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  • Review Article
  • Published:

Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden

Nature Reviews Cardiology volume 15, pages 106–119 (2018)Cite this article

Subjects

Key Points

  • Cardiovascular disease (CVD) mortality in the Eastern Mediterranean region (EMR) is estimated to increase more dramatically in the next decade than in any other global region except Africa

  • CVD risk factors such as tobacco consumption, physical inactivity, depression, overweight/obesity, hypertension, and diabetes mellitus are prominent among the population living in the EMR

  • Despite the high risk factor and disease burden in the EMR, public knowledge and awareness of CVD symptoms and its risk factors are very low, leading to poor control of these risk factors

  • The treatment and management of CVD in the EMR is suboptimal, and mostly involves thrombolysis, with insufficient provision of timely revascularization

  • Secondary prevention through cost-effective strategies such as cardiac rehabilitation is limited by low availability

Abstract

The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.

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Figure 1: Cardiovascular mortality and World Bank income data on countries in the Eastern Mediterranean region.
Figure 2: Physical activity and obesity levels by WHO-designated region and sex.
Figure 3: Global rates of sodium, fruit, and vegetable intake38.

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Acknowledgements

S.L.G. is supported in her work by the Toronto General & Toronto Western Hospital Foundation and the Peter Munk Cardiac Centre, University Health Network. The authors gratefully acknowledge the assistance of Ms Anfal Adawi (York University, Toronto, Canada) in collecting data. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the American Heart Association.

Author information

Authors and Affiliations

  1. Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar

    Karam Turk-Adawi

  2. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran

    Nizal Sarrafzadegan

  3. School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, British Columbia, Canada

    Nizal Sarrafzadegan

  4. Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt

    Ibtihal Fadhil

  5. International Science and Health Strategies, American Heart Association, Aeschengraben 14, 4051, Basel, Switzerland

    Kathryn Taubert

  6. Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran

    Masoumeh Sadeghi

  7. Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, 30303, Georgia, USA

    Nanette K. Wenger

  8. University Health Network, 585 University Ave, Toronto, M5G 2N2, Ontario, Canada

    Nigel S. Tan & Sherry L. Grace

  9. School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, M3J 1P3, Ontario, Canada

    Sherry L. Grace

Authors
  1. Karam Turk-Adawi
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  2. Nizal Sarrafzadegan
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  3. Ibtihal Fadhil
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  4. Kathryn Taubert
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  5. Masoumeh Sadeghi
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  6. Nanette K. Wenger
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  7. Nigel S. Tan
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  8. Sherry L. Grace
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Contributions

K.T.-A., N.S., and S.L.G. researched data and wrote the article. K.T.-A., N.S., I.F., K.T., M.S., N.K.W., and S.L.G. contributed substantially to the discussion of its content. All authors contributed to reviewing and editing the manuscript before submission.

Corresponding author

Correspondence to Nizal Sarrafzadegan.

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Competing interests

The authors declare no competing financial interests.

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Turk-Adawi, K., Sarrafzadegan, N., Fadhil, I. et al. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 15, 106–119 (2018). https://doi.org/10.1038/nrcardio.2017.138

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  • DOI: https://doi.org/10.1038/nrcardio.2017.138

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