Cardiovascular Diseases in the MENA region
The rapid urbanization, sociocultural changes and economic development of MENA over the past 30 years has transformed the face of the region. These kinds of changes are known to be associated, around the world, with the development of an unhealthy lifestyle and MENA is no exception.
The high prevalence of CVDs in the MENA region is thought to be due to the recorded increases, and combination of, multiple CVD risk factors such as:
- Diet,
- Obesity,
- Diabetes,
- Hypertension,
- Hyperlipidemia,
- Physical inactivity.
With recorded increases in all its major risk factors, ischemic heart disease is now the leading cause of mortality in the region. Cardiovascular Diseases (CVDs) are also affecting the young with the age of patients at presentation in MENA being significantly younger for both myocardial infarction and acute coronary syndrome compared to global averages. In fact, CVDs, cancer, and diabetes account for up to one third of all the current disease burden in the MENA region. The CVD burden has remained relatively stable over the last 10 years at almost 20% of all Disability Adjusted Life-Years (DALYs). In comparison, cancer accounts for approximately 10% of all DALYS and Diabetes represents approximately 4% of all DALYs.
Obesity is of particular concern for women in the oil-rich nations and is the most pressing health concern in the region. The change in dietary factors arise from the increased availability, affordability, and consumption of unhealthy foods and the adoption of a more sedentary lifestyle. Dietary trends have moved away from traditional food habits. There is instead an increased consumption of animal protein and fat, and a decreased intake of carbohydrates from whole grain cereals, fresh fruits, and vegetables.
Data in the WHO Food and Agriculture Organization Statistical Databases shows that there has been a continuous rise in the energy levels of the daily dietary intake per person by approximately 730 kcal between 1970 and 2005.
There are however wide variations in the prevalence of CVD risk factors across MENA and this is reflected in the constituent countries’ CVD profile. For example, hypertension affects around 30% of the general population of MENA, but per country Iran has the highest prevalence of hypertension (44%), followed by Kuwait (39%) and Iraq (38%). There is also a high prevalence of hypercholesterolemia and hyperlipidemia.
A recent epidemiological study in countries including Saudi Arabia, United Arab Emirates, and Iran has investigated the prevalence, awareness, treatment, and control of hypertension in the Middle East. Out of 10,516 patients, 33% had hypertension and only 49% of these were aware of their diagnosis. Also, of those patients with hypertension only 47% were treated and only 19% had their blood pressure levels controlled. The prevalence of hypertension was found to be higher in rural communities and awareness, treatment, and control were significantly higher among the participants who lived in urban areas.
With this disease burden known, sponsors have successfully performed about 1,700 clinical studies on CVD in MENA according to the clinicaltrials.gov website to date.
Prevalence, diagnosis and treatment of hypertension in the Middle East has been found to be in need of improvement and it is hoped that increasing the number and type of clinical studies in CVDs will help to improve this situation.
Further Reading
Aggarwal A, Patel P, Lewison G, et al. (2020) The Profile of Non-Communicable Disease (NCD) research in the Middle East and North Africa (MENA) region: Analyzing the NCD burden, research outputs and international research collaboration. PloS one 15(4), e0232077.
GBD 2017 DALYs and HALE Collaborators (2018) Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. GLOBAL HEALTH METRICS 392(10159): 1859-1922.
Yusufali AM, Khatib R, Islam S, et al. (2017) Prevalence, awareness, treatment and control of hypertension in four Middle East countries. J Hypertens 35(7): 1457-1464.
Mehio Sibai A, Nasreddine L, Mokdad AH, et al. (2010) Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 57(3-4): 193-203.
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