Scientific Journal Of King Faisal University: Basic and Applied Sciences

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Scientific Journal of King Faisal University: Basic and Applied Science

Gender-Specific Prevalence of Ischemic Heart Disease among Emergency-Department Patients: Saudi Arabia

(Emad Ali Al Khoufi)

Abstract

Few epidemiological studies have discussed the gender-specific prevalence of ischemic heart disease (IHD). We aimed to investigate the gender-specific prevalence of IHD among Saudi patients visiting the emergency department and if it is affected by diabetes mellitus and/or hypertension. Three hundred patients were recruited from Prince Sultan Cardiac Center in Al Ahsa, KSA. Hypertension was identified as systolic pressure equal to or more than 140 mmHg and/or diastolic pressure equal to or more than 90 mmHg or by the patient currently being on antihypertensive medication, and coronary artery disease (CAD) was diagnosed by electrocardiogram, cardiac markers, cardiac exercise testing or coronary angiography. Hypertension was found in 80% of males and 72% of females. A significantly higher rate of diabetes was noted in females (62%) compared to males (48%) (p<0.012). Co-existing diabetes and hypertension was found in 70% of females as compared to 38% of males. The occurrence of IHD in males was significantly higher than that in females (p<0.001). However, the incidence of myocardial infarction was greater in females (52%) compared to males (38%) (p<0.035). Co-existing hypertension and diabetes may affect the gender prevalence of myocardial infarction among emergency department patients, with more infarctions being noted among females. This finding helps to guide the treatment strategy for both genders.

KEYWORDS
Al Ahsa, cardiovascular risk, coronary artery disease, ischemic heart disease, systemic hypertension, type 2 diabetes mellitus

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References

Al-Hazzaa, H.M. (2018). Physical inactivity in Saudi Arabia revisited: a systematic review of inactivity prevalence and perceived barriers to active living. International Journal of Health Sciences, 12(6), 50–64.
Al-Nozha, M.M., Arafah, M.R., Al-Mazrou, Y.Y., Al-Maatouq, M.A., Khan, N.B., Khalil, M.Z., Al-Khadra, A.H., Al-Marzouki, K., Abdullah, M.A., Al-Harthi, S.S. and Al-Shahid, M.S. (2004). Coronary artery disease in Saudi Arabia. Saudi Med J, 25(9), 1165–71. 
Al-Turki, K.A., Al-Baghli, N.A., Al-Ghamdi, A.J., and El-Zubaier, A.G. (2008). Hypertension in the eastern province of Saudi Arabia: Results of a screening campaign. Journal of Family & Community Medicine, 15(3), 95–101.
Amsterdam, E.A., Wenger, N.K., Brindis, R.G., Casey, D.E., Ganiats, T.G., Holmes, D.R., Jaffe, A.S., Jneid, H., Kelly, R.F., Kontos, M.C. and Levine, G.N. (2014). 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 64(24), e139–e228.
Anand, S.S., Islam, S., Rosengren, A., Franzosi, M.G., Steyn, K., Yusufali, A.H., Keltai, M., Diaz, R., Rangarajan, S., and Yusuf, S. (2008). Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. European Heart Journal, 29(7), 932–40.
American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes–2018. Diabetes Care, 41(Supplement 1), S13–S27.
Bhatt, D.L., Steg, P.G., Ohman, E.M., Hirsch, A.T., Ikeda, Y., Mas, J.L., Goto, S., Liau, C.S., Richard, A.J., Röther, J. and Wilson, P.W. (2006). International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. Jama, 295(2), 180–9.
Booth, G.L., Kapral, M.K., Fung, K. and Tu, J.V. (2006). Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. The Lancet, 368(9529), 29–36.
Chen, G., McAlister, F.A., Walker, R.L., Hemmelgarn, B.R. and Campbell, N.R. (2011). Cardiovascular outcomes in Framingham participants with diabetes: the importance of blood pressure. Hypertension, 57(5), 891–7.
De Ferranti, S.D., De Boer, I.H., Fonseca, V., Fox, C.S., Golden, S.H., Lavie, C.J., Magge, S.N., Marx, N., McGuire, D.K., Orchard, T.J. and Zinman, B. (2014). Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation, 130(13), 1110–30.
Fox, C.S., Golden, S.H., Anderson, C., Bray, G.A., Burke, L.E., De Boer, I.H., Deedwania, P., Eckel, R.H., Ershow, A.G., Fradkin, J. and Inzucchi, S.E. (2015). Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation, 132(8), 691–718.
Hu, G., Jousilahti, P. and Tuomilehto, J. (2007). Joint effects of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the risk of coronary heart disease. European Heart Journal, 28(24), 3059–66.
Huxley, R.R., Filion, K.B., Konety, S. and Alonso, A. (2011). Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. The American Journal of Cardiology, 108(1), 56–62.
Kannel, W.B. and McGee, D.L. (1979). Diabetes and cardiovascular disease: the Framingham study. Jama, 241(19), 2035–8.
Kappert, K., Böhm, M., Schmieder, R., Schumacher, H., Teo, K., Yusuf, S., Sleight, P. and Unger, T. (2012). Impact of sex on cardiovascular outcome in patients at high cardiovascular risk: analysis of the telmisartan randomized assessment study in ACE-intolerant subjects with cardiovascular disease (TRANSCEND) and the ongoing telmisartan alone and in combination with ramipril global end point trial (ONTARGET). Circulation, 126(8), 934– 41.
Kim, M.J., Lim, N.K., Choi, S.J. and Park, H.Y. (2015). Hypertension is an independent risk factor for type 2 diabetes: the Korean genome and epidemiology study. Hypertension Research, 38(11), 783–9.
Lopez, A.D. (1993). Assessing the burden of mortality from cardiovascular diseases. World Health Stat Q., 46(2), 91–6.
Lucaroni, F., Modica, D.C., Macino, M., Palombi, L., Abbondanzieri, A., Agosti, G., Biondi, G., Morciano, L. and Vinci, A. (2019). Can risk be predicted? An umbrella systematic review of current risk prediction models for cardiovascular diseases, diabetes and hypertension. BMJ Open, 9(12), 1–12.
Madonna, R., Balistreri, C.R., De Rosa, S., Muscoli, S., Selvaggio, S., Selvaggio, G., Ferdinandy, P. and De Caterina, R. (2019). Impact of sex differences and diabetes on coronary atherosclerosis and ischemic heart disease. Journal of Clinical Medicine, 8(1), 98–116.
Masoudkabir, F., Poorhosseini, H., Vasheghani-Farahani, A., Hakki, E., Roayaei, P. and Kassaian, S.E. (2015). Synergistic effect of hypertension with diabetes mellitus and gender on severity of coronary atherosclerosis: Findings from Tehran Heart Center registry. ARYA Atherosclerosis, 11(6), 317–322.
McInnes, G.T. (1995). Hypertension and coronary artery disease: cause and effect. Journal of Hypertension. Supplement: Official Journal of the International Society of Hypertension, 13(2), S49– S56.
Petrie, J.R., Guzik, T.J. and Touyz, R.M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575–84.
Salam, A.A. (2013). Population and household census, Kingdom of Saudi Arabia 2010: facts and figures. International Journal of Humanities and Social Science, 3(16), 258–63.
Sawai, T., Imano, H., Muraki, I., Hayama-Terada, M., Shimizu, Y., Cui, R., Kitamura, A., Kiyama, M., Okada, T., Ohira, T. and Yamagishi, K. (2017). Changes in ischaemic ECG abnormalities and subsequent risk of cardiovascular disease. Heart Asia, 9(1), 36–43.
Stamler, J., Vaccaro, O., Neaton, J.D., Wentworth, D. and Multiple Risk Factor Intervention Trial Research Group. (1993). Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care, 16(2), 434–44.
Thompson, S.K. (2012). Sampling, Third edition, P: 59–60. New York, NY: Wiley.
Wilson, P.W., D’Agostino, R.B., Parise, H., Sullivan, L. and Meigs, J.B. (2005). Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation, 112(20), 3066–72.