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Introduction: Contribution of risk factors for cardiovascular-related deaths in the Eastern Mediterranean Region Organization (EMRO) is not estimated quantitatively. Aim: To determine the avoidable burden of cardiovascular diseases (CVDs) due to hypertension, diabetes, smoking, overweight, and obesity in countries of EMRO of the WHO. Methods: The comparative risk assessment methodology was used to calculate the potential impact fraction (PIF) and percentage of the avoidable burden of CVD-related death due to associated risk factors. Population exposure levels for CVDs and corresponding measures of association were extracted from published studies. The attributable burden was calculated by multiplying the Disability-Adjusted Life-Years (DALYs) for CVDs by the estimated impact fraction of risk factors. DALYs of the CVDs in all countries of the EMRO were extracted from the GBD official website in 2016. Results: Following reduction of the current prevalence of smoking, obesity, hypertension, diabetes, and overweight to a feasible minimum risk exposure level in Lebanon, about 12.4%, 4.2%, 10.2%, 3.8%, and 5.7% of the burden of CVD-related mortality could be avoidable, respectively. The corresponding values of avoidable burden in selected EMRO countries were 5.1%, 3.5%, 9.4%, 5.9% and 5.3% in Iran and 9.5%, 4.1%, 11%, 8.2% and 5.4% in Egypt. Conclusions: Findings suggest that health policy makers of all EMRO countries should take into account the attributable burden of CVD-related mortality due to associated risk factors to effectively develop preventive interventions. [ABSTRACT FROM AUTHOR]

Background: The risk of cardiovascular events in individuals with metabolic syndrome (MetS) is higher than in general populations. We aimed at assessing the association between cardiovascular disease (CVD) and MetS and at identifying triple components that are the most predictive of future CVD events. Methods: Data on 1387 CVD-free individuals recruited in an ongoing cohort in Isfahan, Iran (ICS) were analyzed. This included serum tests and health and lifestyle questionnaires measured at baseline in 2001, 2007, and 2013. The association between CVD and MetS, irrespective of composing components, was evaluated by using logistic regression. The hazard ratio (HR) of CVD events after MetS diagnosis was calculated for different combinations by using Cox PH regression. Results: The prevalence of MetS was 34.4% at baseline, 19.5% of which was with diabetes. The prevalence of hypertension (blood pressure [BP]) and hyperglycemia (fasting plasma glucose [FPG]) increased over time. Irrespective of composing components, the odds of developing CVD in MetS individuals was higher than in those who did not develop MetS with adjusted odds ratio = 1.76; 95% confidence intervals (CI) = 1.22-2.55. Among the five most prevalent triple combinations, there was a significant association between CVD incidence and high-density lipoprotein + BP + waist circumference combination only with HR = 1.66; 95% CI = 1.04-2.67. Conclusion: Some MetS components are more likely to result in CVD. Identifying the most predictive components could help in the timely initiation of proper interventions rather than waiting for all MetS components or symptoms of CVD.

Background: This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries., Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates., Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n = 8; versus globally p < .001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n = 378, 36.3% globally; p < .001). Over 80% of programs accepted guideline-indicated patients. Nurses (n = 20, 95.2%), cardiologists (n = 18, 85.7%) and dietitians (n = 18, 85.7%) were the most common healthcare providers on CR teams (mean = 6.4 ± 2.2/program; 5.9 ± 2.8 globally, p = .18). On average, programs offered 8.9 ± 1.7/11 core components (versus 8.7 ± 1.9 globally, p = .90). These were most commonly initial assessment, management of risk factors, and patient education (n = 21, 100.0% for each), and least commonly return-to-work counselling (n = 15 71.4%). Mean dose was 27.0 ± 13.5 sessions (versus 28.7 ± 27.6 globally, p = .38). Seven (33.3%) programs offered some alternative models., Conclusion: CR is insufficiently implemented, with 2,079,283 more spots needed/year across the EMR. But where offered, CR is consistent with guidelines., (Copyright © 2019 Elsevier B.V. All rights reserved.)