245 results on '"Khalid F. Alhabib"'
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2. Morbidity and mortality of acute heart failure patients stratified by mitral regurgitation in the Arabian Gulf: Observations from the Gulf acute heart failure registry (Gulf CARE)
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Laura AlObaid, Rajesh Rajan, Mohammed Al Jarallah, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Ibrahim Al-Zakwani, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, Haitham Amin, Zhanna Kobalava, Peter A. Brady, Georgiana Luisa Baca, and Ahmad Al-Saber
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Mitral regurgitation ,Acute heart failure ,Mortality ,HF rehospitalization ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p
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- 2023
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3. Physicians' perceptions and beliefs on the current dyslipidemia management practices within Saudi Arabia
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Turky H. Almigbal, Dina S. Almunif, Eman Ali Deshisha, Hani Altaradi, Abdullah A. Alrasheed, Mohammed A. Batais, and Khalid F. Alhabib
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Dyslipidemia ,Low-density lipoprotein cholesterol (LDL-C) ,Physician ,Guideline ,Survey ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Background: Limited reports addressing physicians’ understanding of the various low-density lipoprotein cholesterol (LDL-C) targets/statin intensity required for treating the various dyslipidemia patient populations in Saudi Arabia are available. Therefore, the current study assessed the perceptions and beliefs of practicing clinicians in Saudi Arabia regarding the current practice for management of dyslipidemia and potential perceived barriers to adherence to lipid guidelines encountered in their regular clinical practice. Knowledge of different clinical practices and beliefs could have a positive impact on improving the quality of future care provided by physicians. Methods: A survey questionnaire was designed to assess physicians’ familiarity, usage, and adherence to seven different international guidelines and used to evaluate the management of dyslipidemia, practice of patient treatment, and perceived obstacles to adhering to lipid guidelines related to specific patients, doctors, and practice issues. Results: A total of 467 physicians were recruited for the study: (1) 57.2% were primary care physicians (PCPs) and (2) 42.8% were specialists. About 90.8% of them followed lipid guidelines of which the most common set were based on those by the American College of Cardiology/American Heart Association. The most utilized risk assessment tool was the atherosclerotic cardiovascular disease (ASCVD) risk calculator. About 60% of the physicians set an LDL-C target for their patients based on a combination of patients’ risk factors and lipid profiles. In all, 42.1% of the physicians chose not to change existing therapy among patients with dyslipidemia to attain a non-high-density lipoprotein goal with controlled LDL-C level. Atorvastatin accounted for the greatest percentage of primary and secondary prevention choices (71.9% and 69.6%, respectively). Rosuvastatin was mostly preferred by physicians for patients with familial hypercholesterolemia. About two-thirds of the physicians (77.9%) prescribed statins to diabetic patients aged 40–75 years. Statin intolerance was encountered by 62.9% of the physicians in ≤ 10% of patients by 62.9%. Therapeutic strategies included switching to an alternative statin (40.1%) followed by reducing the statin dose (35.3%). Ezetimibe was prescribed by most physicians (77.9%) as an add-on to statin if the LDL-C target was not achieved. Fibrate was most preferred by physicians (62.7%) for hypertriglyceremia treatment followed by statins (28.7% of the physicians). Sixty-six percent reported not using proprotein convertase subtilisin/kexin type 9 serine protease inhibitors in their clinical practice due to unavailability at their institute (51.8%), high costs (26.3%), and/or lack of knowledge (20.6%). Perceived barriers to guideline adherence identified by physicians were lack of familiarity and knowledge of the guidelines, patient non-adherence, medication costs, and lack of timely follow-up appointments and educational tools. Multiple similarities and differences were observed after comparisons were made between specialists and PCPs in terms of guideline preference, clinical practice, and perceived barriers. Conclusion: Different perceptions and attitudes among physicians in Saudi Arabia were found due to variable recommendations by international lipid guidelines. Perceived barriers that included the patient, physician, and practice were identified by physicians at multiple levels. Multiple challenges and different action gaps were observed when comparing specialists to PCPs. It is recommended that standardized practices be followed by clinicians in Saudi Arabia, and actions to address the outlined barriers are essential for optimizing health outcomes and ASCVD prevention.
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- 2023
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4. The burden of metabolic risk factors in North Africa and the Middle East, 1990–2019: findings from the Global Burden of Disease StudyResearch in context
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Mohammad-Reza Malekpour, Mohsen Abbasi-Kangevari, Seyyed-Hadi Ghamari, Javad Khanali, Mahsa Heidari-Foroozan, Sahar Saeedi Moghaddam, Mohammadreza Azangou-Khyavy, Sahba Rezazadeh-Khadem, Negar Rezaei, Parnian Shobeiri, Zahra Esfahani, Nazila Rezaei, Ali H. Mokdad, Mohsen Naghavi, Bagher Larijani, Farshad Farzadfar, Amirali Aali, Sherief Abd-Elsalam, Meriem Abdoun, Abdorrahim Absalan, Eman Abu-Gharbieh, Niveen ME. Abu-Rmeileh, Ahmed Abu-Zaid, Ali Ahmadi, Sepideh Ahmadi, Ayman Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Tariq A. Alalwan, Khalid F. Alhabib, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Mahmoud A. Alomari, Saleh A. Alqahatni, Rajaa M. Al-Raddadi, Javad Javad Aminian Dehkordi, Mehrdad Amir-Behghadami, Sohrab Amiri, Davood Anvari, Jalal Arabloo, Judie Arulappan, Ashokan Arumugam, Zahra Aryan, Mohammad Athar, Seyyed Shamsadin Athari, Abolfazl Avan, Sina Azadnajafabad, Samad Azari, Hosein Azizi, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Ovidiu Constantin Baltatu, Akshaya Srikanth Bhagavathula, Vijayalakshmi S. Bhojaraja, Souad Bouaoud, Muhammad Hammad Butt, Luciana Aparecida Campos, Abdulaal Chitheer, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Shirin Djalalinia, Milad Dodangeh, Maysaa El Sayed Zaki, Iffat Elbarazi, Muhammed Elhadi, Waseem El-Huneidi, Rana Ezzeddini, Mohammad Fareed, Hossein Farrokhpour, Ali Fatehizadeh, Yaseen Galali, Amir Ghaderi, Mansour Ghafourifard, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Maryam Gholamalizadeh, Pouya Goleij, Mohamad Golitaleb, Parham Habibzadeh, Nima Hafezi-Nejad, Rabih Halwani, Hamidreza Hasani, Maryam Hashemian, Amr Hassan, Soheil Hassanipour, Hadi Hassankhani, Kamal Hezam, Reza Homayounfar, Seyed Kianoosh Hosseini, Kaveh Hosseini, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Jalil Jaafari, Haitham Jahrami, Elham Jamshidi, Tahereh Javaheri, Sathish Kumar Jayapal, Ali Kabir, Amirali Karimi, Neda Kaydi, Mohammad Keykhaei, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Moien A.B. Khan, Kashif Ullah Khan, Yusra H. Khan, Moawiah Mohammad Khatatbeh, Farzad Kompani, Hamid Reza Koohestani, Mohammed Kuddus, Savita Lasrado, Sang-woong Lee, Soleiman Mahjoub, Ata Mahmoodpoor, Elham Mahmoudi, Elaheh Malakan Rad, Narges Malih, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Borhan Mansouri, Mohammad Ali Mansournia, Parham Mardi, Abdoljalal Marjani, Sahar Masoudi, Entezar Mehrabi Nasab, Ritesh G. Menezes, Vildan Mevsim, Yousef Mohammad, Mokhtar Mohammadi, Esmaeil Mohammadi, Noushin Mohammadifard, Arif Mohammed, Sara Momtazmanesh, Fateme Montazeri, Maryam Moradi, Maziar Moradi-Lakeh, Negar Morovatdar, Christopher J.L. Murray, Zuhair S. Natto, Seyed Aria Nejadghaderi, Ali Nowroozi, Morteza Oladnabi, Ahmed Omar Bali, Emad Omer, Hamidreza Pazoki Toroudi, Raffaele Pezzani, Ashkan Pourabhari Langroudi, Sima Rafiei, Mehran Rahimi, Vafa Rahimi-Movaghar, Shayan Rahmani, Amir Masoud Rahmani, Vahid Rahmanian, Chythra R. Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Reza Rawassizadeh, Elrashdy Moustafa Mohamed Redwan, Malihe Rezaee, Maryam Rezaei, Seyed Mohammad Riahi, Gholamreza Roshandel, Aly Saad, Maha Mohamed Saber-Ayad, Siamak Sabour, Leila Sabzmakan, Basema Saddik, Erfan Sadeghi, Saeid Sadeghian, Amirhossein Sahebkar, Morteza Saki, Saina Salahi, Sarvenaz Salahi, Amir Salek Farrokhi, Marwa Rashad Salem, Hamideh Salimzadeh, Abdallah M. Samy, Nizal Sarrafzadegan, Brijesh Sathian, Melika Shafeghat, Syed Mahboob Shah, Jaffer Shah, Ataollah Shahbandi, Fariba Shahraki-Sanavi, Mehran Shams-Beyranvand, Mohd Shanawaz, Kiomars Sharafi, Javad Sharifi-Rad, Jeevan K. Shetty, Zahra Shokri Varniab, Seyed Afshin Shorofi, Soraya Siabani, Mohammad Sadegh Soltani-Zangbar, Seidamir Pasha Tabaeian, Seyed-Amir Tabatabaeizadeh, Mohammad Tabish, Majid Taheri, Yasaman Taheri Abkenar, Moslem Taheri Soodejani, Amir Taherkhani, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Bereket M. Tigabu, Alireza Vakilian, Siavash Vaziri, Bay Vo, Fereshteh Yazdanpanah, Arzu Yigit, Vahit Yiğit, Mazyar Zahir, Burhan Abdullah Zaman, Maryam Zamanian, Moein Zangiabadian, Iman Zare, and Zahra Zareshahrabadi
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Global burden of disease ,Metabolic risk factors ,High systolic blood pressure ,High fasting plasma glucose ,High body-mass index ,High-LDL ,Medicine (General) ,R5-920 - Abstract
Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.
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- 2023
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5. Characteristics and predictors of out-of-hospital cardiac arrest in young adults hospitalized with acute coronary syndrome: A retrospective cohort study of 30,000 patients in the Gulf region
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Abdulelah H. Alsaeed, Ahmed Hersi, Tarek Kashour, Mohammad Zubaid, Jassim Al Suwaidi, Haitham Amin, Wael AlMahmeed, Kadhim Sulaiman, Ahmed Al-Motarreb, Khalid F. Alhabib, and Wael Alqarawi
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Medicine ,Science - Abstract
Introduction The characteristics of young adults with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has not been well described. The mean age of gulf citizens in ACS registries is 10–15 years younger than their western counterparts, which provided us with a unique opportunity to investigate the characteristics and predictors of OHCA in young adults presenting with ACS. Methodology This was a retrospective cohort study using data from 7 prospective ACS registries in the Gulf region. In brief, all registries included consecutive adults who were admitted with ACS. OHCA was defined as cardiac arrest upon presentation (i.e., before admission to the hospital). We described the characteristics of young adults (< 50 years) who had OHCA and performed multivariate logistic regression analysis to assess independent predictors of OHCA. Results A total of 31,620 ACS patients were included in the study. There were 611 (1.93%) OHCA cases in the whole cohort [188/10,848 (1.73%) in young adults vs 423/20,772 (2.04%) in older adults, p = 0.06]. Young adults were predominantly males presenting with ST-elevation myocardial infarction (STEMI) [182/188 (96.8%) and 172/188 (91.49%), respectively]. OHCA was the sentinel event of coronary artery disease (CAD) in 70% of young adults. STEMI, male sex, and non-smoking status were found to be independent predictors of OHCA [OR = 5.862 (95% CI 2.623–13.096), OR: 4.515 (95% CI 1.085–18.786), and OR = 2.27 (95% CI 1.335–3.86), respectively]. Conclusion We observed a lower prevalence of OHCA in ACS patients in our region as compared to previous literature from other regions. Moreover, OHCA was the sentinel event of CAD in the majority of young adults, who were predominantly males with STEMIs. These findings should help risk-stratify patients with ACS and inform further research into the characteristics of OHCA in young adults.
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- 2023
6. Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries
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Amar M. Salam, Mohamed Badie Ahmed, Kadhim Sulaiman, Rajvir Singh, Mohammed Alhashemi, Alison S. Carr, Alawi A. Alsheikh‐Ali, Khalid F. AlHabib, Ibrahim Al‐Zakwani, Prashanth Panduranga, Nidal Asaad, Abdulla Shehab, Wael AlMahmeed, and Jassim Al Suwaidi
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Cardiomyopathy ,Heart failure ,Outcomes ,Peripartum ,Registry ,Symptoms ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
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- 2020
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7. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the Prospective Urban Rural Epidemiology study (PURE-Saudi)
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Khalid F. Alhabib, Mohammed A. Batais, Turky H. Almigbal, Mostafa Q. Alshamiri, Hani Altaradi, Sumathy Rangarajan, and Salim Yusuf
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Demographics ,Prevalence ,Risk factors ,Cardiovascular disease ,Urban ,Rural ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Cardiovascular disease (CVD) is the major cause of death in Saudi Arabia. We aimed to assess associated demographic, behavioral, and CVD risk factors as part of the Prospective Urban Rural Epidemiology (PURE) study. Methods PURE is a global cohort study of adults ages 35–70 years in 20 countries. PURE-Saudi study participants were recruited from 19 urban and 6 rural communities randomly selected from the Central province (Riyadh and Alkharj) between February 2012 and January 2015. Data were stratified by age, sex, and urban vs rural and summarized as means and standard deviations for continuous variables and as numbers and percentages for categorical variables. Proportions and means were compared between men and women, among age groups, and between urban and rural areas, using Chi-square test and t-tests, respectively. Results The PURE-Saudi study enrolled 2047 participants (mean age, 46.5 ± 9.12 years; 43.1% women; 24.5% rural). Overall, 69.4% had low physical activity, 49.6% obesity, 34.4% unhealthy diet, 32.1% dyslipidemia, 30.3% hypertension, and 25.1% diabetes. In addition, 12.2% were current smokers, 15.4% self-reported feeling sad, 16.9% had a history of periods of stress, 6.8% had permanent stress, 1% had a history of stroke, 0.6% had heart failure, and 2.5% had coronary heart disease (CHD). Compared to women, men were more likely to be current smokers and have diabetes and a history of CHD. Women were more likely to be obese, have central obesity, self-report sadness, experience stress, feel permanent stress, and have low education. Compared to participants in urban areas, those in rural areas had higher rates of diabetes, obesity, and hypertension, and lower rates of unhealthy diet, self-reported sadness, stress (several periods), and permanent stress. Compared to middle-aged and older individuals, younger participants more commonly reported an unhealthy diet, permanent stress, and feeling sad. Conclusion These results of the PURE-Saudi study revealed a high prevalence of unhealthy lifestyle and CVD risk factors in the adult Saudi population, with higher rates in rural vs urban areas. National public awareness programs and multi-faceted healthcare policy changes are urgently needed to reduce the future burden of CVD risk and mortality.
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- 2020
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8. Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction
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Mohammed Al‐Jarallah, Rajesh Rajan, Ibrahim Al‐Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A. Alsheikh‐Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al‐Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al‐Motarreb, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
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Heart failure ,Diabetes mellitus ,Mortality ,Middle East ,Readmission ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (
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- 2020
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9. The prognostic impact of hyperglycemia on clinical outcomes of acute heart failure: Insights from the heart function assessment registry trial in Saudi Arabia
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Alwaleed Aljohar, Khalid F. Alhabib, Tarek Kashour, Ahmad Hersi, Waleed Al Habeeb, Anhar Ullah, Abdelfatah Elasfar, Ali Almasood, Abdullah Ghabashi, Layth Mimish, Saleh Alghamdi, Ahmed Abuosa, Asif Malik, Gamal Abdin Hussein, Mushabab Al-Murayeh, and Hussam AlFaleh
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The prognostic impact of hyperglycemia (HG) in acute heart failure (AHF) is controversial. Our aim is to examine the impact of HG on short- and long-term survival in AHF patients. Methods: Data from the Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) for patients who had available random blood sugar (RBS) were analyzed. The enrollment period was from October 2009 to December 2010. Comparisons were performed according to the RBS levels on admission as either
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- 2018
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10. Age‐Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST‐Segment–Elevation Myocardial Infarction: Pooled Analysis of 15 532 Patients From 7 Arabian Gulf Registries
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Abdulla Shehab, Akshaya Srikanth Bhagavathula, Khalid F. Alhabib, Anhar Ullah, Jassim Al Suwaidi, Wael Almahmeed, Hussam AlFaleh, and Mohammad Zubaid
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acute coronary syndrome ,hospitalization ,Middle East ,mortality ,myocardial infarction ,sex ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in‐hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in‐hospital mortality, and 1‐year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age‐stratified analysis showed that younger women (aged
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- 2020
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11. Mortality and Morbidity in HFrEF, HFmrEF, and HFpEF Patients with Diabetes in the Middle East
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Mohammed Al-Jarallah, Rajesh Rajan, Ibrahim Al-Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
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heart failure ,diabetes mellitus ,mortality ,middle east ,patient readmission ,Medicine - Abstract
Objectives: We sought to estimate the mortality and morbidity in diabetic acute heart failure (AHF) patients stratified by left ventricular ejection fraction. Methods: We analyzed the data of patients with AHF from seven Middle Eastern countries (Bahrain, Oman, Yemen, Kuwait, UAE, Qatar, and Saudi Arabia) from February to November 2012, who were enrolled in a multinational registry of patients with heart failure (HF). Results: A total of 2258 AHF patients had diabetes mellitus. The mean age was 63.0±11.0 years (ranging from 18 to 99 years), and 60.3% (n = 1362) of the patients were males. The mean ejection fraction (EF) was 37.0±13.0%. HF with reduced EF (< 40%) (HFrEF) was observed in 1268 patients (56.2%), whereas 515 patients (22.8%) had mid-range (40–49%) (HFmrEF) and 475 patients (21.0%) had preserved EF (≥ 50%) (HFpEF). The overall cumulative all-cause mortalities at three- and 12-months follow-up were 11.8% (n = 266) and 20.7% (n = 467), respectively. Those with HFpEF were associated with lower three-months cumulative all-cause mortality compared to those with HFrEF (7.6% vs. 5.9%; adjusted odds ratio (aOR) = 0.54, 95% confidence interval (CI): 0.31–0.95; p =0.031), but not significantly different when compared to those with HFmrEF (aOR = 0.86, 95% CI: 0.53–1.40; p =0.554). There were largely no significant differences among the groups with regards to the 12-months all-cause cumulative mortality (11% vs. 11% vs. 10%; p =0.984). There were also no significant differences in re-hospitalization rates between the three HF groups not only at three months (23% vs. 20% vs. 22%; p =0.520), but at one-year follow-up (28% vs. 30% vs. 32%; p =0.335). Conclusions: Three-month cumulative all-cause mortality was high in diabetic HFrEF patients when compared to those with HFpEF. However, there were no significant differences in mortality at one-year follow-up between the HF groups. There were also no significant differences in re-hospitalization rates between the HF groups not only at three months but also at one-year follow-up in the Middle East.
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- 2020
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12. Demystifying Smoker's Paradox: A Propensity Score–Weighted Analysis in Patients Hospitalized With Acute Heart Failure
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Suhail A. Doi, Nazmul Islam, Kadhim Sulaiman, Alawi A. Alsheikh‐Ali, Rajvir Singh, Awad Al‐Qahtani, Nidal Asaad, Khalid F. AlHabib, Ibrahim Al‐Zakwani, Mohammed Al‐Jarallah, Wael AlMahmeed, Bassam Bulbanat, Nooshin Bazargani, Haitham Amin, Ahmed Al‐Motarreb, Husam AlFaleh, Prashanth Panduranga, Abdulla Shehab, Jassim Al Suwaidi, and Amar M. Salam
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covariate adjustment ,covariate balance ,heart failure ,mortality ,study design ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in‐hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52–0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31–0.70) covariate adjustment. With the propensity score–derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36–1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.
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- 2019
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13. Baseline characteristics, management practices, and long-term outcomes among patients with first presentation acute myocardial infarction in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II)
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Abdulaziz U. Joury, Ahmed S. Hersi, Hussam Alfaleh, Khalid F. Alhabib, and Tarek Seifaw Kashour
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background and objectives: Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality. Methods: We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients. Results: Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55 years vs. 53 years; p
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- 2018
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14. β‐Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In‐Hospital and 12‐Month Outcome: Results From the GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2)
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Charbel Abi Khalil, Khalid F. AlHabib, Rajvir Singh, Nidal Asaad, Hussam Alfaleh, Alawi A. Alsheikh‐Ali, Kadhim Sulaiman, Mostafa Alshamiri, Fayez Alshaer, Wael AlMahmeed, and Jassim Al Suwaidi
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acute coronary syndrome ,β‐adrenergic receptor blocker ,heart failure ,ST‐segment elevation myocardial infarction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe prognostic impact of β‐blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in‐hospital outcome in patients without HF, and whether they also reduce 12‐month mortality if still prescribed on discharge. Methods and ResultsThe GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in‐hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1‐year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in‐hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non‐BB group. Even after correcting for confounding factors in 2 different models, in‐hospital and 12‐month mortality risk was still lower in the BB group. ConclusionsIn this cohort of ACS, BB therapy before admission for ACS is associated with decreased in‐hospital mortality and major cardiovascular events, and 1‐year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge.
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- 2017
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15. Incidence of ventricular arrhythmia and associated patient outcomes in hospitalized acute coronary syndrome patients in Saudi Arabia: findings from the registry of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE)
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Ahmad S. Hersi, Khalid F. Alhabib, Hussam F. AlFaleh, Khalid AlNemer, Shukri AlSaif, Amir Taraben, Tarek Kashour, Ahmed M. Abuosa, and Mushabab A. Al-Murayeh
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Medicine - Abstract
BACKGROUND AND OBJECTIVES: Mortality in acute coronary syndrome (ACS) patients with ventricular arrhythmia (VA) has been shown to be higher than those without VA. However, there is a paucity of data on VA among ACS patients in the Middle Eastern countries. DESIGN AND SETTING: Prospective study of patients admitted in 17 government hospitals with ACS between December 2005 and December 2007. PATIENTS AND METHODS: Patients were categorized as having VA if they experienced either ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) or both. RESULTS: Of 5055 patients with ACS enrolled in the SPACE registry, 168 (3.3%) were diagnosed with VA and 151 (98.8%) occurred in-hospital. The vast majority (74.4%) occurred in patients with ST-segment elevation myocardial infarction. In addition, males were twice as likely to develop VA than females (OR 1.7; 95% CI 1.1–3). Killip class >I (OR 2.0; 95% CI 1.3–3.1); and systolic blood pressure
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- 2012
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16. Are acute coronary syndrome patients admitted during off-duty hours treated differently? An analysis of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study
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Hussam F. Al Faleh, Lukman Thalib, Khalid F. AlHabib, Anhar Ullah, Khalid AlNemer, Shukri M. AlSaif, Amir N. Taraben, Asif Malik, Ahmed M. Abuosa, Layth A. Mimish, and Ahmad Salah Hersia
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Medicine - Abstract
BACKGROUND AND OBJECTIVES: It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. DESIGN AND SETTING: Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. PATIENTS AND METHODS: ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days. RESULTS: Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P
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- 2012
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17. Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2)
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Khalid F. AlHabib, Kadhim Sulaiman, Ahmed Al-Motarreb, Wael Almahmeed, Nidal Asaad, Haitham Amin, Ahmad Hersi, Shukri Al-Saif, Khalid AlNemer, Jawad Al-Lawati, Norah Q. Al-Sagheer, Nizar AlBustani, and Jassim Al Suwaidi
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Medicine - Abstract
BACKGROUND AND OBJECTIVES: Limited data are available on patients with acute coronary syndromes (ACS) and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes in such a population. DESIGN AND SETTING: A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up. PATIENTS AND METHODS: ACS patients included those with ST-elevation myocardial infarction (STEMI) and non–ST-elevation acute coronary syndrome (NSTEACS), including non-STEMI and unstable angina. The registry collected the data prospectively. RESULTS: Between October 2008 and June 2009, 7930 patients were enrolled. The mean age [standard deviation (SD)], 56 (17) years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes (interquartile range, 210 minutes); 22.3% had primary percutaneous coronary intervention (PCI) and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2%, and at 1 year after hospital discharge the mortality was 9.4%; 1-year mortality was higher in STEMI (11.5%) than in NSTEACS patients (7.7%; P
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- 2012
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18. Clinical characteristics, management and outcomes of Indian subcontinent and Middle East acute heart failure patients: Results: From the Gulf acute heart failure registry
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Prashanth Panduranga, Ibrahim Al-Zakwani, Kadhim Sulaiman, Khalid F. AlHabib, Wael Almahmeed, Mohammed Al-Jarallah, Alawi Alsheikh-Ali, Jassim Al-Suwaidi, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Mustafa Ridha, Bassam Bulbanat, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2014
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19. Polyvascular Disease in Patients Presenting with Acute Coronary Syndrome: Its Predictors and Outcomes
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Hassan Al Thani, Ayman El-Menyar, Khalid F. AlHabib, Ahmed Al-Motarreb, Ahmad Hersi, Hussam AlFaleh, Nidal Asaad, Shukri Al Saif, Wael Almahmeed, Kadhim Sulaiman, Haitham Amin, Alawi A. Alsheikh-Ali, Khalid AlNemer, and Jassim Al Suwaidi
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Technology ,Medicine ,Science - Abstract
We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures.
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- 2012
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20. Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): a prospective cohort study
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Patricio, Lopez-Jaramillo, Diego, Gomez-Arbelaez, Daniel, Martinez-Bello, Marc Evans M, Abat, Khalid F, Alhabib, Álvaro, Avezum, Olga, Barbarash, Jephat, Chifamba, Maria L, Diaz, Sadi, Gulec, Noorhassim, Ismail, Romaina, Iqbal, Roya, Kelishadi, Rasha, Khatib, Fernando, Lanas, Naomi S, Levitt, Yang, Li, Viswanathan, Mohan, Prem K, Mony, Paul, Poirier, Annika, Rosengren, Biju, Soman, Chuangshi, Wang, Yang, Wang, Karen, Yeates, Rita, Yusuf, Afzalhussein, Yusufali, Katarzyna, Zatonska, Sumathy, Rangarajan, and Salim, Yusuf
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Psychiatry and Mental health ,Health (social science) ,Geriatrics and Gerontology ,Family Practice - Abstract
The triglyceride glucose (TyG) index is an easily accessible surrogate marker of insulin resistance, an important pathway in the development of type 2 diabetes and cardiovascular diseases. However, the association of the TyG index with cardiovascular diseases and mortality has mainly been investigated in Asia, with few data available from other regions of the world. We assessed the association of insulin resistance (as determined by the TyG index) with mortality and cardiovascular diseases in individuals from five continents at different levels of economic development, living in urban or rural areas. We also examined whether the associations differed according to the country's economical development.We used the TyG index as a surrogate measure for insulin resistance. Fasting triglycerides and fasting plasma glucose were measured at the baseline visit in 141 243 individuals aged 35-70 years from 22 countries in the Prospective Urban Rural Epidemiology (PURE) study. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] x fasting plasma glucose [mg/dL]/2). We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random effects to test the associations between the TyG index and risk of cardiovascular diseases and mortality. The primary outcome of this analysis was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, and non-fatal myocardial infarction, or stroke). Secondary outcomes were non-cardiovascular mortality, cardiovascular mortality, all myocardial infarctions, stroke, and incident diabetes. We also did subgroup analyses to examine the magnitude of associations between insulin resistance (ie, the TyG index) and outcome events according to the income level of the countries.During a median follow-up of 13·2 years (IQR 11·9-14·6), we recorded 6345 composite cardiovascular diseases events, 2030 cardiovascular deaths, 3038 cases of myocardial infarction, 3291 cases of stroke, and 5191 incident cases of type 2 diabetes. After adjusting for all other variables, the risk of developing cardiovascular diseases increased across tertiles of the baseline TyG index. Compared with the lowest tertile of the TyG index, the highest tertile (tertile 3) was associated with a greater incidence of the composite outcome (HR 1·21; 95% CI 1·13-1·30), myocardial infarction (1·24; 1·12-1·38), stroke (1·16; 1·05-1·28), and incident type 2 diabetes (1·99; 1·82-2·16). No significant association of the TyG index was seen with non-cardiovascular mortality. In low-income countries (LICs) and middle-income countries (MICs), the highest tertile of the TyG index was associated with increased hazards for the composite outcome (LICs: HR 1·31; 95% CI 1·12-1·54; MICs: 1·20; 1·11-1·31; pThe TyG index is significantly associated with future cardiovascular mortality, myocardial infarction, stroke, and type 2 diabetes, suggesting that insulin resistance plays a promoting role in the pathogenesis of cardiovascular and metabolic diseases. Potentially, the association between the TyG index and the higher risk of cardiovascular diseases and type 2 diabetes in LICs and MICs might be explained by an increased vulnerability of these populations to the presence of insulin resistance.Full funding sources are listed at the end of the paper (see Acknowledgments).
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- 2023
21. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study
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Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Viswanathan Mohan, Sumathi Swaminathan, Alvaro Avezum, Scott A. Lear, Annika Rosengren, Paul Poirier, Fernando Lanas, Patricio Lopez-Jaramillo, Biju Soman, Chuangshi Wang, Andrés Orlandini, Noushin Mohammadifard, Khalid F. AlHabib, Jephat Chifamba, Afzal Hussein Yusufali, Romaina Iqbal, Rasha Khatib, Karen Yeates, Thandi Puoane, Yuksel Altuntas, Homer Uy Co, Sidong Li, Weida Liu, Katarzyna Zatońska, Rita Yusuf, Noorhassim Ismail, Victoria Miller, and Salim Yusuf
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
22. Influenza vaccine to reduce adverse vascular events in patients with heart failure: a multinational randomised, double-blind, placebo-controlled trial
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Mark, Loeb, Ambuj, Roy, Hisham, Dokainish, Antonio, Dans, Lia M, Palileo-Villanueva, Kamilu, Karaye, Jun, Zhu, Yan, Liang, Fastone, Goma, Albertino, Damasceno, Khalid F, Alhabib, Gerald, Yonga, Charles, Mondo, Wael, Almahameed, Arif, Al Mulla, Vitheya, Thanabalan, Purnima, Rao-Melacini, Alex, Grinvalds, Tara, McCready, Shrikant I, Bangdiwala, and Salim, Yusuf
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Adult ,Male ,Heart Failure ,Canada ,Adolescent ,Myocardial Infarction ,Pneumonia ,General Medicine ,Kenya ,Stroke ,Influenza Vaccines ,Influenza, Human ,Humans ,Female - Abstract
Influenza increases the risk of cardiovascular events and deaths. We aimed to see whether influenza vaccination reduces death and vascular events in patients with heart failure.We did a pragmatic, randomised, double-blind, placebo-controlled trial in 30 centres (mostly hospitals affliated with universities or a research institute) in ten countries in Asia, the Middle East, and Africa (7 in India, 4 in Philippines, 4 in Nigeria, 6 in China, 1 in Zambia, 2 in Mozambique, 3 in Saudi Arabia, 1 in Kenya, 1 in Uganda, and 1 in Zambia). Participants (aged ≥18 years; 52·1% female; not disaggregated by race or ethnicity) with heart failure (New York Heart Association class II, III, or IV) were randomly assigned (1:1) by a centralised web-based system with block randomisation stratified by site, to receive 0·5 ml intramuscularly once a year for up to 3 years of either inactivated standard dose influenza vaccine or placebo (saline). We excluded people who had received influenza vaccine in 2 of the previous 3 years, and those likely to require valve repair or replacement. Those who administered assigned treatments were not masked and had no further role in the study. Investigators, study coordinators, outcome adjudicators, and participants were masked to group assignment. The first of two co-primary outcomes was a first-event composite for cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke, and the second was a recurrent-events composite for cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure. Outcomes were assessed every 6 months in the intention-to-treat population. Secondary outcomes were all-cause death, cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, hospitalisation for heart failure, and pneumonia, both overall and during periods of peak influenza exposure. This study is registered with ClinicalTrials.gov, NCT02762851.Between June 2, 2015, and Nov 21, 2021, we enrolled 5129 participants and randomly assigned (1:1) 2560 (50·0%) to influenza vaccine and 2569 (50·0%) to placebo. The first co-primary outcome occurred in 380 (14·8%) of 2560 participants in the vaccine group and 410 (16·0%) of 2569 participants in the placebo group (hazard ratio [HR] 0·93 [95% CI 0·81-1·07]; p=0·30). The second co-primary outcome occurred in 754 (29·5%) of 2560 participants in the vaccine group and 819 (31·9%) of 2569 participants in the placebo group; HR 0·92 [95% CI 0·84-1·02]; p=0·12). The secondary outcomes of all-cause hospitalisations (HR 0·84 [95% CI 0·74-0·97]; p=0·013) and pneumonia (HR 0·58 [0·42-0·80]; p=0·0006) were significantly reduced in the vaccine group compared with in the placebo group but there was no significant difference between groups for all-cause death, cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure. In a prespecified analysis, in which events were limited to periods of peak influenza circulation, the first co-primary outcome, and the secondary outcomes of all-cause death, cardiovasular death, and pneumonia were significantly lower in the vaccinated group than in the placebo group, whereas the second co-primary outcome and the secondary outcomes of non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, and hospitalisation for heart failure were not significantly lower.Although the prespecified co-primary outcomes during the entire period of observation were not statistically significant, the reduction during the peak influenza circulating period suggests that there is likely to be a clinical benefit of giving influenza vaccine, given the clear reduction in pneumonia, a moderate reduction in hospitalisations, and a reduction in cardiovascular events and deaths during periods of peak circulation of influenza. Taken in conjunction with previous trials and the observational studies, the collective data suggest benefit.UK Joint Global Health Trials Scheme and Canadian Institutes for Health Research Foundation.
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- 2022
23. Clinical Features, Socioeconomic Status, Management, and Outcomes of Acute Heart Failure: PEACE MENA Registry Phase I Results
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Khalid F Alhabib, Hanan AlBackr, Kadhim Sulaiman, Amal Jamee, Mohamed Sobhy, Salim Benkhedda, Sobhi Dada, Ayman Hammoudeh, Habib Gamra, Ahmed Al-Motarreb, Fahad Alkindi, Mohammad I Amin, Magdi G. Yousif, Hasan A. Farhan, Nadia Fellat, Wael Almahmeed, Mohammad Al Jarallah, Prashanth Panduranga, Magdy Abdelhamid, Ihab Ghaly, Dahlia Djermane, Ahcene Chibane, Hadi Skouri, Mohamad Jarrah, Hassen Amor, Nora K. Alsagheer, Mohammed A. Hozayen, Hosameldin S. Ahmed, Muhammad Ali, Anhar Ullah, Ayman Al Saleh, and Faiez Zannad
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Pharmacology ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: PEACE MENA (Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa) is a prospective registry in Arab countries for in-patients with acute myocardial infarction (AMI) or acute heart failure (AHF). Here, we report the baseline characteristics and outcomes of in-patients with AHF who were enrolled during the first 14 months of the recruitment phase. Methods: A prospective, multi-centre, multi-country study including patients hospitalized with AHF was conducted. Clinical characteristics, echocardiogram, BNP (B-type natriuretic peptide), socioeconomic status, management, 1-month, and 1-year outcomes are reported Results: Between April 2019 and June 2020, a total of 1258 adults with AHF from 16 Arab countries were recruited. Their mean age was 63.3 (±15) years, 56.8% were men, 65% had monthly income ≤US$ 500, and 56% had limited education. Furthermore, 55% had diabetes mellitus, 67% had hypertension; 55% had HFrEF (heart failure with reduced ejection fraction), and 19% had HFpEF (heart failure with preserved ejection fraction). At 1 year, 3.6% had a heart failure-related device (0-22%) and 7.3% used an angiotensin receptor neprilysin inhibitor (0-43%). Mortality was 4.4% per 1 month and 11.77% per 1-year post-discharge. Compared with higher-income patients, lower-income patients had a higher 1-year total heart failure hospitalization rate (45.6 vs 29.9%, p=0.001), and the 1-year mortality difference was not statistically significant (13.2 vs 8.8%, p=0.059). Conclusion: Most of the patients with AHF in Arab countries had a high burden of cardiac risk factors, low income, and low education status with great heterogeneity in key performance indicators of AHF management among Arab countries.
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- 2023
24. Identifying mortality risk factors amongst acute coronary syndrome patients admitted to Arabian Gulf hospitals using machine-learning methods.
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Syed Asif Raza, Lukman Thalib, Jassim Al Suwaidi, Kadhim Sulaiman, Wael Almahmeed, Haitham Amin, and Khalid F. AlHabib
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- 2019
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25. Medications for blood pressure, blood glucose, lipids, and anti-thrombotic medications: relationship with cardiovascular disease and death in adults from 21 high-, middle-, and low-income countries with an elevated body mass index
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Darryl P Leong, Sumathy Rangarajan, Annika Rosengren, Aytekin Oguz, Khalid F Alhabib, Paul Poirier, Rafael Diaz, Antonio L Dans, Romaina Iqbal, Afzalhussein M Yusufali, Karen Yeates, Jephat Chifamba, Pamela Seron, Jose Lopez-Lopez, Ahmad Bahonar, Li Wei, Hu Bo, Liu Weida, Alvaro Avezum, Rajeev Gupta, Viswanathan Mohan, Herculina S Kruger, P V M Lakshmi, Rita Yusuf, and Salim Yusuf
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Epidemiology ,Cardiology and Cardiovascular Medicine - Abstract
Aims Elevated body mass index (BMI) is an important cause of cardiovascular disease (CVD). The population-level impact of pharmacologic strategies to mitigate the risk of CVD conferred by the metabolic consequences of an elevated BMI is not well described. Methods and results We conducted an analysis of 145 986 participants (mean age 50 years, 58% women) from 21 high-, middle-, and low-income countries in the Prospective Urban and Rural Epidemiology study who had no history of cancer, ischaemic heart disease, heart failure, or stroke. We evaluated whether the hazards of CVD (myocardial infarction, stroke, heart failure, or cardiovascular death) differed among those taking a cardiovascular medication (n = 29 174; including blood pressure-lowering, blood glucose-lowering, cholesterol-lowering, or anti-thrombotic medications) vs. those not taking a cardiovascular medication (n = 116 812) during 10.2 years of follow-up. Cox proportional hazard models with the community as a shared frailty were constructed by adjusting age, sex, education, geographic region, physical activity, tobacco, and alcohol use. We observed 7928 (5.4%) CVD events and 9863 (6.8%) deaths. Cardiovascular medication use was associated with different hazards of CVD (interaction P < 0.0001) and death (interaction P = 0.0020) as compared with no cardiovascular medication use. Among those not taking a cardiovascular medication, as compared with those with BMI 20 to Conclusion To the extent that CVD risk among those with an elevated BMI is related to hypertension, diabetes, and an elevated thrombotic milieu, targeting these pathways pharmacologically may represent an important complementary means of reducing the CVD burden caused by an elevated BMI.
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- 2022
26. Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study
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Kwadwo Boakye, Marit Bovbjerg, John Schuna, Branscum Adam, D Ravi Varma, Rosnah Ismail, Olga Barbarash, Juan Dominguez, Yuksel Altuntas, Ranjit Anjana, Rita Yusuf, Roya Kelishadi, Patricio Jaramillo, Romaina Iqbal, Pamela Seron, Annika Rosengren, Paul Poirier, PVM Lakshmi, Rasha Khatib, Katarzyna Zatońska, Bo Hu, Lu Yin, Chuangshi Wang, Karen Yeates, Jephat Chifamba, Khalid F Alhabib, Álvaro Avezum, Antonio Das, Scott Lear, Salim Yusuf, and Perry Hystad
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Multidisciplinary - Abstract
Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003–2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (− 12.4% per IQR, 95% CI − 16.0, − 8.7) and impervious surface area (− 29.2% per IQR, 95% CI − 37.5, − 19.7), as well as the rate of change in 5-year population density (− 17.2% per IQR, 95% CI − 25.7, − 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.
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- 2023
27. Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries
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Thirunavukkarasu Sathish, Koon K Teo, Philip Britz-McKibbin, Biban Gill, Shofiqul Islam, Guillaume Paré, Sumathy Rangarajan, MyLinh Duong, Fernando Lanas, Patricio Lopez-Jaramillo, Prem K Mony, Lakshmi Pinnaka, Vellappillil Raman Kutty, Andres Orlandini, Alvaro Avezum, Andreas Wielgosz, Paul Poirier, Khalid F Alhabib, Ahmet Temizhan, Jephat Chifamba, Karen Yeates, Iolanthé M Kruger, Rasha Khatib, Rita Yusuf, Annika Rosengren, Katarzyna Zatonska, Romaina Iqbal, Weida Lui, Xinyue Lang, Sidong Li, Bo Hu, Antonio L Dans, Afzal Hussein Yusufali, Ahmad Bahonar, Martin J O’Donnell, Martin McKee, Salim Yusuf, Masira, and 12079642 - Kruger, Iolanthe Marike
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Adult ,Male ,Carbon Monoxide ,Nicotine ,Developed Countries ,Respiratory Tract Diseases ,Myocardial Infarction ,General Medicine ,Middle Aged ,Stroke ,Cardiovascular Diseases ,Neoplasms ,Tobacco Smoking ,Humans ,Female ,Prospective Studies ,Developing Countries ,Aged - Abstract
Digital, Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p, Funding Full funding sources are listed at the end of the paper (see Acknowledgments)., Ciencias Médicas y de la Salud
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- 2022
28. Care of patients with ST-Elevation MI: an international analysis of Quality Indicators in the Acute Coronary Syndrome (ACS) STEMI Registry of the EURObservational Research Programme (EORP) and ACVC and EAPCI Associations of the European Society of Cardiology (ESC) in 11,462 patients
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Peter, Ludman, Uwe, Zeymer, Nicolas, Danchin, Petr, Kala, Cécile, Laroche, Masoumeh, Sadeghi, Roberto, Caporale, Sameh Mohamed, Shaheen, Jacek, Legutko, Zaza, Iakobishvili, Khalid F, Alhabib, Zuzana, Motovska, Martin, Studencan, Jorge, Mimoso, David, Becker, Dimitrios, Alexopoulos, Zviad, Kereseselidze, Sinisa, Stojkovic, Parounak, Zelveian, Artan, Goda, Erkin, Mirrakhimov, Gani, Bajraktari, Hasan Ali, Farhan, Pranas, Šerpytis, Bent, Raungaard, Toomas, Marandi, Alice May, Moore, Martin, Quinn, Pasi Paavo, Karjalainen, Gabriel, Tatu-Chitoiu, Chris P, Gale, Aldo P, Maggioni, and Franz, Weidinger
- Abstract
To use Quality Indicators to study the management of ST segment elevation myocardial infarction (STEMI) in different regions.Prospective cohort study of STEMI within 24 hours of symptom onset (11,462 patients, 196 centres, 26 ESC member and 3 affiliated countries). The median delay between arrival at a PCI centre and primary PCI was 40 min (IQR 20 to 74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 mins. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4% to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented LVEF ≤40%, 84.0% were discharged on an ACEI/ARB and 88.7% were discharged on beta blockers.Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
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- 2022
29. Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDs with Inflammatory Bowel Disease: Results from the Prospective Urban Rural Epidemiology (PURE) Study
- Author
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Neeraj Narula, Emily C.L. Wong, Cara Pray, John K. Marshall, Sumathy Rangarajan, Shofiqul Islam, Ahmad Bahonar, Khalid F. Alhabib, Anna Kontsevaya, Farnaza Ariffin, Homer U. Co, Wadeia Al Sharief, Andrzej Szuba, Andreas Wielgosz, Maria Luz Diaz, Rita Yusuf, Lanthé Kruger, Biju Soman, Yang Li, Chuangshi Wang, Lu Yin, Mirrakhimov Erkin, Fernando Lanas, Kairat Davletov, Annika Rosengren, Patricio Lopez-Jaramillo, Rasha Khatib, Aytekin Oguz, Romaina Iqbal, Karen Yeates, Álvaro Avezum, Walter Reinisch, Paul Moayyedi, and Salim Yusuf
- Subjects
Hepatology ,Gastroenterology - Abstract
Several medications have been suspected to contribute to the etiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) were evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).During a median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], there were 571 incident IBD cases (143 CD and 428 UC). Incident IBD was significantly associated with baseline antibiotic [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p0.001]. NSAID users were also observed to have increased odds of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term use [aOR: 5.58 (95% CI: 2.26-13.80), p0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.
- Published
- 2022
30. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study
- Author
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Marjan Walli-Attaei, Annika Rosengren, Sumathy Rangarajan, Yolandi Breet, Suraya Abdul-Razak, Wadeia Al Sharief, Khalid F Alhabib, Alvaro Avezum, Jephat Chifamba, Rafael Diaz, Rajeev Gupta, Bo Hu, Romaina Iqbal, Rosnah Ismail, Roya Kelishadi, Rasha Khatib, Xinyue Lang, Sidong Li, Patricio Lopez-Jaramillo, Viswanathan Mohan, Aytekin Oguz, Lia M Palileo-Villanueva, Katarzyna Poltyn-Zaradna, Sreelakshmi P R, Lakshmi V M Pinnaka, Pamela Serón, Koon Teo, Sejil T Verghese, Andreas Wielgosz, Karen Yeates, Rita Yusuf, Sonia S Anand, and Salim Yusuf
- Subjects
Male ,Cardiovascular Diseases ,Risk Factors ,Income ,Humans ,Female ,General Medicine ,Prospective Studies ,Middle Aged ,Lipids - Abstract
Background There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants’ metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35–70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586. Findings In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5–12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9–5·2] per 1000 person-years) and 4911 in men (8·2 [8·0–8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01–1·21) in women and 1·28 (1·19–1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98–1·21) in women and 1·42 (1·25–1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08–1·26]) than in men (1·07 [0·99–1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5–2·1] in women vs 10·7% [8·8–12·6] in men). Interpretation Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women.
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- 2022
31. Perceived built environment characteristics associated with walking and cycling across 355 communities in 21 countries
- Author
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Kwadwo Boakye, Marit Bovbjerg, John Schuna, Adam Branscum, Nafiza Mat-Nasir, Ahmad Bahonar, Olga Barbarash, Rita Yusuf, Patricio Lopez-Jaramillo, Pamela Seron, Annika Rosengren, Karen Yeates, Jephat Chifamba, Khalid F. Alhabib, Kairat Davletov, Mirac Vural Keskinler, Maria Diaz, Lanthe Kruger, Yang Li, Liu Zhiguang, Lap Ah. Tse, Andreas Wielgosz, Koon Teo, Mirrakhimov Erkin, Sumathy Rangarajan, Scott Lear, Salim Yusuf, and Perry Hystad
- Subjects
Urban Studies ,Sociology and Political Science ,Tourism, Leisure and Hospitality Management ,Development - Published
- 2023
32. Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis
- Author
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Aditya K Khetan, Salim Yusuf, Patricio Lopez-Jaramillo, Andrzej Szuba, Andres Orlandini, Nafiza Mat-Nasir, Aytekin Oguz, Rajeev Gupta, Álvaro Avezum, Ismail Rosnah, Paul Poirier, Koon K Teo, Andreas Wielgosz, Scott A. Lear, Lia M. Palileo-Villanueva, Pamela Serón, Jephat Chifamba, Sumathy Rangarajan, Maha Mushtaha, Deepa Mohan, Karen Yeates, Martin McKee, Prem K Mony, Marjan Walli-Attaei, Hamda Khansaheb, Annika Rosengren, Khalid F Alhabib, Iolanthé M Kruger, María-José Paucar, Erkin Mirrakhimov, Batyrbek Assembekov, Darryl P Leong, and Masira
- Subjects
Medicine (General) ,R5-920 ,Articles ,General Medicine - Abstract
Digital, Background COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. Methods Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. Findings Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88–2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69–19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. Interpretation The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries., Funding Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre., Ciencias Médica y de la Salud
- Published
- 2022
33. White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries
- Author
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Jephat Chifamba, Chuangshi Wang, Afzalhussein Yusufali, Rajeev Gupta, Viswanathan Mohan, Balaji Bhavadharini, Andrew Mente, Katarzyna Zatońska, Noushin Mohammadifard, Edelweiss Wentzel-Viljoen, Patricio Lopez-Jaramillo, Paul Poirier, Mirac Vural Keskinler, Noor Hassim Ismail, Xiaoyun Liu, Sumathi Swaminathan, Rasha Khatib, Fernando Lanas, Rita Yusuf, Ng Kien Keat, P V M Lakshmi, Andreas Wielgosz, Annika Rosengren, Patrick Sheridan, Romaina Iqbal, Li Wei, Sumathy Rangarajan, Khalid F. AlHabib, Rafael Diaz, Alvaro Avezum, Mahshid Dehghan, Salim Yusuf, Lia M. Palileo-Villanueva, Antonio L. Dans, Karen Yeates, Masira, and 10998497 - Wentzel-Viljoen, Edelweiss
- Subjects
Adult ,Male ,Rural Population ,Research design ,Canada ,medicine.medical_specialty ,Asia ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Eating ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Diabetes mellitus ,Epidemiology ,Prevalence ,Internal Medicine ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Proportional Hazards Models ,Advanced and Specialized Nursing ,business.industry ,Proportional hazards model ,Incidence ,Incidence (epidemiology) ,Oryza ,Middle Aged ,South America ,medicine.disease ,Diet ,Europe ,Diabetes Mellitus, Type 2 ,Africa ,Cohort ,White rice ,Female ,business ,Follow-Up Studies ,Demography - Abstract
Digital, OBJECTIVE Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study. RESEARCH DESIGN AND METHODS Data on 132,373 individuals aged 35–70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as, Ciencias Médicas y de la Salud
- Published
- 2020
34. Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study
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Russell J. de Souza, Rosnah Ismail, Pure study investigators, Paul Poirier, G Dagenais, Mahshid Dehghan, Roya Kelishadi, Rafael Diaz, Alicja Basiak-Rasała, Leela Itty Amma, Sonia S. Anand, Karen Yeates, Yuksel Altuntas, Rasha Khatib, Khalid F. AlHabib, Koon K. Teo, Shrikant I. Bangdiwala, Annika Rosengren, Edelweiss Wentzel-Viljoen, Rita Yusuf, Sumathy Rangarajan, Andrew Mente, Salim Yusuf, Patricio Lopez-Jaramillo, Sumathi Swaminathan, Viswanathan Mohan, Scott A. Lear, SH Ahmed, and 10998497 - Wentzel-Viljoen, Edelweiss
- Subjects
Adult ,Male ,Rural Population ,Nut ,medicine.medical_specialty ,Urban Population ,Global health ,Medicine (miscellaneous) ,Disease ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Epidemiology ,medicine ,Humans ,Nuts ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Mortality ,Prospective cohort study ,Stroke ,Nutrition and Dietetics ,Asia, Eastern ,business.industry ,Middle Aged ,Prospective cohort ,Cardiovascular disease ,medicine.disease ,United States ,Europe ,Cardiovascular Diseases ,Heart failure ,Female ,business ,Demography - Abstract
Background The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries. Objective To assess the association of nuts with mortality and cardiovascular disease (CVD). Methods The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35–70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure]. Results We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with
- Published
- 2020
35. The burden of disease in Saudi Arabia 1990–2017: results from the Global Burden of Disease Study 2017
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Badr Hasan Sobaih, Rajaa Al-Raddadi, Varsha Krish, Ziad A. Memish, Suliman Alghnam, Neeraj Bedi, Nasir Salam, Ali H. Mokdad, Yousef Mohammad, Charbel El Bcheraoui, Demosthenes B. Panagiotakos, Majid A Almadi, Khalid F. AlHabib, Stefanos Tyrovolas, Alex Molassiotis, and Maha El Tantawi
- Subjects
Burden of disease ,Health (social science) ,Index (economics) ,Occupational risk ,Health Status ,Population ,education ,Saudi Arabia ,Medicine (miscellaneous) ,Population health ,010501 environmental sciences ,01 natural sciences ,Health Services Accessibility ,Global Burden of Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Environmental health ,Health care ,parasitic diseases ,Medicine ,030212 general & internal medicine ,Mortality ,lcsh:Environmental sciences ,0105 earth and related environmental sciences ,lcsh:GE1-350 ,education.field_of_study ,Middle East ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Articles ,humanities ,Substance use ,business ,geographic locations - Abstract
Summary Background Availability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990–2010 (before the health-care investments and reform) and 2010–17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries. Findings Age-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of −0·58%), and this decrease was further accelerated from 2010 to 2017 (–2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010–17 the decrease was not as low as in Saudi Arabia (–1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990–2010 and 2010–17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region. Interpretation Decreases in mortality continued at greater rates in Saudi Arabia during the period of 2010–17 than in 1990–2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability. Funding Bill & Melinda Gates Foundation.
- Published
- 2020
36. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study
- Author
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Afzalhussein Yusufali, Rajeev Gupta, Karen Yeates, Khawar Kazmi, K Vijayakumar, Katarzyna Zatońska, Viswanathan Mohan, Jephat Chifamba, Manmeet Kaur, Ahmet Temizhan, Li Wei, Rafael Diaz, Gilles R. Dagenais, Philip Joseph, Roya Kelishadi, Sumathy Rangarajan, Noor Hassim Ismail, Fernando Lanas, Rasha Khatib, Alvaro Avezum, Salim Yusuf, Shameena R Parambath, Andreas Wielgosz, Annika Rosengren, Patricio Lopez-Jaramillo, Koon K. Teo, Darryl P. Leong, Omar Rahman, Jun Zhu, Khalid F. AlHabib, Gustavo B. F. Oliveira, and Prem Mony
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Global Health ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Neoplasms ,Epidemiology ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Mortality ,Prospective cohort study ,education ,Cause of death ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Mortality rate ,General Medicine ,Middle Aged ,Cardiovascular Diseases ,Cohort ,Female ,business ,Cohort study ,Demography - Abstract
Summary Background To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. Methods The PURE study is a prospective, population-based cohort study of individuals aged 35–70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. Findings This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5–10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. Interpretation Among adults aged 35–70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).
- Published
- 2020
37. The Gulf Familial Hypercholesterolemia Registry (Gulf FH): Design, Rationale and Preliminary Results
- Author
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Mohammed A. Batais, Ibrahim Al-Zakwani, Hani Sabbour, Khalid Al-Rasadi, Khalid Al-Waili, Abdulhalim Jamal Kinsara, Ahmad Al-Sarraf, Nasreen Al-Sayed, Turky H. Almigbal, Hani Altaradi, Mohammad Alghamdi, Wael Almahmeed, Zuhier Awan, Omer A. Elamin, Khalid F. AlHabib, Fahad Alnouri, Ashraf Hammouda, Mohammed Al-Jarallah, Haitham Amin, Faisal A. Al-Allaf, Heba Kary, Abdullah Shehab, and Fahad Zadjali
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Adult population ,Consanguinity ,Familial hypercholesterolemia ,030204 cardiovascular system & hematology ,Hyperlipoproteinemia Type II ,Middle East ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Prevalence ,Humans ,Medicine ,Genetic Predisposition to Disease ,Longitudinal Studies ,Registries ,030212 general & internal medicine ,Lipid clinic ,Aged ,Retrospective Studies ,Genetic testing ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Lipids ,Cross-Sectional Studies ,Phenotype ,Research Design ,Clinical diagnosis ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lipid profile ,Biomarkers ,Preliminary Data - Abstract
Aim: To determine the prevalence, genetic characteristics, current management and outcomes of familial hypercholesterolaemia (FH) in the Gulf region. Methods: Adult (18-70 years) FH patients were recruited from 9 hospitals and centres across 5 Arabian Gulf countries. The study was divided into 4 phases and included patients from 3 different categories. In phase 1, suspected FH patients (category 1) were collected according to the lipid profile and clinical data obtained through hospital record systems. In phase 2, patients from category 2 (patients with a previous clinical diagnosis of FH) and category 1 were stratified into definitive, probable and possible FH according to the Dutch Lipid Clinic Network criteria. In phase 3, 500 patients with definitive and probable FH from categories 1 and 2 will undergo genetic testing for 4 common FH genes. In phase 4, these 500 patients with another 100 patients from category 3 (patients with previous genetic diagnosis of FH) will be followed for 1 year to evaluate clinical management and cardiovascular outcomes. The Gulf FH cohort was screened from a total of 34,366 patients attending out-patient clinics. Results: The final Gulf FH cohort consisted of 3,317 patients (mean age: 47±12 years, 54% females). The number of patients with definitive FH is 203. In this initial phase of the study, the prevalence of (probable and definite) FH is 1/232. Conclusion: The prevalence of FH in the adult population of the Arabian Gulf region is high. The Gulf FH registry, a first-of-a-kind multi-national study in the Middle East region, will help in improving underdiagnosis and undertreatment of FH in the region.
- Published
- 2019
38. Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction
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Ahmed Al-Motarreb, Haitham Amin, Abdelfatah Elasfar, Nooshin Bazargani, Ibrahim Al-Zakwani, Alawi A. Alsheikh-Ali, Rajesh Rajan, Kadhim Sulaiman, Jassim Al Suwaidi, Khalid F. AlHabib, Mustafa Ridha, Prashanth Panduranga, Hussam AlFaleh, Mohammed Al-Jarallah, Raja Dashti, Nidal Asaad, Bassam Bulbanat, and Wael Almahmeed
- Subjects
Adult ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Adolescent ,Heart failure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,Middle East ,Young Adult ,0302 clinical medicine ,Diabetes mellitus ,Risk Factors ,Internal medicine ,Original Research Articles ,Cause of Death ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Original Research Article ,Prospective Studies ,Registries ,Mortality ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,Mean age ,Stroke Volume ,Odds ratio ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Hospitalization ,lcsh:RC666-701 ,Cohort ,Acute Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,Readmission ,Follow-Up Studies - Abstract
Aims The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (
- Published
- 2019
39. Timing of Staged Nonculprit Artery Revascularization in Patients With ST-Segment Elevation Myocardial Infarction
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Complete Investigators, Brandi Meeks, David A. Wood, Jaydeep Sarma, Robert F. Storey, Stefan James, Madhu K. Natarajan, Vladimir Dzavik, Jia Wang, Michel Nguyen, John A. Cairns, Matyas Keltai, Roxana Mehran, Helen Nguyen, Payam Dehghani, Sanjit S. Jolly, Shamir R. Mehta, Asim N. Cheema, Ota Hlinomaz, Jean-François Tanguay, Hahn-Ho Kim, Khalid F. AlHabib, Kari Niemelä, Anthony Della Siega, Basil S. Lewis, Vijay Kunadian, and John Amerena
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medicine.medical_specialty ,Randomization ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,ST segment ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Objectives The purpose of this study was to determine the effect of nonculprit-lesion PCI timing on major CV outcomes and also the time course of the benefit of complete revascularization. Methods Following culprit-lesion PCI, 4,041 patients with STEMI and multivessel CAD were randomized to staged nonculprit-lesion PCI or culprit-lesion only PCI. Randomization was stratified according to investigator-planned timing of nonculprit-lesion PCI: during or after the index hospitalization. The first coprimary outcome was the composite of CV death or myocardial infarction (MI). In pre-specified analyses, hazard ratios (HRs) were calculated for each time stratum. Landmark analyses of the entire population were performed within 45 days and after 45 days. Results For nonculprit-lesion PCI planned during the index hospitalization (actual time: median 1 day), CV death or MI was reduced with complete revascularization compared with culprit-lesion only PCI (HR: 0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion PCI planned to occur after hospital discharge (actual time: median 23 days), CV death or MI was also reduced with complete revascularization (HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for intended nonculprit lesion PCI versus culprit lesion only PCI. Conclusions Among STEMI patients with multivessel disease, the benefit of complete revascularization over culprit-lesion only PCI was consistent irrespective of the investigator-determined timing of nonculprit-lesion intervention. The benefit of complete revascularization on hard clinical outcomes emerged mainly over the long term.
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- 2019
40. In‐hospital ventricular arrhythmia in heart failure patients: 7 year follow‐up of the multi‐centric HEARTS registry
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Tarek Kashour, Ahmad Hersi, Khalid F. AlHabib, Basel Alenazy, Hussam AlFaleh, and Shabana Tharkar
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Population ,Saudi Arabia ,Cardiomyopathy ,Heart failure ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Internal medicine ,medicine ,Humans ,Original Research Article ,Prospective Studies ,Registries ,In‐hospital ventricular arrhythmia ,030212 general & internal medicine ,Myocardial infarction ,education ,Stroke ,Aged ,education.field_of_study ,business.industry ,Cardiogenic shock ,Incidence (epidemiology) ,Arrhythmias, Cardiac ,Middle Aged ,Prognosis ,medicine.disease ,Hospitalization ,Treatment Outcome ,lcsh:RC666-701 ,Ventricular fibrillation ,Cardiology ,Female ,HEARTS registry ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Aims The aim of this study was to determine the incidence, predictors, and short‐term and long‐term outcomes associated with in‐hospital sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) collectively termed ventricular arrhythmia (VA) in the heart failure (HF) patients. Methods and results The HEart function Assessment Registry Trial in Saudi Arabia (HEARTS registry) is a prospective national registry of patients with chronic HF from18 tertiary care hospitals across Saudi Arabia. Diagnosis of HF was in accordance with American Heart Association/European Society of Cardiology definition criteria. The registry had enrolled 2610 HF patients during the 14 month recruitment period between October 2009 and December 2010. Occurrence of in‐hospital cardiac events, prognosis, and outcome were monitored during the 7 year follow‐up period. The incidence of in‐hospital VA in HF was 4.2%. VA was more common among men, and mean age was lesser than non‐VA patients (58.5 ± 16: 61.5 ± 15 years; P = 0.042). Smoking and family history of cardiomyopathy were significant risk factors of VA. Previous history of arrhythmia, ST elevated myocardial infarction, infections, and hypotension remained significant predictors of in‐hospital VA associated with three to seven times more risk. Patients with VA had higher rates of in‐hospital events like recurrent HF, haemodialysis, shock, sepsis, major bleeding, intra‐aortic balloon pump, and stroke compared with those without VA, all being highly significant (P
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- 2019
41. Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries
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Ailiana Santosa, Annika Rosengren, Chinthanie Ramasundarahettige, Sumathy Rangarajan, Sadi Gulec, Jephat Chifamba, Scott A. Lear, Paul Poirier, Karen E. Yeates, Rita Yusuf, Andreas Orlandini, Liu Weida, Li Sidong, Zhu Yibing, Viswanathan Mohan, Manmeet Kaur, Katarzyna Zatonska, Noorhassim Ismail, Patricio Lopez-Jaramillo, Romaina Iqbal, Lia M. Palileo-Villanueva, Afzalhusein H. Yusufali, Khalid F. AlHabib, Salim Yusuf, and Masira
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Adult ,Male ,Social Determinants of Health ,Financial Stress ,Disclosure ,Global Health ,Life Change Events ,Humans ,cardiovascular diseases ,Prospective Studies ,Developing Countries ,Original Investigation ,Aged ,Proportional Hazards Models ,Conflict of Interest ,Research ,Developed Countries ,General Medicine ,Middle Aged ,Online Only ,Socioeconomic Factors ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Female ,Public Health ,Stress, Psychological ,Follow-Up Studies - Abstract
Digital, IMPORTANCE Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. OBJECTIVE To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. EXPOSURES All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. MAIN OUTCOMES AND MEASURES The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. RESULTS A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. CONCLUSIONS AND RELEVANCE This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events., Ciencias Médicas y de la Salud
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- 2021
42. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries
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Sidong Li, Scott A. Lear, Sumathy Rangarajan, Bo Hu, Lu Yin, Shrikant I. Bangdiwala, Khalid F. Alhabib, Annika Rosengren, Rajeev Gupta, Prem K. Mony, Andreas Wielgosz, Omar Rahman, M. Y. Mazapuspavina, Alvaro Avezum, Aytekin Oguz, Karen Yeates, Fernando Lanas, Antonio Dans, Marc Evans M. Abat, Afzalhussein Yusufali, Rafael Diaz, Patricio Lopez-Jaramillo, Lloyd Leach, P. V. M. Lakshmi, Alicja Basiak-Rasała, Romaina Iqbal, Roya Kelishadi, Jephat Chifamba, Rasha Khatib, Wei Li, Salim Yusuf, and Masira
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Cohort Studies ,Heart Failure ,Male ,Stroke ,Myocardial Infarction ,Humans ,Female ,Prospective Studies ,Sedentary Behavior ,Cardiology and Cardiovascular Medicine ,Original Investigation - Abstract
Digital, Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (, Ciencias Médicas y de la Salud
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- 2022
43. Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals
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Salim Yusuf, Philip Joseph, Fernando Lanas, Khawar Kazmi, Katarzyna Zatońska, Thomas Iype, Rajesh Kumar, Shofiqul Islam, Quazi Ibrahim, Karen Yeates, Hugo W. Huisman, Reuben Douma, Gilles R. Dagenais, Sumathy Rangarajan, Parminder Raina, Andres Orlandini, Stuart J. Connolly, Jephat Chifamba, Alvaro Avezum, Andre Pascal Kengne, Li Wei, Antonio L. Dans, Patricio Lopez-Jaramillo, Mirac Vural Keskinler, Afzalhussein Yusufali, Koon K. Teo, Ahmad Bahonar, Rajeev Gupta, Viswanathan Mohan, Scott A. Lear, Annika Rosengren, Khalid F. AlHabib, Jeff S. Healey, Prem Mony, Omar Rahman, Rosnah Ismail, and Masira
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Physiology ,030204 cardiovascular system & hematology ,Global Health ,Risk Assessment ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Fibrinolytic Agents ,Risk Factors ,Physiology (medical) ,Antithrombotic ,Epidemiology ,Atrial Fibrillation ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Healthcare Disparities ,Practice Patterns, Physicians' ,Stroke ,Aged ,business.industry ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Confidence interval ,Drug Utilization ,3. Good health ,Cross-Sectional Studies ,Treatment Outcome ,Atrial Flutter ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fibrinolytic agent ,Demography - Abstract
Digital, Aims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P, Ciencias Médicas y de la Salud
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- 2021
44. Health-related quality of life and mortality in heart failure. The global congestive heart failure study of 23000 patients from 40 countries
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Andrzej Budaj, Abel Makubi, Philip Joseph, T. Wittlinger, Anastase Dzudie, Khalid F. AlHabib, Jefferey L. Probstfield, Patricio Lopez-Jaramillo, A. Temizhan, Isabelle Johansson, Aldo P. Maggioni, Koon K. Teo, Bianca Fukakusa, Tara McCready, Keith A.A. Fox, Alex Grinvalds, Kumar Balasubramanian, Antonio L. Dans, Salim Yusuf, John J.V. McMurray, Deepak Y. Kamath, Justin A. Ezekowitz, Antoni Bayes-Genis, Lars H. Lund, José Silva-Cardoso, Fernando Lanas, Karen Sliwa, Kamilu M. Karaye, Hisham Dokainish, and Masira
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Heart Failure ,Male ,Health related quality of life ,medicine.medical_specialty ,business.industry ,heart failure ,health status ,medicine.disease ,Survival Analysis ,Quality of life (healthcare) ,quality of life ,Physiology (medical) ,Heart failure ,Quality of Life ,medicine ,Geographic regions ,Humans ,ventricular function, left ,Female ,prognosis ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Aged - Abstract
Digital, Background: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. Methods: We used the Kansas City Cardiomyopathy Questionnaire–12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. Results: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17–1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03–1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21–1.42]; interaction P, Ciencias Medicas y de la Salud
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- 2021
45. Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study
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Ahmad Bahonar, Romaina Iqbal, Salim Yusuf, Jephat Chifamba, Chuangshi Wang, Viswanathan Mohan, Afzalhussein Yusufali, Scott A. Lear, Rajeev Gupta, Rafael Diaz, Wei Li, Prospective Urban Rural Epidemiology (Pure) study investigators, Katarzyna Zatońska, Patricio Lopez-Jaramillo, Shrikant I. Bangdiwala, Iolanthé M. Kruger, Biju Soman, Marc Evans M Abat, Annika Rosengren, Fernando Lanas, Khalid Yusoff, Khalid F. AlHabib, Sumathy Rangarajan, Alvaro Avezum, Bo Hu, Karen Yeates, and Masira
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medicine.medical_specialty ,Health outcomes ,Bedtime ,Cardiovascular events ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Epidemiology ,medicine ,Humans ,Prospective Studies ,Myocardial infarction ,Risk factor ,Mortality ,Association (psychology) ,Life Style ,Stroke ,Proportional Hazards Models ,business.industry ,General Medicine ,medicine.disease ,030228 respiratory system ,Cardiovascular Diseases ,Heart failure ,business ,030217 neurology & neurosurgery ,Demography - Abstract
Digital, Objectives This study aimed to examine the association of bedtime with mortality and major cardiovascular events. Methods Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as ‘earlier’ sleepers and those who reported a bedtime after midnight as ‘later’ sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers. Results A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03–1.16]) and later sleepers (HR of 1.10 [1.02–1.20]). Conclusion Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes., Ciencias Médicas y de la Salud
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- 2021
46. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries
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Haitham Amin, Mohammed Al Jarallah, K. Sulaiman, Wael Almahmeed, Jassim Al Suwaidi, Khalid F. AlHabib, Abdulla Shehab, Ahmad Hersi, Alwai A. Alsheikh-Ali, Anhar Ullah, Akshaya Srikanth Bhagavathula, Hussam AlFaleh, Mostafa Q Alshamiri, and Amar M Salam
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Adult ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,Time Factors ,Multivariate analysis ,Health Status ,medicine.medical_treatment ,Comorbidity ,Inferior Wall Myocardial Infarction ,030204 cardiovascular system & hematology ,Risk Assessment ,Middle East ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Healthcare Disparities ,Anterior Wall Myocardial Infarction ,Aged ,Quality Indicators, Health Care ,Pharmacology ,business.industry ,Mortality rate ,Age Factors ,Percutaneous coronary intervention ,Health Status Disparities ,Emergency department ,Middle Aged ,medicine.disease ,Outcome and Process Assessment, Health Care ,Treatment Outcome ,ST Elevation Myocardial Infarction ,Women's Health ,Female ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Developed country - Abstract
Background:Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited.Aims:To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East.Methods:Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups.Results:Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all pConclusion:Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
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- 2019
47. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study
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Marjan W. Attaei, Jephat Chifamba, Noor Hassim Ismail, Chuangshi Wang, Manmeet Kaur, Rasha Khatib, Karen Yeates, Iolanthé M. Kruger, Fernando Lanas, Noushin Mohammadifard, Prem Mony, Shrikant I. Bangdiwala, Deren Quiang, Kristina Bengtsson Boström, Afzalhusein H. Yusufali, Andreas Wielgosz, Rajeev Gupta, Annika Rosengren, Philip Joseph, Sarojiniamma Srilatha, Yang Wang, Khalid F. AlHabib, Koon K. Teo, Andrzej Szuba, Romaina Iqbal, Patricio Lopez-Jaramillo, Khalid Yusoff, Sadi Gulec, Salim Yusuf, Paul Poirier, Viswanathan Mohan, Scott A. Lear, Martin McKee, Chinthanie Ramasundarahettige, Ehi Igumbor, Wei Li, Pablo Lamelas, Rita Yusuf, Sumathy Rangarajan, Alvaro Avezum, Andrew Smyth, and 12079642 - Kruger, Iolanthé Marike
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Male ,Rural Population ,Urban Population ,Higher education ,030231 tropical medicine ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Risk factor ,Prospective cohort study ,Developing Countries ,Socioeconomic status ,business.industry ,Developed Countries ,lcsh:Public aspects of medicine ,Incidence (epidemiology) ,lcsh:RA1-1270 ,General Medicine ,Middle Aged ,Social Class ,Cardiovascular Diseases ,Female ,business ,Inclusion (education) ,Demography - Abstract
Background Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. Methods In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. Findings Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96–1·58) for high-income countries, 1·59 (1·42–1·78) in middle-income countries, and 2·23 (1·79–2·77) in low-income countries (pinteractionInterpretation Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).
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- 2019
48. Randomized controlled trial of influenza vaccine in patients with heart failure to reduce adverse vascular events (IVVE): Rationale and design
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Wael Almahmeed, Albertino Damasceno, Gerald Yonga, Jun Zhu, Ambuj Roy, Khalid F. AlHabib, Mark Loeb, Antonio L. Dans, Salim Yusuf, Yan Liang, Kamilu M. Karaye, Lia M. Palileo-Villanueva, Arif Al Mulla, Hisham Dokainish, Charles Mondo, and Fastone Goma
- Subjects
Research design ,medicine.medical_specialty ,Intention-to-treat analysis ,Influenza vaccine ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Article ,3. Good health ,law.invention ,Vaccination ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Heart failure ,medicine ,Observational study ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Influenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events. Research Design and Methods In a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been enrolled. The primary outcome is a composite of the following: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalizations for heart failure using standardized criteria. Analyses will be based on comparing event rates between influenza vaccine and control groups and will include time to event, rate comparisons using Poisson methods, and logistic regression. The analysis will be conducted by intention to treat i.e. patients will be analyzed in the group in which they were assigned. Multivariable secondary analyses to assess whether variables such as age, sex, seasonality modify the benefits of vaccination are also planned for the primary outcome. Conclusion This is the largest randomized trial to test if influenza vaccine compared to control reduces adverse vascular events in high risk individuals. Trial registration number Clinicaltrials.gov NCT02762851
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- 2019
49. ‘Corrigendum to 'Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study' [Sleep Medicine 80 (2021) 265–272]’
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Chuangshi Wang, Bo Hu, Sumathy Rangarajan, Shrikant I. Bangdiwala, Sadi Gulec, Scott A. Lear, Viswanathan Mohan, Rajeev Gupta, Khalid F. Alhabib, Biju Soman, Marc Evans M. Abat, Annika Rosengren, Fernando Lanas, Alvaro Avezum, Patricio Lopez-Jaramillo, Rafael Diaz, Khalid Yusoff, Romaina Iqbal, Jephat Chifamba, Karen Yeates, Katarzyna Zatońska, Iolanthé M. Kruger, Ahmad Bahonar, Afzalhussein Yusufali, Wei Li, and Salim Yusuf
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General Medicine - Published
- 2022
50. Pure Autonomic Failure with Asymptomatic Hypertensive Urgency: A Case Report and Literature Review
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Abdulrahman Aldeeri, Ahmad Hersi, Khalid F. AlHabib, Anwar Jammah, Alwaleed Aljohar, and Taim Muayqil
- Subjects
medicine.medical_specialty ,Ambulatory blood pressure ,Supine hypertension ,Fludrocortisone ,Midodrine ,Saudi Arabia ,Case Report ,030204 cardiovascular system & hematology ,Asymptomatic ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Pure autonomic failure ,lcsh:Neurology. Diseases of the nervous system ,Orthostatic hypotension ,business.industry ,Hypertensive urgency ,medicine.disease ,Blood pressure ,Cardiology ,Ambulatory blood pressure monitoring ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuations.
- Published
- 2018
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