|Year : 2017 | Volume
| Issue : 2 | Page : 104-110
Risk factors of cardiovascular diseases among population of Arar City, Northern Saudi Arabia
Ali Ghannam A Almuhawwis1, Nagah M.A el-Fetoh2, Muhammad Abdullah M Almalki1, Muhammad Sari Z Alanazi1, Naif Salem H Alshammari1, Anwar K Alruwaili1, Adel T Alenezi1, Muaz B Wali1, Zaid Q.B Fawwaz Alshammari1, Wasan L Alanazi1
1 Students, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
2 Department of Community Medicine, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
|Date of Submission||12-May-2017|
|Date of Acceptance||26-Sep-2017|
|Date of Web Publication||21-Nov-2017|
Ali Ghannam A Almuhawwis
Faculty of Medicine, Northern Border University, Arar 31991
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background Awareness of cardiovascular diseases (CVDs) and risk factors has been linked to the prevalence of CVDs.
Objective The current study was conducted to compare the prevalence of CVDs risk factors among male and female populations in Arar City, Northern Saudi Arabia.
Participants and methods A cross-sectional study was carried out in three randomly chosen primary health care centers in Arar City. A total of 401 Saudi nationals were included.
Results Most (59.1%) of female and 44.5% of males did not check their blood glucose (P<0.05). The majority (61.7%) of female and 44.1% of males did not check their blood pressure (P<0.05). Most (98.7%) of females and 50.6% of male were nonsmokers. Most (82.6 and 80.5%) of males and females ate fruits less than three times per week, 69.6% of females and 53.5% of males performed light physical exercise, whereas 12.1% of males and 7.1% of females did not perform physical exercise at all (P<0.05). Between male and female, the mean BMI was 27.49±5.4 and 26.23±13.4, the mean intake of fruits per week was 2.80±1.73 and 3.77±1.99 days, and the mean vegetable intake per week was 4.19±1.97 and 5.87±1.85 days, with no significant difference (P>0.05).
Conclusion and recommendations The prevention of CVDs is based on the control of several risk factors and associated conditions. Specific studies or programs are needed to raise the awareness of what CVDs are, its risk factors, and how to control or modify it.
Keywords: cardiovascular diseases, risk factors, Saudi Arabia
|How to cite this article:|
Almuhawwis AA, el-Fetoh NM, Almalki MM, Alanazi MZ, Alshammari NH, Alruwaili AK, Alenezi AT, Wali MB, Fawwaz Alshammari ZQ, Alanazi WL. Risk factors of cardiovascular diseases among population of Arar City, Northern Saudi Arabia. Al-Azhar Assiut Med J 2017;15:104-10
|How to cite this URL:|
Almuhawwis AA, el-Fetoh NM, Almalki MM, Alanazi MZ, Alshammari NH, Alruwaili AK, Alenezi AT, Wali MB, Fawwaz Alshammari ZQ, Alanazi WL. Risk factors of cardiovascular diseases among population of Arar City, Northern Saudi Arabia. Al-Azhar Assiut Med J [serial online] 2017 [cited 2019 Sep 23];15:104-10. Available from: http://www.azmj.eg.net/text.asp?2017/15/2/104/218851
| Introduction|| |
Cardiovascular diseases (CVDs) are considered the first cause of mortality at the global level; each year, more people die of CVDs than from any other cause. According to a WHO report, an estimated 17.3 million people died of CVDs in 2008, constituting 30% of all global deaths; it was estimated that ∼23.6 million people will die of CVDs, mainly from heart disease and stroke, by 2030 . Owing to rapid demographic and epidemiologic transitions, life expectancy is increasing, which leads to an increased health burden of noncommunicable diseases (NCDs) .
The leading risk factors for the development of NCD are high blood pressure, increased level of cholesterol, inadequate intake of fruit and vegetables, overweight or obesity, lack of physical activity, and smoking . Hypertension affects approximately one billion people worldwide, and it is expected to increase to 1.5 billion by the year 2025 . Modern lifestyle associated with easy access to food, lack of exercise, sedentary lifestyles, calorie dense foods, and excessive television viewing contribute to development of NCDs .
CVDs are a growing health concern in the middle-eastern region and the Gulf Council Countries (GCC) ,,. Among the six GCC countries, CVD was estimated to account for 45% of deaths overall. Oman and Kuwait had the highest proportion of deaths attributed to CVD (49 and 46%, respectively); Saudi Arabia, United Arab Emirates, Bahrain, and Qatar (42, 38, 32, and 23%, respectively) also had a significant proportion of CVD deaths (WHO country profiles) .
Studies in Saudi Arabia estimated that the prevalence of hypertension is ∼49%, whereas coronary heart disease (CHD) is between 5 and 6% . Regional studies (e.g. Gulf RACE)  have identified a set of common risk factors for CVD, which include the following: hypertension, diabetes, dyslipidemia, obesity, smoking, physical activity, poor diet, and alcohol consumption.
Studies in Saudi Arabia suggest that the presence of these risk factors, particularly hypertension, obesity, and diabetes, continue to rise each consecutive year ,,. The CVD risk profile differs between men and women; for example, men are more likely to smoke but women are more likely to be obese ,. Moreover, men are more likely to have dyslipidemia, but women are more likely to have type 2 diabetes .
In the study by Khot et al. , the results showed that among patients with CHD, at least one of the four conventional risk factors was present in 84.6% of women and 80.6% of men. In younger patients (men 55 years and women 65 years) and most patients presenting either with unstable angina or for percutaneous coronary intervention, only 10–15% of patients lacked any of the four conventional risk factors. Premature CHD was related to cigarette smoking in men and cigarette smoking and diabetes in women. Smoking decreased the age at the time of CHD event (at trial entry) by nearly one decade in all risk factor combinations .
| Objective|| |
The current study was conducted to compare the prevalence of CVDs risk factors among male and female populations in Arar District, Northern Saudi Arabia.
| Participants and methods|| |
Study type and sitting
A cross-sectional study was carried out in three randomly chosen primary health care centers in Arar City, the capital of the Northern Province of KSA, during the period from 1 May to 30 October 2016.
A total of 401 Saudi nationals aged 18–93 years were included in the study.
Data were collected by means of personal interview with the sampled population using a predesigned questionnaire covering the following items:
- Sociodemographic characteristics, including age, sex, educational, marital status, and occupation.
- Smoking status and certain types of diseases that suggested to effect cardiovascular system diseases such as diabetes mellitus (DM) and hypertension, history of checking of blood pressure, history of checking of blood glucose, frequency of eating vegetables and fruits, excess coffee drinking, and performing physical exercise.
- Anthropometric examination included height and weight measurements with the use of a calibrated balance beam scale and a wall-mounted stadiometer and calculation of BMI. Normal weight was defined as BMI less than 25 kg/m2, overweight as 25 less than or equal to BMI less than 30 kg/m2, and obesity as BMI more than or equal to 30 kg/m2 .
- Blood sample is drawn under complete septic conditions to determine random blood glucose level. A person is considered diabetic if random blood sugar was more than or equal to 200 ml/dl .
This study was reviewed and approved by the Research Ethics Committee of Faculty of Medicine, Northern Border University. Participants were informed that participation is completely voluntary, and written consent was obtained from each participant before being subjected to the questionnaire and after discussing the objective with the participants. No names were recorded on the questionnaires. Adequate training of data collectors took place to ensure protection of confidentiality, and all questionnaires were kept safe.
Collected data were coded and analyzed using statistical package for the social sciences (SPSS, version 15; SPSS Inc., Chicago, Illinois, USA). The χ2-test and independent samples t-test were used as tests of significance, and differences were considered significant at P value 0.05 or less.
| Results|| |
[Table 1] illustrates the sociodemographic characteristics of study population. From the table, it is clear that most of the study population (61.6%) was males, aged 20–30 years (48.1%), followed by the age group 30–40 years (21.4%). Regarding the educational level, the majority (56.1%) completed their university education. More than half (57.6%) were married and 29.9% were still studying.
|Table 1 Sociodemographic characteristics of study population, Arar City, 2016 (n=401)|
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[Table 2] presents the percentage distribution of risk factors of CVDs in the study population. From the table, it is clear that 30.9% of the study population was smokers, 50.9% did not check their blood pressure, and 50.1% did not check their blood glucose. Regarding BMI, 38.9% only were normal, 34.4% were overweight, and 21.7% were obese. Of the study population, 11.7% were diabetics (had random blood glucose above 200 mg/dl). Regarding hypertension, 8.8% were hypertensive. Overall, 30.9% of the study population were smokers, 50.9% did not check their blood pressure, 50.1% did not check their blood glucose, 34.4% were overweight, and 21.7% were obese. Of the study population, 11.7% were diabetics and 8.8% were hypertensive. Approximately half (50.6%) ate vegetables less than three times per week, 81.8% ate fruits less than three times per week, 60.0% perform light physical exercise, and 10.2% did not perform physical exercise at all. Moreover, 42.1% were exposed to stress, and excess coffee drinking was found in 87.4%.
|Table 2 Percentage distribution of risk factors of cardiovascular diseases in the study population|
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[Table 3] illustrates the relationship between sociodemographic risk factors and sex of the studied population. It is clear that most of the female study population (61.7%) were within the age group 20–30 years, compared with 39.7% of males; 54.5% of females were single, whereas the majority (70.4%) of males were married. Regarding the educational level, the majority (69.5%) of females had university or more education as compared with 47.8% of males.
|Table 3 Relationship between sociodemographic risk factors and sex of the studied population|
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[Table 4] illustrates the sociodemographic characteristics of study population. From the table, it is clear that 59.1% who did not check their blood glucose were female. Regarding checking blood pressure, the majority (61.7%) were female who did not check their blood pressure. The majority of females (98.7) were nonsmokers, as compared with 50.6% of male. Females ate vegetables less than 3 days per week. Regarding fruits intake, the majority (82.6%) of males ate fruits less than three times per week, and 69.6% of females performed light physical activity. Most (63.2%) of females were not exposed to stress. Regarding excess coffee drinking, the majority (91.4%) were females.
|Table 4 Relationship between risk factors and sex of the studied population|
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[Table 5] compares mean values of male and female population. The mean age of study population was 36.71±14.11 and 27.2±9.23 years in the male and female populations, respectively. Between male and female populations, the mean BMI was 27.49±5.4 and 26.23±13.4, the mean intake of fruits per week was 2.80±1.73 and 3.77±1.99 days, and the mean vegetable intake per week was 4.19±1.97 and 5.87±1.85 days. The differences in the mean values between males and females were statistically insignificant in all of the parameters.
| Discussion|| |
Awareness of CVD risk factors has been linked to taking preventive action. CVD is a class of diseases that involve the heart or blood vessels. They are the leading cause of death globally, except in Africa . Deaths, at a given age, from CVD are more common and have been increasing in much of the developing world, whereas rates have declined in most of the developed world since the 1970s . CVD due to narrowing of blood vessels might not be diagnosed until underlying condition worsens to the point of heart attack, chest pain (angina), stroke, heart failure, or sudden cardiac death. It is therefore important to watch for cardiovascular symptoms . Among the six GCC countries, CVD was estimated to account for 45% of deaths, overall. Oman and Kuwait had the highest proportion of deaths attributed to CVD (49 and 46%, respectively); Saudi Arabia, United Arab Emirates, Bahrain, and Qatar (42, 38, 32, and 23%, respectively) also had a significant proportion of CVD deaths (WHO country profiles) .
The current study is a cross-sectional study carried out in three randomly chosen primary health care centers in Arar City, Northern Province of KSA. The study was conducted to compare the prevalence of CVDs risk factors among male and female populations in Arar District, Northern Saudi Arabia. A total of 401 Saudi nationals (61.6% males and 38.4% females) aged 18–93 years were included in the study (48.1% of them aged between 20 and 30 years). Data were collected by means of personal interview with the sampled population using a predesigned questionnaire. Of the numerous causes of CVD, the predominant ones identified are as follows: obesity, DM, and hypertension, in addition to low vegetable and fruit intake, smoking, stress exposure, and lack of physical activities. In this study, we review the contribution of each of these factors toward the existence of CVD in Saudi Arabia.
The study showed the percentages of these factors as smoking in 30.9%, no checking of blood glucose in 50.1%, no checking of blood pressure in 50.9%, obesity in 21.7%, overweight in 34.4%, hypertension in 8.7%, and DM in 11.7%. This was supported by a study conducted on urban and rural population in Tamil Nadu; it found the proportion of male and female smokers was 4.9 and 3.7%, respectively, in urban areas and 4.8 and 6.2%, respectively, in rural areas, and the proportion of overweight was 73.8 and 40.6% in urban and rural areas, respectively. Nearly 37.2 and 23.6% of the urban population and 6.9 and 9.0% of the rural population had systolic and diastolic hypertension, respectively . Our results were more or less in accordance with the results of a study conducted in the USA  that showed among 115.9 million US adults aged more than or equal to 35 years, 40% had hypertension, 20% of the patients smoked, and 11% had diabetes, all counted as risk factors of CVD. The same study also reviewed increasing blood pressure increased the risk for CVD. Our findings were also approved by a study on Asian population which revealed that the most important risk factors of CVD were hypertension, smoking, total cholesterol in serum, and finally DM . Midha et al.  reported a prevalence of hypertension of 32.8% in urban population and 14.5% in rural population. De et al.  reported a prevalence of hypertension in 52.9% of urban and 35% of rural populations. Gupta et al.  reported the prevalence of hypertension to range between 20 and 40% in urban adults and 12 and 17% among rural adults.In Saudi Arabia, studies suggest that the presence of risk factors, particularly hypertension, obesity, and diabetes, continue to rise with concomitant rise in the prevalence of different CVDs each consecutive year ,,.
In our study, between male and female populations, the mean intake of fruits per week was 2.80±1.73 and 3.77±1.99 days, and the mean vegetable intake per week was 4.19±1.97 and 5.87±1.85 days, with no significant difference (P>0.05). In urban and rural populations in Tamil Nadu, the mean intake of fruits per week was 2.70±1.95 and 3.88±2.21 days and the mean vegetable intake per week was 4.72±1.97 and 5.91±1.84 days . WHO reports the prevalence of inadequate fruits and vegetable consumption was higher among females than males in the south East Asia region .
In our results, most females (98.7) were nonsmokers as compared with 50.6% of males. Mean BMI±SD was higher in males than females (27.49±5.43 vs 26.23±13.46). In the study by Ibrahim et al. , the risk factors of CHD were compared among medical students in King Abdulaziz University, Jeddah, Saudi Arabia; it was found that the CVD risk profile differs between males and females; for example, males are more likely to smoke but females are more likely to be obese .
Conclusion and recommendations
The prevention of CHD is based on the control of several factors associated with a disease or clinical condition. Several studies have shown that good metabolic control and multifactorial risk factor reduction significantly lower the coronary risk in these patients. Specific studies or programs are needed to raise the awareness of the risk factors and what CVDs are.
The authors thank Omar Tabaan Alenezi, Bader Khalid Alruwaili, Abdulaziz Inad Alanazi and Anwar Matar Alhaziemi Alsulobi, Reem Subh A. Alhazmi (students, Faculty of Medicine NBU) and Omar Mohamed Bakr Ali for their help in different steps of the research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Engelgau M, El-Saharty S, Kudesia P, Rajan V, Rosenhouse S, Okamoto K. Capitalizing on the demographic transition: Tackling noncommunicable diseases in South Asia. Washington, DC: World Bank; 2011.
World Health Organization. The world health report 2002: Reducing risk promoting healthy life. Geneva: World Health Organization; 2002.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217–223.
Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle behaviors in Iran: findings from the First National Noncommunicable Disease Risk Factor Surveillance Survey. Public Health Nutr 2008; 11:246–251.
Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the gulf region: a systematic review. Adv Pub Health 2015; 2015:1–23.
Motlagh B, O’Donnell M, Yusuf S. Prevalence of cardiovascular risk factors in the Middle East: a systematic review. Eur J Cardiovasc Prev Rehabil 2009; 16:268–280.
Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL et al.
Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): a decade of an epidemic. BMC Med 2011; 9:76.
El Bcheraoui C, Memish ZA, Tuffaha M, Daoud F, Robinson M, Jaber S et al.
Hypertension and its associated risk factors in the kingdom of saudi arabia, 2013: a national survey. Int J Hypertens 2014; 2014:564679.
Ahmed AA, Alsharief E, Alsharief A. Evaluation of risk factors for cardiovascular diseases among Saudi diabetic patients attending primary health care service. Diabetes Metab Syndr 2013; 7:133–137.
Koura MR, Al-Dabal BK, Rasheed P, Al-Sowielem LS, Makki SM. Prehypertension among young adult females in Dammam, Saudi Arabia. East Mediterr Health J 2012; 18:728–734.
Ibrahim NK, Mahnashi M, Al-Dhaheri A, Al-Zahrani B, Al-Wadie E, Aljabri M et al.
Risk factors of coronary heart disease among medical students in King Abdulaziz University, Jeddah, Saudi Arabia. BMC Public Health 2014; 14:411.
Garawi F, Ploubidis GB, Devries K, Al-Hamdan N, Uauy R. Do routinely measured risk factors for obesity explain the sex gap in its prevalence? Observations from Saudi Arabia. BMC Public Health 2015; 15:254.
Alharbi NS, Almutari R, Jones S, Al-Daghri N, Khunti K, de Lusignan S. Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: systematic review and meta-analysis. Diabetes Res Clin Pract 2014; 106:e30–e33.
Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ et al.
Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290:898–904.
Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P et al.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344:1343–1350.
Somannavar S, Ganesan A, Deepa M, Datta M, Mohan V. Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India. Diabetes Care 2009; 32:641–643.
Mendis S, Puska P, Norrving B. World Health Organization Global Atlas on cardiovascular disease prevention and control (ISBN 978-92-4-156437-3). World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization 2011; 3–18.
Bridget BK. Promoting cardiovascular health in the developing world: a critical challenge to achieve global health (ISBN 978-0-309-14774-3). Washington, DC: National Academies Press 2010.
Kumosani TA, Alama MN, Iyer A. Cardiovascular diseases in Saudi Arabia. PROM 2011; 1:01–06.
Logaraj M, Balaji R, John K, Shailendra Kumar B Hegde. Comparative study on risk factors for cardiovascular diseases between urban and rural population in Tamil Nadu. Nat J Res Commu Med 2014; 3:103–112.
Singh G, Miller JD, Lee FH, Pettitt D, Russell MW. Prevalence of cardiovascular disease risk factors among US adults with self-reported osteoarthritis: data from the Third National Health and Nutrition Examination Survey. Am J Manag Care 2002; 8:S383–S391.
Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y et al.
Cardiovascular disease and risk factors in Asia. Circulation 2008; 118:2702–2709.
Midha T, Idris MZ, Saran RK, Srivastav AK, Singh SK. Prevalence and determinants of hypertension in the urban and rural population of a north Indian district. East Afr J Public Health 2009; 6:268–273.
De A, Podder G, Adhikari A, Haldar A, Banerjee J, De M. Comparative study of risk factors of cardiac diseases among Urban and Rural population. Int J Hum Genet 2013; 13:15–19.
Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertension 2004; 18:73–78.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]