With one of the highest rates of obesity in the world, the Gulf region is facing an epidemic of cardiovascular disease. At least 50% of the population is below the age of 25 and the high prevalence of risk factors signals a massive wave of cardiovascular disease in 10-15 years. Cardiovascular centres are already bursting at the seams and prevention services are nonexistent.
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 European Society of Cardiology (ESC), which is sending European experts to discuss prevention and other topics in a 1-day collaborative programme on 14 February.
Cardiovascular diseases cause 45% of early deaths in the Gulf region. Around 30% of men and 44% of women in Saudi Arabia are obese 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), who will present data on cardiovascular risk factors and prevention, 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 5055 acute coronary syndrome patients in the study had diabetes. These patients had a significantly worse prognosis, with higher in-hospital heart failure, cardiogenic shock and re-infarction rates. The researchers conclude that the high diabetes prevalence in their study probably reflects the high prevalence in the general population, and highlights 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 guidelines 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."
He added: "Rescuing a patient with an acute evolving myocardial infarction through primary angioplasty and stenting is lifesaving but if the underlying causes of the disease are not addressed, then the risk of recurrence or dying from this disease remains the same. They need to seize the opportunity of coupling their world class interventional cardiology facilities with world class prevention services."
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."
In the Gulf region, people do not know what is good for their health and education programmes are needed around diet and exercise. There are also cultural hurdles to living a healthy lifestyle, such as the lack of healthy food choices in restaurants. Professor Najm added: ""Very little is provided for women to do exercise or sport."
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 but it doesn't seem that they are. Everything is mobile - they drive cars, use escalators and elevators and don't do enough exercise. So this is the message: please don't follow our errors."
He added: "The European prevention guidelines calculate risk of cardiovascular disease 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. 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.
Professor Wood called for a public health strategy led by the governments which promotes physical activity, encourages healthy diets and reduces the prevalence of smoking. It should be mirrored by a clinical strategy of prevention services which identify those at high risk of developing cardiovascular disease and intervening early, as well as reducing the risk of people with cardiovascular disease.
He said: "The ESC gives a very high priority to prevention of cardiovascular disease and would welcome the opportunity to collaborate with the states in the Middle East to find solutions to this epidemic of cardiovascular disease and diabetes which is causing so much harm in the region."
More information: European Heart Journal. 2012;33:1635–1701.