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Yusufali, Bazargani, Bakir, Muhammed, and The Prevention Group of Emirates Cardiac Society: We should close the tap causing the flood rather than just mop at the flood of cardiovascular diseases – prevention, the way forward

Cardiovascular disease (CVD) and other non-communicable diseases (NCDs) cause 67% of deaths in the United Arab Emirates (UAE). This is well known, but what is less well known is the fact that 60% of the men who die are younger than 60 years of age. It is also known that Arabs, like South Asians, are more prone to heart attacks at a younger age. In a more recent study1 comparing Abu Dhabi nationals with Swedish nationals, the incidence of heart attacks was much higher among Abu Dhabi men and women than among the Swedes, especially in the younger age groups (Table 1.)

TABLE 1

Relative incidence of hospitalization due to acute myocardial infarction in Abu Dhabi compared with Sweden. Reproduced with permission from Hassan E, Harrison O, Engström G, et al. High incidence of hospitalized acute myocardial infarction in Abu Dhabi compared to Sweden. Poster presented at Emirates Cardiac Society Congress, Dubai, UAE, 20121

Age (years) Men Women
Swedish nationals (n = 15 631) Abu Dhabi nationals (n = 421) Swedish nationals (n = 10 219) Abu Dhabi nationals (n = 167)
< 30 1 12.5 1 28.5
30–44 1 3.9 1 3.1
45–59 1 3.7 1 2.7
60+ 1 2.0 1 1.8
Age adjusted 1 2.6 1 2.0

The likely reason for these appalling figures is the very high prevalence of CVD risk factors (smoking, abnormal lipids, hypertension, diabetes and pre-diabetes, abdominal obesity, lack of exercise, unsatisfactory diet and psychosocial abnormalities). These risk factors are present at a very young age in UAE nationals.

In the UAE, there is a well-developed infrastructure coupled with good resources that has allowed infectious diseases to be tackled and infant mortality rate to be considerably reduced. Treatment of heart attacks has caught up with that of the developed world. Thirty years ago, the mortality rate from heart attacks in UAE hospitals was in the region of 30%; the comparable figure is now 2–3%. The same vigour can, and should, now be applied to reducing the incidence of heart attacks.

With a reduction in risk factors, there can be a reduction in heart attacks and related consequences, such as heart failure, by as much as 70–80%, which would be particularly relevant in a young population. Furthermore, this decrease will also reduce the prevalence of other NCDs such as diabetes, lung disease and cancer because they share the same risk factors.

During the September 2011 summit at the United Nations, it was resolved that the probability of people aged 30–70 years dying from NCDs should be reduced by 25% by 2025. Researchers, backed by the World Health Organization (WHO), have identified evidence-based and cost-effective methods to reduce the probability of people dying from NCDs and have labelled them ‘best buy’ interventions (Table 2).

TABLE 2

World Health Organization (WHO) ‘best buy’ interventions for NCDs. Reproduced with permission from World Health Organization (WHO). Scaling up action against noncommunicable diseases: How much will it cost? Geneva, Switzerland: World Health Organization; 2011. URL: http://whqlibdoc.who.int/publications/2011/9789241502313_eng.pdf (accessed March 2013)2

Core intervention set: best buys
Population-based interventions addressing NCD risk factors
  • Tobacco use: tax increases; smoke-free indoor workplaces and public places; health information and warnings about tobacco; bans on advertising and promotion

  • Harmful alcohol use: tax increases on alcoholic beverages; comprehensive restrictions and bans on alcohol marketing; restrictions on the availability of retailed alcohol

  • Unhealthy diet and physical inactivity: salt reduction through mass media campaigns and reduced salt content in processed foods; replacement of trans-fats with polyunsaturated fats; public awareness programme about diet and physical activity

Individual-based interventions addressing NCDs in primary care
  • Cancer: prevention of liver cancer through hepatitis B immunization; prevention of cervical cancer though screening [visual inspection with acetic acid (VIA)] and treatment of pre-cancerous lesions

  • CVD and diabetes: multidrug therapy (including glycaemic control for diabetes mellitus) to individuals who have had a heart attack or stroke, and to persons with a high risk (> 30%) of a CVD event in the next 10 years; providing aspirin to people having an acute heart attack

It is known that the UAE has a large problem involving the young population, but there is a viable solution that is evidence based and do-able. It is high time that this opportunity was seized to dramatically change the fate of those within the UAE. If the UAE has been able to excel in curative medicine, then it can also excel in preventing these eminently preventable diseases.

One of the areas where there will have to be investment, besides deploying the relevant ‘best buy’ interventions, is in conducting regular nationwide surveys of risk factors and keeping accurate data on CVD diseases and mortality rates. This will be essential for monitoring progress.

Prevention should start in early childhood, with young adolescents and women being particularly targeted by this collective effort to improve the health of the nation and prevent disease. A healthy nation is indeed a progressive nation.

References

1. 

Hassan E, Harrison O, Engström G, et al. High incidence of hospitalized acute myocardial infarction in Abu Dhabi compared to Sweden. Poster presented at Emirates Cardiac Society Congress 2012, Dubai, UAE.

2. 

World Health Organization (WHO). Scaling up action against noncommunicable diseases: How much will it cost? Geneva, Switzerland: World Health Organization; 2011. URL: http://whqlibdoc.who.int/publications/2011/9789241502313_eng.pdf (accessed March 2013).





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