As a manifestation of the epidemiologic transition being experienced throughout the developing world, the prevalence of diabetes mellitus (DM) is increasing. However, whether an individual's risk of cardiovascular diseases as a consequence of DM is also higher in these countries is unknown. We conducted a case-control study at the medical center in the state of Qatar comparing the prevalence of DM in 512 patients who were admitted with acute myocardial infarctions (MI) and 262 cases of cerebrovascular accidents (CVA) to 382 hospital and outpatient controls to calculate the odds ratios (OR) associated with DM for MI and CVA. The OR for MI was estimated to be 4.01 compared to 2.92 for other countries in the Middle East and 1.75 for North America. The OR was even higher for Qatari natives. Understanding the reasons for this increase, including genetic differences, lifestyle, and medical management issues, is critical for the design and prioritization of effective interventions.

The importance of diabetes mellitus in the global epidemic of cardiovascular disease: the case of the state of Qatar.

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, ...

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

This paper examines the inclusion of ethnicity and race as variables in current, leading edge research on chronic disease and its risk factors. Of 100 randomly selected original research articles published in high-impact journals in 2005, 85% did not report either a definition of ethnicity or its conceptualisation in terms of theoretical reasoning, and 98% did not report an actual measurement item. Ethnicity and race remain non-standardised and largely underdescribed variables in research on chronic disease. This represents an important loss of opportunity to articulate and test hypotheses about the mechanisms underlying ethnic group differences in chronic disease.

https://pmj.bmj.com/content/postgradmedj/82/973/737.full.pdf

Reporting of ethnicity in research on chronic disease: update.

Background Heart failure (HF) is an increasing problem for the aging population, specifically among women. The etiology of HF influences both the selection and outcome of the treatment. There are variations between genders in morbidity and mortality in different studies, possibly reflecting etiology. The objective of this study was to examine the strength of evidence available for gender differences in the etiology of chronic heart failure. Methods Computer-assisted searches from 19802009 for gender differences in the etiology of heart failure were performed (Medline, EMBASE and PubMed). From 2347 abstracts reviewed based on inclusion criteria, 35 original articles were chosen for review. Data extraction was based on observational studies (prospective/retrospective cohort or cross sectional) with a mean follow up of 3 months. There was no interrater variability between the 2 reviewers on data-extraction. Results Ventricular systolic dysfunction being more associated with male sex, but female sex was more reported to be associated with preserved left ventricular function. Ischemic etiology and associated coronary heart disease were strongly correlated with male sex. The risk for HF was dramatically more elevated for women with systolic hypertension but the association for diabetes mellitus as the etiology of HF was somewhat equal between males and females. Conclusions One of the limitations in reaching conclusions about gender differences in cardiovascular disease is that many major clinical trials do not include a gender analysis nor they are powered to do so as women are under-represented in most of the HF studies. The need remains for a well designed prospective study of sufficient numbers of male and female patients with and without heart failure and analyzing etiology and risk factors based on the sex differences. J Geriatr Cardiol 2011; 8: 1523. doi: 10.3724/SP.J.1263.2011.00015

Gender differences in the etiology of heart failure: A systematic review.

This study assessed whether a structured nurse-led diabetes educational program underpinned by the theories of the health belief model, change in locus of control, and patient empowerment is effective in improving glycemic and metabolic parameters among South Asians with type II diabetes compared to regular outpatient care. This was a parallel-group randomized trial in South Asian adult patients with type II diabetes living in Qatar. 460 subjects were randomized to a nurse-led, group-based diabetes educational program (n = 230) or to usual care (n = 230). The primary outcome was the improvement in HbA1c and other metabolic parameters, including lipid profile, albumin/creatinine ratio, blood pressure, and body mass index. Patients in the intervention group were invited to attend four 2-h sessions of self-efficacy improvement education once weekly. Outcomes were assessed at baseline and 12 months later. An intention-to-treat analysis was performed using repeated measures ANOVA (analysis of variance) for each of the clinical outcome variables. After 12 months, 290 patients completed the study. Subjects in the intervention group had statistically significant improvements in HbA1c (−0.55 %, p = 0.012), fasting blood sugar (−16.6 mg/dl, p = 0.022), albumin/creatinine ratio (−3.09, p < 0.001), and HDL cholesterol (+6.08 mg/dl, p < 0.0001). The inclusion of South Asian patients with type II diabetes in a structured, theory-based diabetes educational program that is led by nurses improves glycemic and metabolic parameters after 12 months.

Nurse-led theory-based educational intervention improves glycemic and metabolic parameters in South Asian patients with type II diabetes: a randomized controlled trial

This was a retrospective cohort study to assess the effect of hypertension (HTN) among Qatari and Asian patients admitted to the Hamad General Hospital in Qatar with heart failure (HF) and to identify risk factors that contribute to the development of HF in HTN patients in the State of Qatar. A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris and 60% were male. Among the total Qatari patients admitted with HF (n=2342), 52.4% had HTN. The incidence of HTN was slightly higher in males than in females (50.4 vs. 49.6%; p<0.001). Significantly more HTN patients had diabetes mellitus (DM) (p<0.001) and hypercholesterolemia (p<0.001). There was also a significant difference between Qatari and Asian HTN patients in respect of their age (p<0.001) and gender (p<0.001). Qatari hypertensive patients were more likely to have DM (p<0.001). HTN and DM were the most common risk factors for HF.

Is hypertension a predictor for heart failure? A cross cultural comparison over a 10-year period

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Is hypertension a predictor for heart failure? A cross cultural comparison over a 10-year period