Advancements in Cardiovascular Disease Management in MENA: Strategies for Prevention and Treatment

The right to good nutrition is out of reach for over 16 million children under 5 years old in the MENA region. Despite some improvements, trends in children’s nutrition have stagnated or worsened since 2000.

DATE
June 20, 2024
CATEGORY
Blog

Introduction

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, with a particularly high prevalence in the Middle East and North Africa (MENA) region. According to estimates, around 34% of deaths caused by non-communicable diseases in the Eastern Mediterranean Region are due to CVDs. In the Region, nearly 40% of adults, or two out of every five people, have high blood pressure, with rates varying between 34% (Djibouti and United Arab Emirates) and 48% (Iraq) across different countries. Both men and women are almost equally affected. The Eastern Mediterranean Region has the highest prevalence of diabetes, ranging from 7% (Somalia) to 18% (Egypt), making it the worst region globally for this condition.

When it comes to adults above the age of 15, data from the Region highlights Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates as having the highest rates of overweight and obesity, exceeding 70%, especially among women. The growing issue of obesity among school children is a significant concern. Physical inactivity rates in the Region are also higher compared to other regions, with about 50% of women and over a third of men not engaging in sufficient physical activity. Tobacco use is on the rise as well, with smoking prevalence among adult men ranging from 14% to 57%.

One key challenge faced by low-resource countries in the Region is the affordability and accessibility of essential medicines for managing common CVDs. Many cases of hypertension and diabetes can be effectively treated at primary healthcare facilities. The involvement of doctors and trained healthcare professionals is crucial in detecting and treating high blood pressure (WHO, 2024).

Fig: Distribution of deaths in the United Arab Emirates in 2019, by cause

In 2019, the share of deaths in the UAE caused by cardiovascular diseases was the highest among other causes at 36%.

The Prevalence of CHD in the MENA

Manla & Almahmeed, (2023) found that CHD contributed the most to the number of prevalent cases of CVD in the region (54.7%), with 19,979,927.2 (UI 18,501,725.4–21,563,634.7) cases, corresponding to an increase of 41% in the rate of prevalence (2,333 to 3,282.3 cases per 100,000) and a decrease of 3% (5,087.4 to 4,911.1 cases per 100,00) in the age-standardized rate of prevalence between 1990 and 2019.

At a national level, in 2019, the three countries with the highest age-standardized prevalence rates were Iran (6,198.5 [UI 5,644.4–6,814.6] per 100,000), Egypt (5,623.95 [UI 5,255.3–6,014.9] per 100,000), and Kuwait (5,583.1 [UI 5,166.6–6,015.9] per 100,000), while the three countries with the lowest age-standardized prevalence rates were Turkey (3,227 [UI 2,942.1–3,563.6] per 100,000), Tunisia (4,480.2 [UI 4,161–4,823.8] per 100,000), and Algeria (4,581.4 [UI 4,248.9–4,938.7] per 100,000).

Fig: Prevalence of CV risk enhancers in Saudi Arabia (Tash & Bawardy, 2023)

The Incidence of CHD in the MENA

Manla & Almahmeed, (2023) found that CHD contributed the most to the number of incident cases of CVD in the region (58.5%), with 2,550,431.6 uncertainty interval (UI) (2,287,729.8–2,826,389.56) cases, corresponding to an increase of 33% in the rate of incidence (314.4 to 419 cases per 100,000) and a decrease of 9% (674.5 to 613.9 cases per 100,000) in the age-standardized rate of incidence between 1990 and 2019.

At a national level, in 2019, the three countries with the highest age-standardized incidence rates were Iran (829.1 [UI 719.9–945.2] per 100,000), Egypt (759.9 [UI 705.9–819.4] per 100,000), and Oman (731.2 [UI 639.4–831.3] per 100,000), while the three countries with the lowest age-standardized incidence rates were Turkey (325.5 [UI 293.7–359.9] per 100,000), Tunisia (558.1 [UI 496.6–627.1] per 100,000), and Algeria (577.8 [UI 525.2–637.5] per 100,000).

Current Status of CHD Prevention in the MENA

Prevention Strategies

  • Public health campaigns: Governments and healthcare organizations in the MENA region have launched extensive public health campaigns to raise awareness about the risk factors associated with CVDs, such as hypertension, diabetes, obesity, and smoking. These campaigns emphasize the importance of lifestyle modifications, including healthy eating habits, regular exercise, and smoking cessation, in reducing the risk of developing CVDs.
  • Screening programs: Screening programs have been implemented to detect early signs of CVDs and identify individuals at high risk. These programs often include blood pressure measurements, cholesterol screenings, and assessments of other risk factors. By identifying high-risk individuals early, healthcare providers can intervene with preventive measures, such as lifestyle changes or medication, to reduce the risk of CVDs.
  • Technology Integration: The integration of technology, such as mobile health apps and wearable devices, has revolutionized preventive care in the MENA region. These technologies allow individuals to monitor their cardiovascular health in real-time, track their progress toward health goals, and receive personalized recommendations for lifestyle modifications. Additionally, telemedicine platforms enable remote consultations with healthcare providers, improving access to preventive care, particularly in rural or underserved areas (Tash & Al-Bawardy, 2023).

Next Steps for Better Management

Awareness and behavioral change

  • While the healthcare system is being revamped and the focus now is on promoting better sustainable and accessible care, as well as a better workforce, the Saudi population needs to be educated on the importance of seeking medical care promptly. Population education can be achieved through mass media (television, social media platforms, etc.) and targeted patient education at medical centers, schools, and focused communities.
  • In particular, people at high risk of CVD or with established CVD must be encouraged to seek medical care, starting at the primary care level. Communities should trust their primary care physicians and should be made aware of the efficiency of primary prevention of CVDs and early diagnosis of CVDs, to ensure timely management takes place. In the absence of local guidelines for CVD prevention, internationally recognized guidelines could guide medical practice in the prevention of CVDs.
  • Furthermore, tools for behavioral changes should be widely provided to promote a healthy lifestyle given the rise of obesity (Tash & Al-Bawardy, 2023).

Leveraging CV healthcare

  • A multidisciplinary approach can be implemented in primary care clinics throughout the Saudi Arabian territories. Primary healthcare clinics could be expanded to include a CVD prevention program; and step up CV health prevention across all Saudi Arabia provinces.
  • The government has indeed recognized the need for healthcare restructuring and the importance of leveraging care in primary care centers, which are at the forefront of prevention and timely diagnosis of CV risk factors.
  • These prevention programs can be implemented virtually, for selected follow-up appointments. This could help solve the issue of understaffed medical facilities that hinder PCPs from fulfilling their role in CV prevention (Tash & Al-Bawardy, 2023).

Stakeholders in CV health

  • The goal of containing CV risk factors and promoting healthful practices requires a collaboration of governmental institutions, municipalities, schools and colleges, food manufacturers and restaurants, as well as the community and individuals.
  • The MOH operates over half of medical facilities across the country, and other governmental hospitals directed by the Ministry of Defense, the Ministry of National Guard, the Ministry of Interior, and King Faisal Specialist hospitals. These governmental institutions could liaise with other organizations such as the Sports Medicine Association, sports for All Federation, Saudi Heart Association, Saudi Society of Endocrinology and Metabolism, Saudi Society for Food and Nutrition, and others to design and implement programs to combat sedentary lifestyles and promote CV health (Tash & Al-Bawardy, 2023).

Treatment Strategies

  • Pharmacological interventions: The development of new pharmacological agents has expanded the treatment options for CVDs in the MENA region. Novel medications, such as statins, antiplatelet agents, and anticoagulants, have demonstrated efficacy in reducing the risk of cardiovascular events, such as heart attacks and strokes. Healthcare providers in the MENA region are increasingly prescribing these medications to individuals at high risk of CVDs or those with established cardiovascular conditions.
  • Interventional cardiology: Interventional cardiology procedures, such as percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR), have become standard treatments for various cardiovascular conditions in the MENA region. These minimally invasive procedures offer shorter recovery times and lower complication rates compared to traditional surgical approaches, making them particularly suitable for elderly or high-risk patients.
  • Cardiac rehabilitation programs: Cardiac rehabilitation programs play a crucial role in the comprehensive management of CVDs in the MENA region. These programs, which combine exercise training, nutritional counseling, and psychosocial support, help individuals recover from cardiovascular events, such as heart attacks or cardiac surgeries, and reduce the risk of future complications. By participating in cardiac rehabilitation, patients can improve their cardiovascular health, enhance their quality of life, and reduce their healthcare costs (Tash & Al-Bawardy, 2023).

Measures that can be undertaken

  • Smoking ban, including electronic cigarettes and smokeless tobacco; as well as promotion of smoking cessation programs.
  • Rigorous control of salt content and consumption in the diet.
  • Promote physical activity by enhancing accessibility and affordability of sports venues, focusing on mandatory physical education at schools and universities, developing community and sports centers across the country, and organizing large-scale community sporting events for the public to participate in
  • Develop an action for early detection and treatment of dyslipidemia, with a particular focus on LDL-cholesterol (Screening programs).
  • Make regular health checks mandatory for all adults of all ages to make sure screening is done appropriately per guidelines.
  • Provide primary care physicians with all the resources they need (time, support, training, etc.) to focus on high-quality prevention programs.
  • Enforce quality measures on CV risk factors management.
  • Establish a health literacy committee at the MOH to promote patient and community education on health matters, disease prevention, early symptoms reporting, and treatment adherence; with a dedicated task force for CV health (Tash & Al-Bawardy, 2023).

Gaps in CHD Prevention in the MENA

  • Albeit the high burden of CVD risk factors in the region, up to 90% of healthcare expenditure in developed countries is allocated to secondary prevention, while only 5% is allocated to primary care interventions.
  • The WHO service coverage index, which measures coverage of selected essential health services on a scale of 0–100, ranged between 37 and 79 in the MENA in 2019.
  • Turkey, UAE, and Iran had the highest coverage indices, while countries with the lowest indices were Afghanistan, Sudan, and Yemen. However, even in countries with high coverage index, data from the region showed that only half of the patients with chronic conditions had access to medication.
  • In most MENA countries, comprehensive preventive programs with suitable surveillance and monitoring policies for metabolic health are not widely implemented in primary health settings.
  • There is also a lack of national task forces and guidelines addressing non-communicable diseases in the MENA.
  • Additionally, CVD risk assessment tools are still underutilized in the region. Surveys from the MENA revealed that only 7–23% of primary care and family physicians routinely use cardiovascular risk assessment tools despite being aware of these scores.
  • An analysis from the UAE showed poor agreement between six CVD risk tools which considerably impacted decision-making and public health interventions concerning the primary prevention of CVD in the country.
  • In another study from Iran, treatment recommendations were controversial despite a high correlation between risk tools. Furthermore, CVD secondary prevention remains suboptimal in the region.
  • Rabizadeh et al. reported in their study of 323 Iranian patients with DM and CHD that only 7.7% achieved their target goals for blood pressure, LDL, and HbA1c (Tash & Al-Bawardy, 2023).

Challenges and Future Directions

  • While advancements in cardiovascular disease management have improved outcomes for individuals in the MENA region, several challenges remain. These include limited access to healthcare services, disparities in healthcare infrastructure and resources, and cultural barriers to preventive care.
  • Addressing these challenges will require a multi-faceted approach involving collaboration between governments, healthcare providers, and community organizations.
  • Looking ahead, the future of cardiovascular disease management in the MENA region holds promise. Continued investment in preventive strategies, technological innovations, and healthcare infrastructure will be essential to reducing the burden of CVDs and improving the overall health of the population.
  • By adopting a comprehensive approach to cardiovascular health, the MENA region can achieve significant progress in the prevention and treatment of these life-threatening conditions.

Conclusion

The MENA region is making significant strides in managing cardiovascular diseases through innovative prevention and treatment strategies. Public health campaigns, policy interventions, advanced medical treatments, and digital health solutions are transforming the landscape. Continued efforts to improve healthcare access, workforce training, and research will be crucial in sustaining these advancements and reducing the burden of cardiovascular diseases in the region. By adopting a comprehensive and collaborative approach, the MENA region can pave the way for a healthier future.

Despite these advancements, challenges remain. Ensuring equitable access to healthcare across urban and rural areas, addressing workforce training needs, and fostering ongoing research and innovation are critical for sustaining progress. Moreover, achieving long-term lifestyle changes within the population requires culturally sensitive and sustained public health efforts.

Source: Delveinsight http://www.delveinsight.com/