Incidence of cardiovascular disease and its associated risk factors in at-risk men and women in the United Arab Emirates: a 9-year retrospective cohort study

Abstract

Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide; however, the epidemiology of CVD among nationals from the United Arab Emirates (UAE) remains unknown. This study aimed to estimate the 9-year incidence rate of CVD and determine the risk factors associated with CVD among UAE nationals at high cardiovascular risk. In addition, we investigated whether sex was an important modifier of the risk factors associated with incident CVD in this population. Methods A retrospective cohort study was conducted on 977 subjects, including 492 women, aged ≥18 years, who did not have histories of CVD, and who had ≥1 CVD risk factors. Multivariable Cox proportional hazards regression analyses stratified by sex were used to examine the predictors of major CVD events, namely, myocardial infarction (MI), stroke, and acute peripheral arterial occlusion. Results During a median follow-up period of 8.9 years, the incidence rate of major CVD was 12.7 per 1000 person-years (95% confidence interval [CI] 10.4–15.4), and among men and women were 16.8 (95% CI 12.9–21.4) and 9.0 (95% CI 6.4–12.4) per 1000 person-years, respectively. Major CVD and MI were significantly more frequent among men than women, and the stroke and acute peripheral arterial occlusion rates were similar for both sexes. Multivariable Cox analyses showed that the systolic blood pressure, estimated glomerular filtration rate, and serum glycosylated hemoglobin A1c level were strong predictors of major CVD in both sexes. Among women, the total cholesterol (TC)-to-high-density lipoprotein-cholesterol (HDL-C) ratio (hazard ratio [HR] 1.44, 95% CI 1.02–2.04) was an additional independent predictor of major CVD. Age (HR 1.50, 95% CI 1.19–1.89) and a history of smoking (HR 1.80, 95% CI 1.07–3.02) were significant risk factors associated with major CVD in men. Conclusions Among high-risk UAE nationals who did not have histories of CVD, the risk of major CVD was associated with high systolic blood pressure, a low estimated glomerular filtration rate, and poorly controlled diabetes. The high TC-to-HDL-C ratios, especially among women, and smoking among men, are modifiable risk factors that should be managed aggressively. Electronic supplementary material The online version of this article (10.1186/s12872-019-1131-2) contains supplementary material, which is available to authorized users.

WITHDRAWN: Incidence and Predictors of Cardiovascular Disease Among Type 1 and Type 2 Diabetes Mellitus in Tertiary Health Care Setting of Ethiopia: 8-Year Retrospective Follow Up Study.

“…Similarly, diabetic patients with systolic HTN comorbid had more than four-fold higher risk of developing CVD than those who had no systolic HTN which agrees with the ndings from other longitudinal studies (14,18,44). Even though the recent guideline by American College of Cardiology and American Heart Association showed importance of detection, evaluation and management of high blood pressure in reducing the risk of CVD (45), a signi cant number of patients fail to achieve blood pressure targets in developing countries (46).…”

“…Several epidemiological researchers around the world identi ed older age and longer duration of DM (14), high density lipoprotein cholesterol (HDL-C) level (15), smoking and heavy alcohol consumption (16), hypertension (HTN) (17,18), poor glycemic control (high glycosylated hemoglobin (HbA1c) (18) and triglyceride (TG) (19) to be independent predictors for incident CVD. In response to the recent rise of CVDs in developing countries, World health organization (WHO) has identi ed very cost-effective interventions that are applicable even in low-resource settings for prevention and control of CVDs (20).…”

External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study

“…For adults ≤39 years of age, there are sparse data relating to the utility and performance of the 2013 PCE risk prediction model. In the UAE national population, age has been shown to be an independent predictor of incident CVD, 25 with several studies in the region having reported a high incidence of atherosclerotic CVD in younger age groups. 26–28 A study conducted in six Middle Eastern countries, including the UAE, found that 50% of patients diagnosed with an acute coronary syndrome were aged <55 years, a decade younger than those being diagnosed in North America and Europe.…”

Performance of the Framingham coronary heart disease risk score for predicting 10-year cardiac risk in adult United Arab Emirates nationals without diabetes: a retrospective cohort study

“…Cardiovascular risk prediction tools, such as the FRS model, have been widely recommended by international and local guidelines to better target primary preventive treatments, particularly lipid-lowering therapy, in susceptible individuals [15,21]. However, the FRS model does not include emerging risk factors, such as renal failure, which is associated with increased cardiovascular risk among UAE nationals [5]. Therefore, developing novel risk prediction models based on local data would be more appropriate in populations with varying disease patterns and risk factors.…”

“…In the Middle East, CHD is by far the most serious public health concern [2,3]. Premature deaths associated with CHD have tripled over the past decade [4] and in a recent United Arab Emirates (UAE) study, the cumulative incidence of acute CHD events among men with one or more vascular risk factors was noted to be 8.9% over nine years [5]. While the crude incidence of acute CHD over ten years was 4.7% among European men in the general population [6].…”