Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndrome: final data of the nationwide cross-sectional ‘CardioRisk’ project

Accepted: 26 January 2021
APPENDIX: 343
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Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS).
Objective: Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation.
Methods: From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS.
Results: The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants.
Conclusion: Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
* A complete list of contributors is available as ad hoc online appendix
Stanaway, J.D., Afshin, A., Gakidou, E., et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2018; 392: 1923-94. DOI: https://doi.org/10.1016/S0140-6736(18)32225-6
Yusuf, S., Hawken, S., Ôunpuu, S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The lancet 2004; 364: 937-52. DOI: https://doi.org/10.1016/S0140-6736(04)17018-9
Primatesta, P. Guidelines and risk factor management. Heart 2005; 91: 417. DOI: https://doi.org/10.1136/hrt.2004.048058
Roth, G.A., Huffman, M.D., Moran, A.E. et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation 2015; 132: 1667-78. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.008720
Yusuf, S., Reddy, S., Ôunpuu, S. and Anand, S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104: 2746-53. DOI: https://doi.org/10.1161/hc4601.099487
Popkin, B.M., Adair, L.S. and Ng, S.W. Global nutrition transition and the pandemic of obesity in developing countries. Nutrition reviews 2012; 70: 3-21. DOI: https://doi.org/10.1111/j.1753-4887.2011.00456.x
Maziak, W. The global epidemic of waterpipe smoking. Addictive behaviors 2011; 36: 1-5. DOI: https://doi.org/10.1016/j.addbeh.2010.08.030
Gottlieb, S., Harpaz, D., Shotan, A. et al. Sex differences in management and outcome after acute myocardial infarction in the 1990s: a prospective observational community-based study. Circulation 2000; 102: 2484-90. DOI: https://doi.org/10.1161/01.CIR.102.20.2484
Bearden, D., Allman, R., McDonald, R., et al. Age, race, and gender variation in the utilization of coronary artery bypass surgery and angioplasty in SHEP. Journal of the American Geriatrics Society 1994; 42: 1143-49. DOI: https://doi.org/10.1111/j.1532-5415.1994.tb06979.x
Shehab, A., Al-Dabbagh, B., AlHabib, K.F., et al. Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). PloS one 2013; 8: 55508. DOI: https://doi.org/10.1371/journal.pone.0055508
Perers, E., Caidahl, K., Herlitz, J., et al. Treatment and short-term outcome in women and men with acute coronary syndromes. International journal of cardiology 2005; 103: 120-7. DOI: https://doi.org/10.1016/j.ijcard.2004.07.015
Alfredsson, J., Stenestrand, U., Wallentin, L. and Swahn, E. Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. Heart 2007; 93: 1357-62. DOI: https://doi.org/10.1136/hrt.2006.102012
Reda, A., Ashraf, M., Soliman, M., et al. The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project. Cardiovascular journal of Africa 2019; 30: 87-94. DOI: https://doi.org/10.5830/CVJA-2018-074
Catapano, A.L., Graham, I., De Backer, G et al. ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016; 253: 281-344. DOI: https://doi.org/10.1016/j.atherosclerosis.2016.08.018
Williams, B., Mancia, G., Spiering, W et al. ESC/ESH Guidelines for the management of arterial hypertension. European heart journal 2018; 39: 3021-3104. DOI: https://doi.org/10.1093/eurheartj/ehy339
Waist Circumference and Waist-Hip Ratio Report of a WHO Expert Consultation (2008). Available at: https://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf. Accessed January 2020.
Lloyd-Jones, D.M., Nam, B.H., D'Agostino Sr, R.B., et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA 2004; 291: 2204-11. DOI: https://doi.org/10.1001/jama.291.18.2204
Avezum, A., Makdisse, M., Spencer, F., et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (G Coronary Heart Disease in the Middle East). American heart journal 2005; 149: 67-73. DOI: https://doi.org/10.1016/j.ahj.2004.06.003
Dehmer, Gregory J., Vinay Badhwar, Edmund A. Bermudez, et al. AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization)." Circulation: Cardiovascular Quality and Outcomes 2020; 13: e000059. DOI: https://doi.org/10.1161/HCQ.0000000000000059
World Health Organization (2019). Available at: http://www.emro.who.int/entity/about-us/index.html. Accessed June 2019.
International Epidemiological Association Guidelines (2019). Available at: https://ieaweb.org/. Accessed June 2019.
Chakrabarti, S., Morton, J.S. and Davidge, S.T.. Mechanisms of estrogen effects on the endothelium: an overview. Canadian Journal of cardiology 2014; 30: 705-712. DOI: https://doi.org/10.1016/j.cjca.2013.08.006
Mendelsohn, Michael E., and Richard H. Karas. The protective effects of estrogen on the cardiovascular system. New England journal of medicine 1999; 23: 1801-11. DOI: https://doi.org/10.1056/NEJM199906103402306
Marjoribanks, J., Farquhar, C., Roberts, H. and Lethaby, A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 2012; 7. DOI: https://doi.org/10.1002/14651858.CD004143.pub4
Leifheit-Limson, E.C., D’Onofrio, G., Daneshvar, M., et al. Sex differences in cardiac risk factors, perceived risk, and health care provider discussion of risk and risk modification among young patients with acute myocardial infarction: the VIRGO study. Journal of the American College of Cardiology 2015; 66:1949-57. DOI: https://doi.org/10.1016/j.jacc.2015.08.859
Dey, S., Flather, M.D., Devlin, G., et al. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart 2009; 95: 20-6. DOI: https://doi.org/10.1136/hrt.2007.138537
Pagidipati, N.J. and Peterson, E.D. Acute coronary syndromes in women and men. Nature Reviews Cardiology 2016; 13: 471. DOI: https://doi.org/10.1038/nrcardio.2016.89
Jneid, H., Fonarow, G.C., Cannon, C.P., et al. Get With the Guidelines Steering C, Investigators. Sex differences in medical care and early death after acute myocardial infarction. Circulation 2008; 118: 2803-10. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.789800
Hess, C.N., McCoy, L.A., Duggirala, H.J. et al. Sex‐based differences in outcomes after percutaneous coronary intervention for acute myocardial infarction: a report from TRANSLATE‐ACS. Journal of the American Heart Association 2014; 3: 000523. DOI: https://doi.org/10.1161/JAHA.113.000523
Chen, A.Y. Baseline risk of major bleeding in non-ST segment elevation myocardial infarction: the CRUSADE bleeding score. Circulation 2009; 119: 2168-94.
Zubaid, M., Rashed, W.A., Al-Khaja, N., et al. Clinical presentation and outcomes of acute coronary syndromes in the gulf registry of acute coronary events (Gulf RACE). Saudi medical journal 2008; 29: 251-5.
AlHabib, K.F., Sulaiman, K., Al-Motarreb, A., et al. Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Annals of Saudi medicine 2012; 32: 9-18. DOI: https://doi.org/10.5144/0256-4947.2012.9
Dugani, S.B., Murad, W., Damilig, K., et al. Premature Myocardial Infarction in the Middle East and North Africa: Rationale for the Gulf PREVENT Study. Angiology 2019: 0003319719849737. DOI: https://doi.org/10.1177/0003319719849737
Musaiger, A.O. Overweight and obesity in eastern mediterranean region: prevalence and possible causes. Journal of obesity 2011. DOI: https://doi.org/10.1155/2011/407237
Traina, M.I., Almahmeed, W., Edris, A. and Tuzcu, E.M. Coronary heart disease in the Middle East and North Africa: current status and future goals. Current atherosclerosis reports 2017; 19: 24. DOI: https://doi.org/10.1007/s11883-017-0659-9
Finucane, M.M., Stevens, G.A., Cowan, M.J., et al. systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. The Lancet 1980; 377: 557-67. DOI: https://doi.org/10.1016/S0140-6736(10)62037-5
Aljefree, N. and Ahmed, F. Association between dietary pattern and risk of cardiovascular disease among adults in the Middle East and North Africa region: a systematic review. Food & nutrition research 2015; 59: 27486. DOI: https://doi.org/10.3402/fnr.v59.27486
World Health Organization (2016). World Health Statistics 2016 data visualizations dashboard: prevalence of tobacco smoking. Available at: http://apps.who.int/gho/data/node.sdg.3-a-viz?lang=en. Accessed June 2019.
World Health Organization (2012). Global progress report on implementation of the WHO framework convention on tobacco control. Available at: https://apps.who.int/iris/handle/10665/79170. Accessed June 2019.
Ibrahim, M.M., Appel, L.J., Rizk, H.H. et al. Cardiovascular risk factors in normotensive and hypertensive Egyptians. Journal of hypertension 2001; 19: 1933-40. DOI: https://doi.org/10.1097/00004872-200111000-00002
Romdhane, H.B., Ali, S.B., Skhiri, H., et al. Hypertension among Tunisian adults: results of the TAHINA project. Hypertension Research 2012; 35: 341. DOI: https://doi.org/10.1038/hr.2011.198
World Health Organization (2014). Global status report on noncommunicable diseases. Available at: https://www.who.int/nmh/publications/ncd-status-report-2014/en/. Accessed June 2019.
Whiting, D.R., Guariguata, L., Weil, C. and Shaw, J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice 2011; 94: 311-21. DOI: https://doi.org/10.1016/j.diabres.2011.10.029
Weyer, C., Foley, J.E., Bogardus, C., et al. Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts type II diabetes independent of insulin resistance. Diabetologia 2000; 43: 1498-506. DOI: https://doi.org/10.1007/s001250051560
Zhang, Huabing, Jorge Plutzky, Maria Shubina, and Alexander Turchin. Drivers of the sex disparity in statin therapy in patients with coronary artery disease: a cohort study. PLoS 2016; e0155228. DOI: https://doi.org/10.1371/journal.pone.0155228