Coronary artery disease in Africa and the Middle East

Wael Almahmeed¹, Mohamad Samir Arnaout², Rafik Chettaoui³, Mohsen Ibrahim⁴, Mohamed Ibrahim Kurdi⁵, Mohamed Awad Taher⁶, Giuseppe Mancia^7
1Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; ²American University of Beirut Medical Center, Beirut, Lebanon; ³General and Cardiovascular Clinic of Tunis, Tunisia; ⁴Cairo University, Cairo, Egypt; ⁵King Khalid University Hospital and The Kingdom Hospital, Saudi Arabia; ⁶Ain Shams University School of Medicine, Cairo, Egypt; ⁷University of Milan, Bicocca, Milan, Italy

Abstract: Countries in Africa and the Middle East bear a heavy burden from cardiovascular disease. The prevalence of coronary heart disease is promoted in turn by a high prevalence of cardiovascular risk factors, particularly smoking, hypertension, dyslipidemia, diabetes, and sedentary lifestyles. Patients in Africa and the Middle East present with myocardial infarction at a younger age, on average, compared with patients elsewhere. The projected future burden of mortality from coronary heart disease in Africa and the Middle East is set to outstrip that observed in other geographical regions. Recent detailed nationally representative epidemiological data are lacking for many countries, and high proportions of transient expatriate workers in countries such as Saudi Arabia and the United Arab Emirates complicate the construction of such datasets. However, the development of national registries in some countries is beginning to reveal the nature of coronary heart disease. Improving lifestyles (reducing calorie intake and increasing physical activity) in patients in the region will be essential, although cultural and environmental barriers will render this difficult. Appropriate prescribing of pharmacologic treatments is essential in the prevention and management of cardiovascular disease. In particular, recent controversies relating to the therapeutic profile of beta-blockers may have reduced their use. The current evidence base suggests that beta-blockers are as effective as other therapies in preventing cardiovascular disease and that concerns relating to their use in hypertension and cardiovascular disease have been overstated.

Keywords: coronary heart disease, beta-blockers, cardiovascular risk factors, cardiovascular disease, heart failure