Advances in Public Health / 2015 / Article / Tab 1

Review Article

Prevalence of Cardiovascular Disease and Associated Risk Factors among Adult Population in the Gulf Region: A Systematic Review

Table 1

The characteristics and the main outcomes of the included studies on CHD and strokes in the GCC region.

Reference
country
Year(s) of surveyTotal sampleAge, range, and meanSampling methodsStudy designResponse rate (%)Diagnostic criteriaThe main outcomes (CHD/stroke/associated risk factors/mortality rates)Quality assessment checklist (*)

CHD studies
[11]
Saudi Arabia
1995–200017293
M: 47.3%
F: 52.04%
30–70Two-stage stratified clusterNational cross-sectional surveyNRWHO MONICA (monitoring trends and determinant in cardiovascular disease)Overall prevalence: 5.5%
M: 6.6%
F: 4.4%
1-Y, 2-Y, 3-Y, 4-Y, 5-Y, 6-N, 7-NA

[14]
Saudi Arabia
2005-2006435
M: 77%
F: 23%
57.1No sampling (all ACS patients included with no excluded patients)Prospective studyNRThe Joint Committee of the European Society of Cardiology/American College of Cardiology (ACC)Risk factors of ACS: DM 56%, HTN 48%, smoking 39%, and hyperlipidaemia 31%1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-Y, 7-NA

[13]
(Kuwait, Oman, Qatar, Bahrain, the UAE, and Yemen)
20076704
M & F = not clear
56No sampling (all ACS patients included with no excluded patients)Prospective multinational study NRThe American College of Cardiology clinical data standards (ACC)/DM, hypertension, dyslipidaemia defined when patients known to have these risk factors and on treatment/regular smoking defined as 1 cigarette per day/nonsmoker after stopping 12 months agoOverall prevalence: DM 40%, HTN 49%, dyslipidaemia 32%, and smoking 38%
In Oman: DM 37%, HTN, 53%, smoking 18%, dyslipidaemia 35%, and obesity 22%
In the UAE: DM 40%, HTN 50%, smoking 49%, dyslipidaemia 36%, and obesity 20%
In Qatar: DM 46%, HTN 49%, smoking 37%, dyslipidaemia 29%, and obesity 23%
In Bahrain: DM 51%, HTN 60%, smoking 32%, dyslipidaemia 45%, and obesity 28%
In Kuwait: DM 50%, HTN 56%, smoking 40%, dyslipidaemia 37%, and obesity 37%
1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-Y, 7-NA

[12]
(Kuwait, Oman, Qatar, Bahrain, the UAE, and Yemen)
20078166
M: 6183
F: 1983
M: 53 years
F: 62 years
No sampling (all ACS patients included with no excluded patients)Prospective multinational study NRThe American College of Cardiology clinical data standards (ACC)/DM, hypertension, dyslipidaemia defined when patients known to have these risk factors and on treatment/regular smoking defined as 1 cigarette per day/nonsmoker after stopped 12 months agoAssociated risk factors in men: DM 36%, HTN 43%, dyslipidaemia 28%, and smoking 47%
In women: DM 55% and HTN 70%,
Dyslipidaemia 44% and smoking 5%
1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-N, 7-NA

Strokes studies
[15]
Saudi Arabia
1982–1992500
M: 342
F: 158
M: 65.2 years
F: 62.2 years
Nonrandom sampling (500 medical records of stroke patients)Retrospective studyNRNAIncidence of stroke:
43.8 per 100,000
30-day mortality: 12%
Stroke types: ischemic strokes (76.2%)
Risk factors: HTN 56%, DM 42%, and smoking 6%
1-Y, 2-Y, 3-Y, 4-Not well described, 5-N, 6-N, 7-NA

[20]
Kuwait
1989, 1992 and 1993Not clear60.6 yearsNonrandom (all patients with first-ever stroke, patients with previous stroke were excluded)Prospective studyNRWHO definition for diagnosing stroke/HC defined as more than 5.78 mmol/L/smoking as any current use of cigarette/hypertension and DM were not clearAnnual incidence: 27.6 per 100,000
The age-adjusted annual crude incidence: 145.6 per 100,000
30-day mortality: 10%
Stroke types: Carotid-territory large infarction (46.5%), Risk factors:
HTN 53%/DM 42%/HC 61%/smoking 23%
1-Y, 2-Y, 3-Y, 4-Y, 5-Y, 6-N, 7-NA

[22]
Kuwait
2008151
M: 96
F: 55
60.5 yearsNonrandom (all ischemic stroke patients, there was an inclusion criterion)Retrospective studyNRStroke defined according to WHO/stroke subtypes was defined according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteriaStroke types: Ischemic stroke (90.1%)
Risk factors:
DM 56.3%/dyslipidaemia 57%/HTN 68.9%/smoking 40%
1-Y, 2-Y, 3-Y, 4-N, 5-N, 6-Y, 7-NA

[21]
Kuwait
1995–199962
M: 30
F: 32
64.1 yearsNo random (all ischemic stroke patients included)Retrospective studyNRStroke defined according to WHO criteriaRisk factors:
HTN 72.5%/DM 69.4%, dyslipidaemia 30.6%/smoking 1.6%
30-day mortality: 12.9%
1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-N, 7-NA

[23]
Qatar
2005–2008116
M: 85%
F: 15%
53 yearsNonrandom (all patients diagnosed with PCS stroke, there was an inclusion criterion)Prospective studyNRStroke defined according to Kidwell and Warach/DM as fasting blood glucose >140 mg/dL or in medication/hypertension as >140/90 mmHg or on medication/dyslipidaemia as TC >5 mmol/L/smokers as currently smokers or during the last 12 months/obesity as BMI ≥30Risk factors:
HTN 61%, DM 44%, obesity 66%, smoking 20%, and dyslipidaemia 12%
30-day mortality rate: 10%
1-Y, 2-Y, 3-Y, 4-Y, 5-Y, 6-Partly, 7-NA

[17]
Saudi Arabia
1989-1990 and 1991–1993488
M: 314
F: 174
All Nonrandom (all Saudi patients with first stroke were included, and there was excluded patients)Prospective registerNRThe WHO multicentre Stroke Register/hypertension defined as BP >160/90 mmHg/DM defined as fasting blood sugar above 6.6 mmol/LIncidence of stroke:
29.8 per 100,000
Age-adjustment incidence:
125.8 per 100 000
Stroke types: ischemic stroke 69%
Risk factors:
HTN 38.1%/DM 37.1%/smoking 19.3%
1-Y, 2-Y, 3-Y, 4-Y, 5-Y, 6-N, 7-NA

[18]
Saudi Arabia
1997–200071
M: 55
F: 16
63 yearsNonrandom (all stroke patients included, no excluded patients)Retrospective studyNRNRStroke types: cerebral infarction 80%
Risk factors: DM 27%/HTN 61%/smoking 28%/dyslipidaemia 4%/Ischemic heart disease 8.5%
30-day mortality: 31%
1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-N, 7-NA

[25]
Qatar
1997217
M: 72.4%
F: 27.6%
57 yearsNonrandom (all stroke patients records were reviewed, and only first-ever stroke cases were included)Retrospective studyNRStroke defined according to the WHO criteriaIncidence of stroke: 41 per 100,000
Stroke types: ischemic stroke (80%)
Risk factors:
HTN 63%/DM 42%/Ischemic heart disease 17%
30-day mortality rate: 16%
1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-Y, 7-NA

[19]
Bahrain
1995144
M & F =
not clear
≥20Nonrandom (all stroke cases were reviewed)Retrospective studyNRStroke defined according to the WHO criteriaIncidence of stroke: 57 per 100,000
Stroke types: cerebral infarction 60%
Risk factors: HTN 52%/DM 20%/dyslipidaemia 29%/smoking 29%/Ischemic heart disease 50%
1-Y, 2-Y, 3- Y, 4-N, 5-N, 6-N, 7-NA

[24]
Qatar
2001303
M: 72%
F: 28%
61.2 yearsNonrandom (the data of all stroke patients were reviewed, and there were inclusion criteria)Retrospective studyNRStroke: WHO criteria
HTN: BP >140/90 mmHg or on medication/DM: past history or FPG (>7 mmol/L) or on medication/dyslipidaemia: TC >5.2 mmol/L or TG >2.0 mmol/L or HDL <0.9 mmol/L LDL >3.4 mmol/L/BMI ≥30 kg/m²/smokers: regular smoking within the last 5 years
Risk factors: HTN 69%/DM 51%/dyslipidaemia 57%/obesity 30%/smoking 26%/CAD 23%1-Y, 2-Y, 3-Y, 4-Y, 5-N, 6-Y, 7-NA

[26]
(Kuwait, Oman, Qatar, and the UAE)
2006-2007780
M: 63.7%
F: 36.3%
58.9 yearsNo sampling (all ischemic stroke patients were included, and there were inclusion criteria)Prospective registryNRHTN: BP >160/90 mmHg or on medication/DM: past history or elevated A1c or on medication/dyslipidaemia: TC >5.2 mmol/L or TG >1.7 mmol/L or HDL >1.0 mmol/L LDL <3.4 mmol/L/BMI ≥30 kg/m²/smokers: regular smoking within the last 5 yearsRisk factors: HTN 66.4%/DM 55.3%/current smokers 19.6%/dyslipidaemia 30.1%
90-day mortality: 2.1%
1-Y, 2-Y, 3-Y, 4-Y, 5-Y, 6-Y, 7-NA

[16]
Saudi Arabia
199323,227
M: 49.8%
F: 50.2%
NR No sampling (all Saudi living in the Thuqbah area were screened)Community-based cross-sectional surveyNRStroke defined “sudden or rapid onset of focal or global brain dysfunction of vascular origin lasting for more than 24 h or leading to death especially if diagnosed by physicians”The overall prevalence of stroke survivors:
186 per 100 000
1-Y, 2-Y, 3-Y, 4-N, 5-Y, 6-N, 7-NA

M, male; F, female; U, urban; R, rural; DM, diabetes; IFG, impaired fasting glucose; HC, hypercholesterolemia; TG, triglyceride; TC, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HTN, hypertension; SBP, systolic blood pressure; DBP, diastolic blood pressure; NR, not reported; ACS, acute coronary syndrome; BMI, body mass index; Y, yes; N, no; and NA, not applicable. (*) the quality assessment checklist assessed according to the Centre for Reviews and Dissemination guidelines (CRD) for nonrandomized studies: 1- Was the aim of the study stated clearly? 2- Was the methodology stated? And was it appropriate? 3- Were appropriate methods used for data collection and analysis? 4- Was the data analysis sufficiently rigorous? 5- Were preventive steps taken to minimize bias? 6- Were limitations of the study discussed? 7- In systematic review, was search strategy adequate and appropriate?

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