Coronary Artery Disease Incidence, Risk Factors, Awareness, and Medication Utilization in a 10-Year Cohort Study

Abstract

Abstract Background: There is a substantial disparity in coronary artery disease (CAD) burden between Iran and other nations that place a strong emphasis on the assessment of CAD risk factors and individuals' awareness and ability to control them. Methods: Two-thousand participants of a community-based Iranian population aged 20-74 years, were investigated with a mean follow-up of 9.9 years (range: 7.6 to 12.2). An analysis of Cox regression was conducted to determine the association between CAD development and classic risk factors like age, gender, smoking, physical activity, education, obesity, dyslipidemia, hypertension, and diabetes mellitus. We calculated attributed risk percent and absolute risk reductions for risk factors and protective factors. Results: After a follow-up period of nearly 10 years, a total of 225 CAD events were reported, constituting 14.5% of the overall incidences. Nighty three percent of participants had more than one risk factor. Age was the most predictive risk factor with a hazard ratio (HR) and confidence interval (CI) of 5.56 (3.87-7.97, p <0.001) in men older than 45 and female older than 55 compared to lower ages. In comparison to females, male gender had (HR) of 1.45 (CI: 1.11-1.90, p-value=0.006) for developing CAD. Nearly 80% of the patients had dyslipidemia with a hazard ratio of 2.19 (CI: 1.40-3.44, p=0.01). Among the participants, 28.9% had hypertension, and 52% had prehypertension, which had a HR of 4.1 (2.4-7.2, p <0.001) and 2.4 (1.4-4.2, p < 0.001) respectively. Diabetes with a prevalence of 17% had a HR of 2.63 (CI: 2 -3.47, p < 0.001), but pre-diabetes was not significantly associated with CAD. Awareness of diabetes, dyslipidemia, and hypertension were 81%, 27.9%, and 48.1%, respectively. Regarding medication usage, the corresponding percentages were 51% for diabetes, 13.2% for dyslipidemia, and 41% for hypertension. Conclusions: Compared to previous studies in Iran and neighboring countries, the current study found a higher incidence of CAD, more prevalent risk factors, lower awareness and ability to control these risk factors. Thus, an effective preventive strategy is needed to reduce the CAD burden in Iran.