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CVD epidemic envisaged in Gulf region

With one of the highest rates of obesity in the world, the Gulf region is facing an epidemic of cardiovascular disease (CVD), according to a report released recently by the European Society of Cardiology.

At least 50% of the population is below the age of 25 and the high prevalence of risk factors signals a massive wave of CVD in 10–15 years. Cardiovascular centres are already bursting at the seams and prevention services are nonexistent, the report says.

Prevention will be a key theme at the Saudi Heart Association annual conference, held 13–16 February 2013 in Riyadh, Saudi Arabia. The Saudi Heart Association is an affiliated society of the ESC, which is sending European experts to discuss prevention and other topics in a 1-day collaborative programme on 14 February.

CVD causes 45% of early deaths in the Gulf region. Around 30% of men and 44% of women in Saudi Arabia are obese1 and one-quarter of adults have diabetes. Metabolic syndrome is prevalent in 39% of men and 42% of women.

Professor Mohammed R Arafah (Riyadh, Saudi Arabia) said: “We are on the edge of an epidemic. The cardiac problem is progressing too fast to be coped with and there is under treatment of risk factors.”

The Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) found that 58% of the 5,055 acute coronary syndrome patients in the study had diabetes.2 These patients were found to have a significantly worse prognosis, with higher in-hospital heart failure, cardiogenic shock and re-infarction rates. The researchers concluded that the high diabetes prevalence in their study probably reflected the high prevalence in the general population, and highlighted the importance of cardiovascular prevention.

ESC prevention expert Professor David Wood (London, UK) said: “The biggest challenge in the Middle East and Saudi Arabia in particular is the growing prevalence of obesity – they have one of the highest rates of obesity in the world. These populations are especially sedentary; the use of the motor vehicle is the norm and walking is not.”

He continued: “Coupled with that is the correspondingly high prevalence of diabetes mellitus. These together put their population at great risk of premature cardiovascular disease. They really have a true epidemic on their hands.”

European prevention guidelines3 focus on a lifestyle approach to cardiovascular prevention through multidisciplinary preventive cardiology programmes. Professor Wood said: “In Saudi Arabia, whilst they have world class facilities in interventional cardiology, they do not have the comparable services in cardiovascular prevention. And that is a big gap in their national health service.”

Professor Hani Najm, Vice President of the Saudi Heart Association, said: “The prevalence of risk factors is so high in our young society that they will get cardiovascular disease early, in their 40s and 50s. We’re facing a tsunami of cardiovascular disease in the Gulf region in the coming 10–15 years. People drink soft drinks instead of water, eat unhealthy food and don’t exercise, and obesity is starting at a younger and younger age.”

He continued: “Cardiovascular centres can’t cope with the current disease burden in the Gulf region, which means preventive measures are urgent. It’s more glamorous to open a cardiac centre than implement a preventive programme but governments have no choice now but to do the latter.”

Professor Roberto Ferrari, a former ESC president, said: “The Gulf area and Saudi Arabia have this advantage that they could learn from our mistakes in the West. Everything is mobile – they drive cars, use escalators and elevators and don’t exercise enough. So this is the message: please don’t follow our errors.”

He added: “The European prevention guidelines4 calculate risk of CVD according to where people were born. Countries like Lebanon and Egypt are considered high risk which suggests that the Gulf could also be a high risk region.”

The ESC has called for regulation when lifestyle changes fail.4 Strategies include taxation on products with free sugar and saturated fat, subsidies for fruit and vegetables, limiting advertising for junk food, subsidies for public transport, and re-allocating road space to cycle and footpath lanes.


1. WHO World Health Statistics 2012

2. Al Nemer KA, Al Faleh HF, Al Habib KF, et al. Impact of diabetes on hospital adverse cardiovascular outcomes in acute coronary syndrome patients: data from the Saudi project of acute coronary events. J of the Saudi Heart Assoc 2012;24:225–31.

3. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Euro Heart J 2012;33:1635–701.

4. Jørgensen T, Capewell S, Prescott E, et al. Population-level changes to promote cardiovascular health. Eur J Prev Cardiol 2012 [Epub ahead of print]

Published on: February 28, 2013

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