, high‑blood pressure (BP), lack of physical activity and smoking. This study aims to 14
15 summarize previous research on the prevalence and risk factors of CVD in the United Arab Emirates (UAE). Search engines and databases 15
such as PubMed, Scopus and Science Direct, as well as several local journals, were utilised to identify relevant literature. Inclusion
16 was limited to studies published between 2007 and 2016 in the English language and conducted with UAE participants (citizens and/or
16
17 expatriates). Twenty‑one relevant studies were found, including cross‑sectional studies (n = 11), population‑based studies (n = 3), literature 17
18 reviews (n = 2) and a case–control study (n = 1). Estimates of the prevalence of CVD are considerably high, although there is insufficient 18
19 information available on prevalence in the UAE as a whole. Primary determinants of CVD include obesity, smoking and diabetes mellitus. 19
20 The prevalence of risk factors associated with CVD has increased in the UAE and will continue to increase, as made clear by the reviewed 20
studies and as predicted by projections and future estimates. Some risk factors can be controlled, treated and prevented. Further attention
21 should be given to developing preventative and curative strategies in order to reduce BP, increase physical activity, improve dietary habits
21
22 and reduce smoking. 22
23 23
24 Keywords: Cardiovascular diseases, prevalence, risk factors, United Arab Emirates 24
25 25
26 26
27 Introduction infarction (AMI), 16% to cerebrovascular disease, 6% to 27
28 ischaemic heart disease and 5% to hypertension. The WHO 28
Cardiovascular disease (CVD) and the associated burden are
29 has reported[5] on the most effective interventions, which 29
increasing in developing countries and represent a key challenge
30 include drug therapy, the regulation of alcohol and tobacco, 30
in health care. The World Health Organisation (WHO) reports
31 health counselling and public awareness programmes that 31
that CVD is the primary cause of death worldwide, accounting
32 promote regular physical activity and a healthy diet. Greater 32
for 17.5 million deaths (31% of all deaths) in 2012, of which
33 understanding of the epidemiology, prevalence and risk 33
80% occurred in low‑income and middle‑income countries.[1]
factors of CVD is understood to be the basis for designing,
34 Globally, 85% of disability is attributable to CVD.[2] CVD 34
implementing and monitoring effective prevention strategies.
35 includes stroke, coronary heart disease (CHD), and peripheral 35
A Framingham heart study[6] found an association between
36 vascular disease. CVD also accounts for a significant 36
CHD mortality and congestive heart failure (HF), high blood
37 proportion of global deaths caused by non‑communicable 37
pressure (BP), metabolic disorders, abdominal adiposity and
38 diseases among individuals aged under 70 years (37%). If 38
diabetes mellitus (DM).
39 intervention is not improved, global annual CVD deaths will 39
40 increase from 17.5 million in 2012 to 22.2 million by the Correspondence: Hira Abdul Razzak, 40
year 2030.[3] Statistics and Research Center, Ministry of Health and Prevention,
41 41
Dubai, United Arab Emirates.
42 A Ministry of Health and Prevention report[4] has revealed E‑mail: hiraarazzak@gmail.com 42
43 that CVD is a leading cause of mortality in the UAE. Of 43
44 CVD deaths, 22% were attributable to acute myocardial 44
This is an open access journal, and articles are distributed under the terms of the Creative
45 Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to
45
Access this article online
46 remix, tweak, and build upon the work non-commercially, as long as appropriate credit 46
Quick Response Code:
47 is given and the new creations are licensed under the identical terms. 47
Website:
48 www.hamdanjournal.org For reprints contact: reprints@medknow.com 48
49 49
50 DOI: How to cite this article: Razzak HA, Harbi A, Shelpai W, Qawas A. 50
10.4103/HMJ.HMJ_37_18 Prevalence and risk factors of cardiovascular disease in the United Arab
51 Emirates. Hamdan Med J 2018;XX:XX-XX. 51
52 52

© 2018 Hamdan Medical Journal | Published by Wolters Kluwer - Medknow 1

 Razzak, et al.: Prevalence and risk factors of CVD in the UAE

1 According to Assmann et  al.[7] and Hense et  al.,[8] both predominantly on the prevalence and risk factors of CVD in 1
2 prevalence and prognosis are important in the development of the UAE. Studies with insufficient information on risk factors 2
3 risk prediction scores for CHD. Yusuf et al.[9] and Rosengren and studies that did not address the high‑risk UAE population 3
4 et al.[10] have reported on the INTERHEART study and the were excluded. 4
5 nine risk factors (excessive alcohol intake, lack of exercise, 5
psychosocial index, abdominal obesity, hypertension, DM,
Selection and data extraction
6 Overall, 177 records were identified, of which 40 remained 6
smoking, apolipoprotein A‑I and apolipoprotein B) associated
7 after the removal of duplicates. Abstracts and titles were then 7
with AMI, suggesting that risk of AMI is the same for both
8 reviewed to exclude non‑relevant articles. The full text of 8
sexes and is consistent throughout all ethnic groups and regions
9 each of the remaining 21 articles was retrieved for evaluation. 9
worldwide. Teo et al.[11] and Yusuf et al.[12] describe the low
10 Data were extracted into Excel 2013 (Microsoft Corporation, 10
prevalence of healthy lifestyle behaviours across countries of
11 Redmond, WA, USA), including the names of the first author, 11
all income levels, with particularly low prevalence – along
12 publication year, sample, location and specific outcomes. 12
with a lower rate of use of cardioprotective drugs during
13 A research strategy flow chart is presented in Figure 1. 13
secondary prevention – in low‑income countries. The
14 MONICA (MONItoring trends and determinants in CVD) 14
15 project[13,14] found that smoking rates had decreased in men Results 15
16 and increased in women after a 10‑year period, whereas Following a systematic search to identify epidemiological 16
17 cholesterol levels and systolic BP rates had decreased in both studies on the prevalence and risk factors of CVD in the UAE, 17
18 sexes. Furthermore, Body Mass Index (BMI) had significantly 21 studies met the inclusion criteria, including cross‑sectional 18
19 increased in about half of the studied population. The project studies (n = 11), population‑based studies (n = 3), literature 19
20 demonstrated the important relationship between CHD and reviews (n = 2) and a case–control study (n = 1). Of these, 20
21 serum cholesterol. 16 studies [15‑30] reported on CVD risk factors and five 21
22 Bearing this trend in mind – increasing CVD‑related mortality studies[20,21,24,30,31] reported on CVD prevalence. 22
23 in the UAE – there is an evident need to further investigate CVD Prevalence of cardiovascular disease 23
24 prevalence and risk factors across the UAE. This systematic All five studies reporting on CVD prevalence were conducted 24
25 review is intended to offer a comprehensive understanding of in the UAE. One study was conducted at a national level,[24] 25
26 CVD in the UAE and highlight gaps in existing knowledge, two were multicentre studies[20,31] and two were conducted in 26
27 summarizing previous research with UAE participants on CVD Abu Dhabi.[21,30] All were cross‑sectional with the exception 27
28 prevalence and risk factors. of one review[21] [Table 1]. Two studies[20,24] focussed on HF 28
29 and revealed that HF is significantly associated with inpatient 29
30 Methodology mortality: the first involved a multivariate logistic regression 30
31 A systematic review of the literature was performed in analysis, which found that DM, heart rate, hyperlipidaemia 31
accordance with the Preferred Reporting Items for Systematic and age were associated with higher in‑patient HF;[20] the
32 32
Reviews and Meta‑Analyses guidelines for reviewing second reported that the prevalence of HF was higher in
33 33
epidemiological studies. Relevant articles were identified women than in men.[24] Almahmeed et al.[21] focussed on the
34 lack of detailed, nationally representative epidemiological
34
35 by searching data sources such as PubMed, Scopus, 35
ScienceDirect and local journals. Search terms, including data and the need for registry development to reveal the
36 36
keywords and medical subject headings, were related to
37 37
CVD (cerebrovascular disease; stenosis; peripheral arterial
38 38
disease; myocardial infarction (MI); stroke; vascular;
39 cardiovascular event; cardiovascular risk; CVD; angiography;
39
40 coronary artery disease; CHD; atherosclerosis) and the 40
41 UAE (Dubai; Ajman; Al‑Ain; Abu Dhabi; Fujairah; Sharjah; 41
42 Ras al‑Khaimah; Umm al‑Quwain). A standardised approach 42
43 was adopted by the authors and the literature search and 43
44 data extraction were undertaken independently. Research 44
45 articles were similarly searched for in local journals and 45
46 cross‑reference lists to ensure that a thorough search had been 46
47 conducted. 47
48 Inclusion and exclusion criteria 48
49 We included studies that directly concerned potential risk 49
50 factors of CVD. Extracted articles were limited to original 50
51 research conducted in English and published in peer‑reviewed Figure 1: Schematic representation of the selection of studies for the 51
52 journals between 2007 and 2016. The articles focused systematic literature review 52

2 Hamdan Medical Journal  ¦  Volume XX  ¦  Issue XX  ¦  Month 2018

 Razzak, et al.: Prevalence and risk factors of CVD in the UAE

1 1
Table 1: Papers published between 2007 and 2016 on the prevalence of cardiovascular disease in the United Arab Emirates
2 2
3 Study Year Study design Study population Key findings 3
Shehab et al.[20] 2012 Prospective Patients with ACS Results indicate that HF is significantly linked with inpatient
4 multinational multicentre mortality. In multivariate logistic regression, DM, heart rate,
4
5 registry, GRACE hyperlipidaemia and age were associated with higher in‑hospital HF 5
6 Almahmeed 2012 Literature review Patients with CHD Lack of current, detailed, nationally representative epidemiological 6
7 et al.[1] data in the majority of countries. Development of national registries 7
is required to reveal the nature of CHD. Beta‑blockers are important
8 for prevention 8
9 Shehab et al.[24] 2013 GRACE 18 UAE hospitals; Prevalence of HF is higher in women than in men 9
10 patients with ACS 10
11 Shah et al.[30] 2015 Cross‑sectional Random sampling The overall prevalence of BMI‑derived obesity and overweight 11
from health screeningand ‘waist‑to‑hip‑derived central obesity’ was calculated to be
12 centre, Abu Dhabi 44.7% in women and 66.7% in men. Hypertension was reported in 12
13 30.5% (419) of the sample and DM in 9.0% (9) of the subsample 13
14 Thalib et al.[31] 2016 Prospective multicentre Six Gulf countries Results suggest that discrimination, the goodness of fit and 14
study, GRACE (Bahrain, Saudi calibration were excellent. Post‑discharge GRACE risk scores
15 Arabia, Qatar, Oman, can be utilised for stratifying the 1‑year mortality risk across the
15
16 UAE, and Yemen); 65 Arabian Gulf population; it does not need additional calibration and 16
17 hospitals has great discriminatory aptitude 17
18 UAE: United Arab Emirates, CVD: Cardiovascular disease, GRACE: Gulf Registry of Acute Coronary Events, BMI: Body mass index, DM: Diabetes 18
mellitus, ACS: Acute coronary syndrome, HF: Heart failure, CHD: Coronary heart disease
19 19
20 20
nature of the coronary disease. Shah et al.[30] evaluated the than other major risk factors such as DM, dyslipidaemia and
21 21
association between CVD risk factors, acculturation and smoking.[15,16,20‑23,28,30] As evidenced by a Framingham heart
22 obesity among men; hypertension was found in 30.5% (419) study, stroke in women and coronary disease in men are the 22
23 of the sample along with DM in 9.0% (9) of the subsample. principal primary cardiovascular events after the onset of 23
24 Another prospective multicentre study 31 offered detailed hypertension.[6] The risk of both stroke and coronary disease 24
25 information on post‑discharge GRACE (Gulf Registry of rises gradually with the incremental escalation in BP above 25
26 Acute Coronary Events) risk scores in patients from the 115/75 mmHg, as revealed in several epidemiological studies. 26
27 Arabian Gulf with the acute coronary syndrome (ACS). The 23,30 Smoking is a major cause of heart disease and is thought 27
28 results revealed that this score can be used to stratify 1‑year to increase the risk of stroke: nicotine, the addictive component 28
29 mortality risk among the Arab population; it does not need of tobacco, raises BP and increases heart rate. Furthermore, 29
30 additional calibration and often has the great discriminatory smoking is also associated with DM.[17] The rate of smoking 30
31 aptitude. was found to be 46.4% and DM was present in 38.9% of the 31
32 population.[19] 32
Risk factors of cardiovascular disease
33 All 21 studies present data on risk factors. Ten studies were 33
34 cross‑sectional,[15,19,20,24‑30] one was a case–control study,[23] two Discussion 34
35 were literature reviews[18,21] and three were population‑based The results reveal that CVD is a cause for great concern in 35
36 studies [16,17,22] [Table 2]. Five studies were multicentre the UAE. CVD prevalence is precipitated by risk factors such 36
37 studies;[19,26‑29] seven were conducted in Al‑Ain[15‑18,20,24,25] as DM, high cholesterol, obesity and BP, all of which may be 37
38 and three were conducted in Abu Dhabi.[21,22,30] CVD is controlled or prevented through the avoidance of smoking, 38
39 largely caused by risk factors that can be modified, treated or regular exercise and healthy eating. The literature review 39
controlled, for example, obesity and overweight,[15,22,30] high concerned epidemiological studies on CVD prevalence and
40 40
BP,[15,16,20‑23,28,30] DM,[15‑17,19,22,26,28] lack of physical activity[21,22] risk factors in the UAE that were published between 2007
41 41
and smoking.[16,17,19,23,26] and 2016. All 21 studies present data on risk factors and five
42 studies present data on prevalence. 42
43 The findings suggest that a high prevalence of overweight, 43
44 in addition to obesity, further increases CVD risk. The literature revealed that CHD prevalence in Middle 44
45 A population‑wide study reported the following risk factor Eastern regions is high, with a high prevalence of CVD risk 45
prevalence rates: obesity, 35%; central obesity, 55%; factors, particularly sedentary lifestyles, DM, dyslipidaemia,
46 46
overweight, 32%; DM, 18%; preDM, 27%; dyslipidaemia, hypertension and smoking.[21] A research study performed in
47 47
44%; and hypertension, 23.1%. 22 On the other hand, Abu Dhabi within a mandatory residency visa health screening
48 Baynouna et  al.[15] found that 37.3% were obese, and an centre reported an overall hypertension prevalence of 30.5%,[30] 48
49 abnormal lipid profile was found in 53.9% of women and while another prospective multicentre multinational registry 49
50 64.0% of men, largely owing to high triglyceride levels and of individuals hospitalised with ACS reported HF in about one 50
51 low high‑density lipoproteins. Hypertension is the most in five patients in the UAE. HF is often related to a substantial 51
52 significant risk factor for premature CVD and is more common rise in other hospital mortality and adverse outcomes.[20] 52

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 Razzak, et al.: Prevalence and risk factors of CVD in the UAE

1 1
Table 2: Papers published between 2007 and 2016 on cardiovascular disease risk factors in the United Arab Emirates
2 2
3 Study Year Study design Study population Key findings 3
Baynouna 2008 Cross‑sectional, Al‑Ain, UAE (February Risk factor prevalence rates: obesity, 37.3%; hypertension,
4 et al.[15] community‑based 2004‑February 2005) 20.8%; DM, 23.3%; metabolic syndrome, 22.7%; Framingham
4
5 risk assessment score>20%, 28.4%; smoking, 19.6% in men. 5
6 Abnormal lipid profile was observed in 53.9% of women and 6
64% of men, mainly owing to high triglyceride levels and low
7 high‑density lipoprotein
7
8 Abdulle 2008 Health survey stratified Al‑Ain, UAE; included 641 Smoking prevalence was similar in two groups (normotensives 8
9 et al.[16] by self‑reported normotensive subjects of 14.2%, hypertensives 13.2%). Prevalence rates of obesity 9
10 hypertension various ethnicities and overweight, dyslipidaemia and DM, and thus the 10‑year 10
Framingham risk assessment score, were significantly higher in
11 hypertensives 11
12 Baynouna 2009 Community‑based; Al‑Ain, UAE; 817 national Smoking was associated with DM. Few metabolic syndrome 12
13 et al.[17] conventional CVD risk residents adjustments were reduced, while numerous others remained 13
factors
14 14
Binbrek 2010 Six‑study Six studies conducted in the Patients admitted and treated after acute ST‑segment elevation MI
15 et al.[18] meta‑analysis UAE (1995‑2009); 1262 onset at an early age; recanalisation induced via thrombolysis was 15
16 patients with MI a useful therapeutic approach. Patients’ characteristics in the six 16
17 studies were very similar 17
Yusufali 2010 Prospective registry Four tertiary care hospitals; Prevalence rates: smoking, 46.4%; DM, 38.9%; inpatient
18 et al.[19] three major UAE cities mortality, 1.68%. In‑hospital complications were not common
18
19 (December 2003‑December 19
20 2006) 20
21 Shehab 2012 Prospective Patients with ACS Results indicate that HF is significantly linked with inpatient 21
et al.[20] multinational, mortality. In multivariate logistic regression, DM, heart rate,
22 multicentre registry, hyperlipidaemia and age were associated with higher in‑hospital 22
23 GRACE HF 23
24 Almahmeed 2012 Literature review Patients with CHD Beta‑blockers are effective, as are numerous other therapies; 24
et al.[21] issues related to the use of beta‑blockers in CVD and
25 hypertension are overstated
25
26 Hajat et al.[22] 2012 Population‑wide Abu Dhabi, UAE; 138 adults ‘The mean age of the participants was 36.82 years (SD=14.3); 26
27 cardiovascular aged ≥18 years 43% were men. Risk factor prevalence rates were: obesity, 35%; 27
28 screening programme overweight, 32%; central obesity, 55%; DM, 18%; pre‑DM, 27%; 28
using self‑reported dyslipidaemia, 44%; and hypertension, 23.1%. In addition, 26%
29 indicators, blood tests of men were smokers, compared with 0.8% of women’ 29
30 and anthropometric 30
measures
31 31
Jamil et al.[23] 2013 Case‑control study UAE government hospital ‘The relationship among variables were examined followed
32 (2011‑2012); patients with MI by recommendation, discussion, and analysis for the treatment 32
33 and prevention of CAD in UAE. The findings demonstrated 33
34 higher incidence of Type A personality in the MI group. In 34
addition, these individuals were much more likely to suffer from
35 hypertension and a history smoking, when compared to controls’ 35
36 Shehab et al. 2013 GRACE 18 UAE hospitals; patients Women were significantly older, suffered more often from cardiac 36
37 [24]
with ACS risk factors and were treated with reperfusion and beta‑blockers 37
significantly less often. Prevalence of HF was higher in women
38 than in men (24.6% vs. 12.5%; P<0.001)
38
39 Sulaiman 2014 Prospective 47 hospitals in seven Gulf The majority of hospitals were community hospitals (46%, 39
40 et al.[25] multinational, countries (Saudi Arabia, 22/47), including university (17%, 8/47) and non‑university 40
41 multicentre registry, Oman, UAE, Yemen, (32%, 15/47). The majority of hospitals had coronary and 41
GRACE Kuwait, Qatar and Bahrain) intensive care unit facilities (93%, 44/47) and 59% (28/47) had
42 (14 February 2012‑2013 laboratory facilities for catheterisation. Few hospitals (29%, 42
43 November 2012); 5005 14/47) had clinical facilities for HF. The majority of patients were 43
44 patients >18 years of age cared for by a cardiologist (71%) 44
admitted with acute HF
45 Kumar 2014 Cross‑sectional 64 centres in the UAE, Kuwait Multivariate logistic model shows old age as a significant
45
46 et al.[26] multicentre study and Qatar (October 2008 ‑ peripheral arterial disease predictor. DM (OR: 1.49; 95% CI: 46
47 December 2010); patients 1.14‑1.94; P=0.004); smoking (OR: 1.70; 95% CI: 1.22‑2.37: 47
with asymptomatic peripheral P=0.002); ethnicity (OR: 0.39; 95% CI: 0.19‑0.79; P=0.009);
48 arterial disease with prior female (OR: 1.56; 95% CI: 1.06‑2.29; P=0.024); adjusted OR 48
49 cerebrovascular or coronary (OR: 1.04; 95% CI: 1.02‑1.05; P<0.001) 49
50 event 50
51 51
52 Contd... 52

4 Hamdan Medical Journal  ¦  Volume XX  ¦  Issue XX  ¦  Month 2018

 Razzak, et al.: Prevalence and risk factors of CVD in the UAE

1 1
Table 2: Contd...
2 2
3 Study Year Study design Study population Key findings 3
Saheb 2014 Prospective analysis Two UAE government Patients with HFPEF less likely to be prescribed medication
4 et al.[27] hospitals (1 December 2011‑30 for HF and utilised fewer antiplatelet medications and more
4
5 November 2012); patients with anticoagulants 5
6 decompensated HF 6
7 Yusufali 2015 Voluntary point‑of‑care Nine health care facilities, At follow‑up of those with CVDRF, positive lifestyle changes 7
et al.[28] CVDRF screening was four shopping malls and three were reported in 60% and 33% had consulted a doctor; of the
8 conducted in follow‑up labour camps in five cities of latter, the following diagnoses were confirmed: DM, 63%; 8
9 for newly diagnosed the UAE hypertension, 93%; dyslipidaemia, 87%. A new diagnosis of DM, 9
10 DM, hypertension and hypertension or dyslipidaemia was uncovered in 61.5%, with the 10
dyslipidaemia highest yield (74.0%) in labour camps
11 Ong et al.[29] 2015 Prospective January 2009‑December 2012 0.5%‑8.5%, survival to hospital discharge; 1.6%‑3%, survival
11
12 international with good neurological function 12
13 multicentre cohort 13
study of out‑of‑hospital
14 cardiac arrests
14
15 Shah et al.[30] 2015 Cross‑sectional Random sampling from health Overall prevalence of BMI‑derived obesity and overweight and 15
16 screening centre, Abu Dhabi ‘waist‑to‑hip‑derived central obesity’ was calculated to be 44.7% 16
17 in women and 66.7% in men. Hypertension was reported in 17
30.5% (419) of the sample and DM in 9.0% (9) of the subsample
18 UAE: United Arab Emirates, CVD: Cardiovascular disease, GRACE: Gulf Registry of Acute Coronary Events, BMI: Body mass index, DM: Diabetes
18
19 mellitus, ACS: Acute coronary syndrome, HF: Heart failure, CHD: Coronary heart disease, OR: Odds ratio, CI: Confidence interval, MI: Myocardial 19
20 infarction, CVDRF: Cardiovascular disease risk factor; HFPEF: Heart failure with preserved ejection fraction 20
21 21
22 In the UAE, a 3‑year prospective registry of ACS patients found circumference and smoking were associated with hypertension. 22
23 that patients were relatively young and had risk factors such as A case–control study[23] involving 90 patients with MI admitted 23
smoking and DM.[19] On the other hand, a GRACE analysis from to a government hospital in the UAE showed a higher rate of
24 24
18 hospitals in the UAE estimated adjusted mortality rates of incidence of Type A personality in the MI group.
25 25
4.6% in women and 1.2% in men; also, HF was recognised to
26 Four other studies on the management of CVD and the 26
be more common in women than in men.[24] In contrast, another
27 evaluation of public health programmes were identified. 27
GRACE study validated the utilisation of the post‑discharge
28 A meta‑analysis[18] was carried out of six studies conducted 28
GRACE risk score among Arabian Gulf patients and found
29 in the UAE (1995–2009) among individuals with ST‑segment 29
that the score can be utilised for stratifying 1‑year mortality
30 elevation MT who were treated with thrombolytic drugs <6 h 30
risk across the population of the Arabian Gulf.[31]
31 after onset of MI. The mean age of the selected population 31
In Al‑Ain, a cross‑sectional CVD risk assessment study15 was 47 years, and, overall, 9% had suffered MI, 20% were
32 demonstrated the need for targeted interventions. From the 32
hyperlipidaemic, 25% were hypertensive, 28% had DM
33 population screened, around 28.4% had a Framingham risk 33
and 98% were men. Among young men in the UAE who
34 assessment score >20%, 19.6% of men smoked, 22.7% were admitted shortly after MI onset, thrombolysis‑induced 34
35 had metabolic syndrome, 37.3% were obese, 20.8% had recanalisation was found to be an effective treatment strategy. 35
36 hypertension and 23.3% had DM. CHD was reported in 2.4%. 36
37 In 53.9% of women and 64% of men, lipid profiles were A population‑wide cardiovascular screening programme[22] in 37
38 abnormal, largely owing to high triglyceride levels and low Abu Dhabi (with a smaller sample), entitled Weqaya, revealed 38
high‑density lipoproteins. Another study[30] carried out in a a large CVD burden. A study[25] conducted in 47 hospitals in
39 39
mandatory residency visa health screening centre in Abu‑Dhabi seven Gulf states examined the suitability of facilities for the
40 40
reported an overall prevalence of BMI‑derived obesity and management of CVD. Most hospitals had coronary care and
41 intensive unit facilities and the majority of the patients were 41
overweight and ‘waist‑to‑hip‑derived central obesity’ of
42 cared for by a cardiologist. However, only 29% of facilities had 42
44.7% in women and 66.7% in men. A health survey[16] that
43 a dedicated HF service. In a study[28] conducted in four shopping 43
elicited ‘self‑reported hypertension’ reported that high‑density
44 lipoprotein‑cholesterol, triglycerides, obesity/overweight, malls, nine health care facilities and three labour camps across 44
45 dyslipidaemia and DM prevalence, and thus, 10‑year five cities in the UAE, voluntary point‑of‑care screening was 45
46 Framingham risk scores were considerably higher among performed involving participants newly diagnosed with DM, 46
47 hypertensive respondents than in normotensive respondents. hypertension and dyslipidaemia. Positive lifestyle alterations 47
48 were reported in 60%, but only 33% had consulted a health 48
A prospective analysis[27] of patients with decompensated
49 professional; of the latter, 63% were diagnosed with DM, 93% 49
HF at two government hospitals in the UAE found that the
50 with hypertension and 87% with dyslipidaemia. 50
prevalence of respiratory diseases and AF among women
51 and older patients was higher than in developed countries. An international, multicentre and prospective cohort study[29] 51
52 In a community‑based survey, [17] DM, increased waist of out‑of‑hospital cardiac arrests showed that rates of survival 52

Hamdan Medical Journal  ¦  Volume XX ¦ Issue XX ¦ Month 2018 5

 Razzak, et al.: Prevalence and risk factors of CVD in the UAE

1 to hospital discharge vary widely and can be improved via quality of healthcare facilities for the management of CVD, 1
2 interventions, for instance through improved emergency and promising public health programmes such as Weqaya. At 2
3 medical services, public access to defibrillators and bystander the level of the individual, positive changes to lifestyle and 3
4 cardiopulmonary resuscitation (CPR). The large burden of diet, including regular physical activity and healthy eating, can 4
5 CVD revealed in the review is consistent with findings from delay or prevent the onset of risk factors associated with CVD. 5
6 global reports conducted by the WHO. According to the 6
Financial support and sponsorship
Global Health Observatory, the UAE has the second highest
7 Nil. 7
cardiovascular mortality rate, after Saudi Arabia, higher even
8 8
than the rate found in Gulf Cooperation Council countries and Conflicts of interest
9 high‑income countries such as Germany, the USA and Sweden.
9
There are no conflicts of interest.
10 3 The results are also consistent with a Ministry of Health 10
11 and Prevention report published in 2015, which revealed that 11
12 References 12
CVD is the leading cause of death in the UAE, responsible for 1. World Health Organization. Cardiovascular Diseases (CVDs). Fact
13 29.89% of all deaths.[4] Sheet N 317; 2017. Available from: http://www.who.int/mediacentre/
13
14 factsheets/fs317/en/index.html. [Last accessed on 2017 May 22]. 14
This study is the first of its kind investigating the prevalence 2. Hussain SM, Oldenburg B, Wang Y, Zoungas S, Tonkin AM. Assessment
15 15
and risk factors of CVD in the UAE. However, the study had of cardiovascular disease risk in South Asian populations. Int J Vasc
16 16
some limitations: Arabic papers were not included; findings Med 2013;2013:786801.
17 from cross‑sectional studies do not necessarily indicate 3. World Health Organization. Global Health Observatory Data Repository; 17
18 2016. Available from: http://www.apps.who.int/gho/data/node.main. 18
causality; and publication bias may have been a factor. A859?lang=en. [Last accessed on 2017 May 22].
19 Nevertheless, we attempted to minimise bias by searching 4. Ministry of Health and Prevention. United Arab Emirates; 2015 Report.
19
20 local and governmental reports, and the full texts of articles 5. World Health Organization. Global Status Report on Non‑Communicable 20
21 were examined. This review should be a very useful resource Diseases; 2014. Available from: www.who.int/nmh/publications/ 21
ncd‑status‑report‑2014/en/. [Last accessed on 2017 May 22].
22 document for public health professionals and researchers 6. Fox CS, Sullivan L, D’Agostino RB Sr., Wilson PW; Framingham
22
23 concerned with CVD prevention and control, and those who Heart Study. The significant effect of diabetes duration on coronary 23
24 seek a better understanding of the priorities for future research. heart disease mortality: The Framingham Heart Study. Diabetes Care 24
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25 Although no previous studies have been conducted at a national 25
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26 level, studies from numerous geographical regions of the UAE the risk of acute coronary events based on the 10‑year follow‑up of 26
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28 8. Hense HW, Schulte H, Löwel H, Assmann G, Keil U. Framingham 28
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30 women from Germany – Results from the MONICA Augsburg and the 30
31 Conclusion PROCAM cohorts. Eur Heart J 2003;24:937‑45.
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32 Although prevalence studies were relatively rare in comparison Effect of potentially modifiable risk factors associated with myocardial 32
33 with risk factor studies, it is evident that the significant burden infarction in 52 countries (the INTERHEART study): Case‑control 33
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34 of CVD requires further research and improved intervention. 10. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, 34
35 CVD is the leading cause of death worldwide, and risk Almahmeed WA, et al. Association of psychosocial risk factors with risk 35
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38 11. Teo K, Lear S, Islam S, Mony P, Dehghan M, Li W, et al. Prevalence 38
effective strategies for treating and preventing CVD. Further of a healthy lifestyle among individuals with cardiovascular disease in
39 39
evidence‑based research is needed on the association between high‑, middle‑ and low‑income countries: The prospective urban rural
40 epidemiology (PURE) study. JAMA 2013;309:1613‑21. 40
CVD and Type A personality. Our findings support the
41 implementation of opportunistic screening for CVD during
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42 et al. Use of secondary prevention drugs for cardiovascular disease 42
visits to health care professionals, increasing the likelihood in the community in high‑income, middle‑income, and low‑income
43 of early identification and management, including lifestyle countries (the PURE study): A prospective epidemiological survey. 43
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46 other stakeholders and the promotion of healthy lifestyles, is J Epidemiol 2001;30 Suppl 1:S35‑40. 46
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48 Some of the included studies, while investigating preventative 15. Baynouna LM, Revel AD, Nagelkerke NJ, Jaber TM, Omar AO,
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49 measures, revealed areas where further research is needed, Ahmed NM, et al. High prevalence of the cardiovascular risk factors in 49
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