Prevention during the epidemiologic shift to chronic illness: a case control study of risk factors associated with cardiovascular disease in Qatar

Abstract

Background: Cardiovascular diseases (CVD) continue to be the leading cause of death worldwide. Countries in the Arabian Gulf region are prime examples of major shifts in demographic and epidemiologic profiles leading to an increased burden of chronic illness. This study estimated the association between five preventable conditions and risk factors and the development of myocardial infarction (MI) and cerebrovascular accidents (CVA) in the population of Qatar. Methods: We conducted a case control study among patients admitted to Hamad Medical Corporation with acute MI (n = 512) or CVA (n = 262) from June 2006–June 2008. Controls (n = 382) were randomly selected from unrelated inpatient and outpatient departments. Data collected included socio-demographic information, medical/family history, lifestyle characteristics, and depression assessments. Results: Over two thirds of MI and half of CVA cases were younger than 55 years, with 12% and 7%, respectively, being under age 40. Cases were predominantly males, and Qatari nationals constituted 13% of MI and 25% of CVA cases. Approximately 40% of participants were overweight and an additional 30% were obese. Diabetes was the strongest preventable risk factor for MI (adjusted odds ratio [OR] = 3.31, 95% CI 1.97–5.57) and CVA (adjusted OR = 3.67, 95% CI 2.00–6.74). Hypertension was the second major preventable risk factor for CVA (adjusted OR = 2.73, 95% CI 1.59–4.68) and an important factor for MI (adjusted OR = 1.69, 95% CI 1.05–2.72). Minimal physical activity (defined as lack of vigorous or moderate activity for at least 10 minutes in the past month) increased the risk of MI and CVA by approximately 80%, while smoking increased the risk of MI two-fold. Exploratory analyses of the determinants of CVD among Qatari nationals identified diabetes, hypertension, high cholesterol, and smoking as potential preventable risk factors, but with higher odds ratios than other groups. Conclusions: Public health strategies to prevent MI and CVA should be based on alteration of risk factors found elsewhere in the world. However, the magnitude of these factors in Qatar suggests that the effectiveness of altering these risk factors is even more likely to have a significant impact. Designing population-level prevention interventions with awareness campaigns and supporting a culture of preventive health are critical for both Qatari nationals and the expatriate population.