MOHAMMED R ARAFAH MBBS FACP FRCPC FACC PROFESSOR OF CARDIOLOGY
Agenda The size of the problem . Local Data Community based studies ACS Registry Medical Intervention Studies
National Steering committee for
CV guidelines-Primary care .
The size of the problem - Heart disease causes 45% of early deaths in Middle East . - Middle East on "Edge of Epidemic" of heart disease .
The Global Health and the UAE: Asia-Middle East Connections Conference at the UAE University in Al Ain Jan 8, 2010
Coronary Artery Disease in Saudi Arabia Dr. M Al Nozha Mohammed Arafah et al SMJ 2004
Study objective was to determine the prevalence of CAD among Saudis of both sexes, between the ages of 30-70years. In rural as well as urban communities. 17232 persons were screened .
Coronary Artery Disease in Saudi Arabia
Dr. M Al Nozha Mohammed Arafah et al SMJ 2004
The prevalence of coronary artery disease within the Kingdom of Saudi Arabia stands at 5.5 percent of the population with higher prevalence among men and those living in urban areas
Coronary Artery Disease in Saudi Arabia
ď Źstatistically significant risk factors in KSA: age, male gender, body mass index (BMI), hypertension, current smoking, fasting blood glucose, fasting cholesterol and triglycerides
Prevalence of risk factors for CAD in KSA Risk Factor
Diabetes mellitus (FBG ≥7.0 mmol/l)
Hypertension (BP ≥140/90)
Hypercholesterolemia (TC≥5.2 mmol/l)
Hypertriglyceridemia (Trig ≥1.7 mmol/l)
Metabolic syndrome in Saudi Arabia
Males is 37.2% Females 42%
Mansour Al- Nozha ,Akram Al- Khadra ,Mohammed R Arafah , et al 2005 Saudi Medical Journal 2005; Vol. 26 (12): 1918-1925
The Cardio-Metabolic Risk P<0.0001
4 3 2 1 0
Prevalence of DM
Prevalence of CAD
50 40 30 20
Prevalence of Hypertension
50 40 30 20
Prevalence of: a) Coronary Artery Disease (CAD), b) Diabetes Mellitus (DM), c) Hypertension in subjects with metabolic Syndrome.
Diabetes, abdominal obesity and other risk factors prevalence among Saudi population Variables
(Metabolic Syndrome Health Survey)
Abdomin al obesitya (%)
High Triglyceride sb (%)
Low HDLc (%)
High Blood pressured (%)
High Fasting glucosee (%)
30 - 39
40 - 49
50 – 59
Total of each component
a c e
% of study 100 sample Waist circumference: male >102cm; female > 88cm
HDL cholesterol in: male <1.03 mmol/L; female <1.29 mmol/L FPG ≥6.1 mmol/L
triglycerides ≥1.69 mmol/L d Blood pressure ≥130/ 85 mmHg b
Al-Nozha MM, Al-Khadra A, Arafah MR, et al. Saudi Med J 2005; Vol. 26 (12): 1918-1925.
A growing burden Saudi Arabia High prevalence of hypertension in in KSA compared to other countries in Africa and Middle East
fer from f u s n o lati ia popu b a r A i of Saud
sion n e t r e hyp
1. Arnaout MS, Almahmeed W, Ibrahim M, et al. Current Medical Research & Opinion 2011; 27 (6): 1223â€“1236.
A disease that requires attention Control rate of hypertension was low
Cardiovascular disease was responsible for
of all deaths in Saudi Arabia1
50% of Saudi diabetic patients failed to achieve their target BP of 130/85 mmHg1
1. Arnaout MS, Almahmeed W, Ibrahim M, et al. Current Medical Research Opinion 2011; 27 (6): 1223â€“1236.
Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey Abdalla A. Saeed, * Nasser A. Al-Hamdan, Ahmed A. Bahnassy, Abdelshakour M. Abdalla, Mostafa A. F. Abbas, and Lamiaa Z. Abuzaid
Int J Hypertens. Published online 2011 September 6.
Result • Cross-sectional study. • Multistage stratified sampling was used to select 4758 adult participants. • The overall prevalence of hypertension was
• Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled.
RESULTS • Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. • Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. • Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia.
Conclusion Prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension
2 October 2012
ď‚— The median age at presentation with myocardial
infarction was 51 years in the Middle East .
ď‚— This was lower than the median age at
presentation in nine other regions, and was
12 years lower than the median age at
presentation in Western Europe .
Risk of acute myocardial infarction associated with risk factors in the overall Middle East population Current smoking Diabetes Hypertension Abdominal obesity ApoB/ApoA1 ratio
55.81 23.36 22.90 56.37 43.47
Khalid AlHabib et al
Volume 23, Issue 4 , Pages 233-239, October 2011
STEMI/new NSTEACS Overall n=5055 LBBB n=2096 n=2959 (58.5%) P-value n (%) (41.5%) n (%) n (%)
Mean age (SD), 58 (12.9) years Male sex, n (%) 3914 (77.4) BMI, median 27.6 (6.1) (IQR) Diabetes 2937 (58.1) mellitus, n (%) Hypertension, n 2783 (55.3) (%) Current 1638 (32.4) smoking, n (%) Hyperlipidemia 2084 (41.4) , n (%)
Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolemia
AHA 2011 announcement
Study Objectives To establish the proportion of patients on lipid-lowering pharmacological treatment reaching the LDL-C goals according the 2004 updated NCEP ATP III
Study Objectives Primary Secondary
: overall and by country : in the following sub-
populations â€˘ primary/secondary prevention patients â€˘ patients with metabolic syndrome (NCEP III Definition)
Reason for prescribing lipid lowering drug(s) Overall (5457)
Age (mean+SD) years
SBP (mean+SD) mmHg
DBP (mean+SD) mmHg
Body weight (mean+SD) kg
Waist circumference (mean+SD)
History of CHD
History of PAD
History of Cerebrovascular Disease
Family history of premature CVD
Single LLD Statins
2004 Updated NCEP ATP III Risk profile
Proportion of patients attaining their 2004 updated National Cholesterol Educational Program Adult Treatment Panel III-recommended low-density lipoprotein cholesterol (LDL-C) goals, according to risk category
) goals, according to risk category
Attainment of low-density lipoprotein cholesterol (LDL-C) goals in the overall cohort, and in patients with primary and secondary prevention, metabolic syndrome (MS) and familial hypercholesterolemia (FH).
Positive predictors for achievement of LDL-C goals according to 2004-updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) and Third Joint European Task Force (TJETF) guidelines.
Patient- Physician Questionnaire Controversy between Physicians and patients
According to the Patient Questionnaire, Questionnaire, only 43.91% of patients had been informed about their cholesterol levels, even though, according to the Investigator Questionnaire, Questionnaire, physicians set individual target cholesterol levels for 70% of their patients.
% of Goal Achievement
Primary Prevention & Secondary prevention treatment
Overall patients goal Achievement
Conclusion â€˘ Although the risk of mortality for patients with coronary heart disease is well-known and a number of guidelines exist to reduce this risk,
hypercholesterolemia in the 6 Arabian Gulf countries surveyed is still being undertreated .
Steering Committee Members Health Care Professional
Dr.farhan Al Shalaan
Dr.Muayed AL Zaibag
Dr.Khalid AL Nemer
Dr.Badr Al Mostafa
Dr.Mohamed Al Yasaa
Cardio Metabolic Guidelines workshops Local Experts Workshop Workshop: :including including40 40experts expertsacross acrossthe thekingdom kingdomtoto analyze analyzethe thedata dataand andput puttheir theircomments comments
International Internationalexperts experts 1-1-Prof.Peter Prof.PeterJ.J.Lin LinMD MDCCFP CCFP Director of Primary Care Director of Primary CareInitiatives, Initiatives,Canadian CanadianHeart Heart Research ResearchCentre.-Canada Centre.-Canada 2-Prof. 2-Prof.P.J. P.J.Van Vander derWees Wees Dutch Harkness fellow Dutch Harkness fellowofofthe theCommonwealth CommonwealthFund Fund Harvard Medical School Harvard Medical School 180 180Longwood LongwoodAve Ave Boston, MA Boston, MA 3-Prof.Victor 3-Prof.VictorHuckell Huckell Prof.of cardiology Prof.of cardiology University UniversityofofBritish BritishColoumbia-Vancouver Coloumbia-VancouverCanada Canada
Where to start?
Conclusions Cardiovascular Disease is the major cause of
mortality in our region (We are on the edge of an epidemic ) . Cardiovascular Risk factors are very common and the prevalence is increasing . Prevention will be the key theme at all health providers in the Kingdom of Saudi Arabia . Both SHA and MOH made a grate efforts for prevention .
THANK YOU Prof. Mohammed Arafah