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1. Effectiveness and safety of the combination of sodium–glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies

Author

Aftab Ahmad and Hani Sabbour

Subjects
Diabetes mellitus, Sodium–glucose transport protein 2 inhibitor, Glucagon-like peptide-1 receptor agonist, Cardiovascular, Meta-analysis, Observational studies, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Randomized controlled trials and real-world studies suggest that combination therapy with sodium–glucose transport protein 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with improvement in fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), body mass index (BMI), and total cholesterol levels. However, a systematic review of available real-world evidence may facilitate clinical decision-making in the real-world scenario. This meta-analysis assessed the safety and effectiveness of combinations of SGLT2is + GLP-1RAs with a focus on their cardioprotective effects along with glucose-lowering ability in patients with type 2 diabetes mellitus (T2DM) in a real-world setting. Methods Electronic searches were performed in the PubMed/MEDLINE, PROQuest, Scopus, CINAHL, and Google Scholar databases. Qualitative analyses and meta-analyses were performed using the Joanna Briggs Institute SUMARI software package and Review Manager v5.4, respectively. Results The initial database search yielded 1445 articles; of these, 13 were included in this study. The analyses indicated that SGLT2is + GLP-1RAs combinations were associated with significantly lower all-cause mortality when compared with individual therapies (odds ratio [95% confidence interval [CI] 0.49 [0.41, 0.60]; p

Published
2024
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2. Trends and findings of lipoprotein(a) testing and associated cardiovascular disease profiles: a large single-center study from the Middle East-Gulf region

Author

Yosef Manla, Laila AbdelWareth, Ronney Shantouf, Yazan Aljabery, Terrence Lee St John, Hani Sabbour, Bartlomiej Piechowski-Jozwiak, and Wael Almahmeed

Subjects
cardiovascular disease, Middle East, hyperlipidemia, lipoprotein (a), metabolic syndrome, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundLipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (CVD). Limited data are available on Lp(a) testing from the Middle-East region. Therefore, we aim to evaluate the utilization and yield of Lp(a) testing over time and characterize CVD profiles of patients with abnormal Lp(a) tasting at a single-quaternary-care center in the United Arab Emirates.MethodsUnique Lp(a) tests conducted between 07/2017 and 10-2023 were included. Overtime trends in Lp(a) test utilization and abnormal Lp(a) [defined as Lp(a) > 125 nmol/L] test findings were described. CVD rates in patients with abnormal Lp(a) were compared to those with Lp(a) ≤ 125 nmol/L using appropriate methods.ResultsIn our center, 0.95% of the patients (n = 5,677) had their Lp(a) measured, with a median level of 32 [11–82] nmol/L. Lp(a) was abnormal in 15.9% of the tests. Over the years 2018–2022, there was a 109% increase in Lp(a) testing, with concomitant up-trends in findings of abnormal Lp(a) (11.8% to 16.4%, P = 0.02). Compared to patients with Lp(a) ≤ 125 nmol/I, those with abnormal Lp(a) had higher rates of any prevalent CVD (34% vs. 25.1%, P

Published
2024
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4. From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region

Author

Talal Ashour, Sami Azar, Akram Echtay, Muhammad Farooqi, Tarek Fiad, Mohamed Hassanein, Ahmed Hassoun, Abdul Jabbar, Amin Jayyousi, Kari Ranta, Hani Sabbour, Fatih Tangi, and Ibrahim Turfanda

Subjects
cardiovascular outcomes trials, cardiovascular risk, dulaglutide, glucagon-like peptide-1 receptor agonists, gulf and levant, primary prevention, rewind, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Background: Current guidelines recommend that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardiovascular benefit should be considered for first-line therapy in patients with type 2 diabetes (T2D) who have/are at high risk of atherosclerotic cardiovascular disease (CVD). Summary: Only one GLP-1 RA – dulaglutide – has demonstrated superiority versus placebo in reducing cardiovascular risk in patients with T2D with or without a history of CVD in a cardiovascular outcomes trial (CVOT). This trial – REWIND – is the only GLP-1 RA-based CVOT that recruited patients with a CVD prevalence (31%) that is similar to the estimated prevalence in primary care T2D populations in the Gulf and Levant region. In contrast, baseline CVD prevalence in all other GLP-1 RA-based CVOTs ranged from 73 to 100%. REWIND’s results provided the European Association for the Study of Diabetes and American Diabetes Association with data on which to base updated guidelines. These organisations subsequently recommended that GLP-1 RAs should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D, and acknowledged that present evidence supporting GLP-1 RAs for primary prevention of CVD in T2D is strongest for dulaglutide but limited for other GLP-1 RAs. The Emirates Diabetes Society guidelines also support the use of GLP-1 RAs for primary cardiovascular prevention in patients with T2D. The cardiovascular benefit conferred by dulaglutide in patients with no CVD history, and the close alignment of the REWIND cohort with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D and multiple cardiovascular-risk factors, regardless of CVD history. Utilizing published data and author opinion, this review explores the importance of taking a cardiocentric approach to T2D management, and discusses the clinical implications of REWIND for people with T2D in the Gulf and Levant region. Key Messages: Guideline recommendations, including those of the Emirates Diabetes Society, state that GLP-1 RAs with proven cardiovascular benefit should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D. This recommendation was informed, in part, by REWIND; REWIND was the only CVOT to show that a GLP-1 RA (dulaglutide) reduces cardiovascular risk in patients with T2D with or without established CVD. Demonstration of cardiovascular benefit in the REWIND cohort, which aligns closely with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D, regardless of CVD history.

Published
2023
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5. Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey

Author

Magdy Abdelhamid, Kamal Al Ghalayini, Khaldoon Al‐Humood, Bülent Altun, Mohammed Arafah, Feras Bader, Mohamed Ibrahim, Hani Sabbour, Ahmed Shawky Elserafy, Hadi Skouri, and Mehmet Birhan Yilmaz

Subjects
Heart failure, HFpEF, Middle East, North Africa, Preserved ejection fraction, Turkey, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co‐morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5–16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co‐morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium‐glucose co‐transporter‐2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co‐morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.

Published
2023
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6. Cardiometabolic Guidelines: Cardiovascular Risk Assessment and Management in Patients with Dysglycemia

Author

Mohamed Hassanein, Hani Sabbour, Fatheya Al Awadi, Salah Abusnana, Bachar Afandi, Juma Al Kaabi, Alaaeldin Bashier, Francesco Cosentino, Hassan El Tamimi, Mohammed Farghali, M. Hamed Farooqi, Khadija Hafidh, Hussein Heshmat, Rabih Hijazi, Abdul Jabbar, Sami Kenz, Seema Elkhider Nour, Abdullah Shehab, Jeff Shook, Mohamed Suliman, Hosam Zaky, and Wael Almahmeed

Subjects
diabetes mellitus, cardiovascular risk, dysglycemia, cardiometabolic disorder, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Background: Cardiovascular diseases (CVDs) are the major cause of mortality and disability in patients with type 2 diabetes mellitus (T2DM). The increased risk of major cardiovascular (CV) events in patients with T2DM causes an estimated 12-year reduction in life expectancy. Despite their heightened CV risks, most T2DM patients do not meet treatment targets for multiple CV risk factors. Moreover, in the UAE, the incidence of cardiometabolic diseases is exceedingly high, impacting young patients and leading to a high burden of premature CV events. Summary: We propose this comprehensive cardiometabolic evaluation to address both glycemic control and early diagnosis of CV complications as well as early implementation of multifactorial intensive therapies that are evidence and guideline based. Widespread utilization and implementation of the guidelines in primary diabetic care, coupled with early referral to a CV or the relevant specialists, will result in a significant reduction of CV events and CV hospitalization in the UAE population. Hence, the Emirates Diabetes and Endocrine Society with the Emirates Cardiac Society collaborated for the first time to develop these recommendations. These will aid in the early identification of CV risk factors in persons with prediabetes and diabetes, as well as their effective assessment and management. These guidelines are aimed not just at primary care physicians but also specialists, perhaps leading to a more collaborative and multidisciplinary approach to the prevention, diagnosis, and treatment of patients with diabetes and CVD. Key Message: The establishment of combined cardiometabolic clinics providing comprehensive assessment and management in every major cardiology and diabetology center, particularly in patients who have already had a CV event, where the combined involvement of a cardiologist and a diabetologist in an intensive multifactorial outpatient program is urgently required to prevent recurrent CV events. In addition, establishing a National Cardiometabolic Registry is an essential element of this recommendation.

Published
2023
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7. Managing thrombotic risk in patients with diabetes

Author

A. John Camm, Hani Sabbour, Oliver Schnell, Francesco Summaria, and Atul Verma

Subjects
Atrial fibrillation, Diabetes mellitus, NOAC, Non-vitamin K antagonist oral anticoagulants, Thrombosis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract It is well known that diabetes is a prominent risk factor for cardiovascular (CV) events. The level of CV risk depends on the type and duration of diabetes, age and additional co-morbidities. Diabetes is an independent risk factor for atrial fibrillation (AF) and is frequently observed in patients with AF, which further increases their risk of stroke associated with this cardiac arrhythmia. Nearly one third of patients with diabetes globally have CV disease (CVD). Additionally, co-morbid AF and coronary artery disease are more frequently observed in patients with diabetes than the general population, further increasing the already high CV risk of these patients. To protect against thromboembolic events in patients with diabetes and AF or established CVD, guidelines recommend optimal CV risk factor control, including oral anticoagulation treatment. However, patients with diabetes exist in a prothrombotic and inflammatory state. Greater clinical benefit may therefore be seen with the use of stronger antithrombotic agents or innovative drug combinations in high-risk patients with diabetes, such as those who have concomitant AF or established CVD. In this review, we discuss CV risk management strategies in patients with diabetes and concomitant vascular disease, stroke prevention regimens in patients with diabetes and AF and how worsening renal function in these patients may complicate these approaches. Accumulating evidence from clinical trials and real-world evidence show a benefit to the administration of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with diabetes and AF.

Published
2022
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8. Management of Heart Failure in Patients With Diabetes Mellitus in the UAE: A Call to Action

Author

Hani Sabbour MD and Aftab Ahmad MD

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Therapeutics. Pharmacology, RM1-950
Abstract

Background: Heart failure (HF) is an important adverse outcome of diabetes mellitus (DM) with high rates of mortality and HF-related hospitalizations. The risk of HF is 2 times higher in patients with DM compared to those without DM. Due to under-recognition and underdiagnoses, HF is often a neglected outcome in the diabetic population. There is a dearth of data regarding the true prevalence of HF and the management protocols for diabetic patients at risk of HF in the UAE and the Middle East. This lacuna in the information has led to the inception of this “call to action” paper, which identifies the gaps in the true prevalence of HF and describes the importance of early diagnosis and appropriate management of HF in the Middle East. Methodology: An advisory board meeting was convened and a group of key opinion leaders and experts in cardiology and endocrinology assembled to describe the prevalence, diagnosis, and management of HF in diabetes patients and to present a “call to action” in the UAE and Middle East scenario. After the group discussion, key expert opinions were formulated and “call to action” recommendations were proposed. Conclusion: This “call to action” is mainly based on the available evidence from the literature and the experts’ clinical experience. Based on the new evidence from various cardiovascular outcome trials, the “call to action” highlights a series of collaborative learning regarding the role of newer antidiabetic therapies like sodium–glucose cotransporter-2 inhibitors in the prevention and management of HF. This “call to action” intends to serve as a guide for physicians, including primary healthcare providers, in their management of diabetic patients with HF.

Published
2023
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9. 目前中东和非洲国家2型糖尿病患者在管理和及时转诊心肾并发症方面的差距:专家建议

Author

Alper Sonmez, Hani Sabbour, Akram Echtay, Abbas Mahdi Rahmah, Amani Matook Alhozali, Fahad Sulman alSabaan, Fares H. Haddad, Hinde Iraqi, Ibrahim Elebrashy, Samir N. Assaad, Zaheer Bayat, Zeynep Osar Siva, and Mohamed Hassanein

Subjects
心血管风险管理, 糖尿病心肌病, 糖尿病肾病, 中东和非洲, 2型糖尿病, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region‐specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health‐seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high‐risk people with regular and systematic monitoring of cardiorenal parameters, development of region‐specific care pathways for timely referral to specialists, followed by guideline‐recommended care with novel antidiabetics are imperative. Adherence to guideline‐recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon‐like peptide 1 receptor agonists with demonstrated cardiorenal benefits—thus paving the way for overcoming care gaps in a cost‐effective manner. Leveraging digital technology like electronic medical records can help generate real‐world data and provide insights on voids in adoption of newer antidiabetic medications. A patient‐centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.

Published
2022
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10. From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis

Author

Hani Sabbour, Khwaja Yousuf Hasan, Firas Al Badarin, Haluk Alibazoglu, Andrew L. Rivard, Ingy Romany, and Stefano Perlini

Subjects
amyloidosis, ATTR, transthyretin amyloid cardiomyopathy, immunoglobulin light chain amyloidosis, differential diagnosis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic “red flags” associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis. A diagnostic algorithm centered around the use of non-invasive imaging and laboratory analysis is presented. The algorithm generates four differential diagnoses for patients presenting with signs and symptoms consistent with cardiac amyloidosis. Case examples are presented, representing the four potential outcomes of diagnosis using the algorithm. The review provides a guide on how to recognize the often-overlooked presentations of this disease in clinical practice. Non-invasive imaging techniques and diagnostic tools that do not require the involvement of a specialty center have allowed for the improved diagnosis of cardiac amyloidosis. Timely diagnosis of this life-threatening disease is essential for optimal management and it is imperative that clinicians have a high index of suspicion for patients presenting with “red flag” symptoms.

Published
2021
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11. Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases

Author

Alaaeldin Bashier, Azza Bin Hussain, Elamin Abdelgadir, Fatheya Alawadi, Hani Sabbour, and Robert Chilton

Subjects
T2DM, Consensus, CVOTs, CVDs, HF, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Abstract The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium–glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.

Published
2019
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12. Familial Hypercholesterolemia in the Arabian Gulf Region: Clinical results of the Gulf FH Registry.

Author

Khalid F Alhabib, Khalid Al-Rasadi, Turky H Almigbal, Mohammed A Batais, Ibrahim Al-Zakwani, Faisal A Al-Allaf, Khalid Al-Waili, Fahad Zadjali, Mohammad Alghamdi, Fahad Alnouri, Zuhier Awan, Abdulhalim J Kinsara, Ahmed AlQudaimi, Wael Almahmeed, Hani Sabbour, Mahmoud Traina, Bassam Atallah, Mohammed Al-Jarallah, Ahmad AlSarraf, Nasreen AlSayed, Haitham Amin, and Hani Altaradi

Subjects
Medicine, Science
Abstract

Background and aimsFamilial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain).MethodsThe multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up.ResultsAmong 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p ConclusionsThis snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a "call-to-action" for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.

Published
2021
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13. Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa

Author

Ahmad S. Hersi, Yahya S. Alhebaishi, Omar Hamoui, Taher Hassan, Adel Khalifa Hamad, Mohamed Magdy, Hani Sabbour, and Sameh Shaheen

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across the MENA region. The incidence of stroke secondary to atrial fibrillation in patients across the MENA region is higher than rates reported globally, and this might be attributed to a higher incidence of vascular risk factors and underuse of anticoagulants in patients in the MENA. The available evidence supports the established role of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of stroke in patients with NVAF. There is a consistent body of clinical trial and real-world evidence supporting their efficacy for stroke prevention in NVAF, with more favorable bleeding risk profiles relative to vitamin K antagonists, such that guidelines now recommend the use of NOACs in preference over vitamin K antagonists. There are important opportunities to improve the management of NVAF outcomes for patients with NVAF by applying evidence-based guidelines for stroke prevention. Growing experience with NOACs in the MENA region will help guide patient selection and elucidate optimal dosing strategies to maximize the clinical benefits of the NOACs. Keywords: Non-valvular atrial fibrillation, NOACs, Stroke prevention, Middle East and North Africa

Published
2018
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14. The gulf implantable cardioverter-defibrillator registry: Rationale, methodology, and implementation

Author

Alawi A Alsheikh-Ali, Ahmad S Hersi, Adel K. S. Hamad, Ahmed R Al Fagih, Faisal M Al-Samadi, Abdulmohsen M Almusaad, Fayez A Bokhari, Fawzia Al-Kandari, Bandar S Al-Ghamdi, Najib Al Rawahi, Nidal Asaad, Salem Alkaabi, Amin Daoulah, Hosam A Zaky, Omer Elhag, Yahya S Al Hebaishi, Raed Sweidan, Haitham Alanazi, David Chase, Hani Sabbour, Mohammad Al Meheiri, Ismail Al Abri, Mohammad Amin, Khaled Dagriri, Adil O Ahmed, Azam Shafquat, and Shahul Hameed Khan

Subjects
Arabian Gulf, implantable defibrillator, registry, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Results: Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute

Published
2015
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17. A cross‐sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa ( <scp>PACT‐MEA</scp> ): Study design and rationale

Author

Subodh Verma, Hani Sabbour, Naji Alamuddin, Fatheya Alawadi, Hessa Alkandari, Wael Almahmeed, Samir H. Assaad‐Khalil, Jihad Haddad, Landman Lombard, Rayaz A. Malik, Emel Mashaki Ceyhan, Preethy Prasad, Gamze Tombak, and Sam Salek

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism, Internal Medicine
Published
2023

19. Attacking the Achilles heel of cardiac amyloid nuclear scintigraphy: How to reduce equivocal and false positive studies

Author

Zainab Al Taha, Deniz Alibazoglu, Hani Sabbour, Ingy Romany, Haluk Alibazoglu, and Sabahat Bokhari

Subjects
Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Abstract

Background Planar and single-photon emission computed tomography (SPECT) nuclear imaging techniques with bone seeking radiotracers have been increasingly adopted for diagnosis of ATTR cardiac amyloidosis. However, inherent limitations of these techniques due to lack of anatomical landmarks have been recognized, with consequent high numbers of equivocal or false positive cases. SPECT/computed tomography (CT) fusion imaging offers a significant advantage to overcome these limitations by substantially reducing inaccurate interpretations. The authors present the results of a 3-year imaging quality improvement project that focused on reducing the high number of equivocal studies that were noted in the first two years of the amyloidosis program, comparing SPECT only to SPECT/CT fusion technique. Methods A retrospective, systematic analysis of 176 patient records was performed to test the premise that SPECT/CT fusion imaging has the potential to reduce equivocal and false positive results. Results Of a total of 176 patients, 35 equivocal (19.8%), 32 (18.18%) strongly suggestive, and 109 (61.93%) not suggestive cases were identified. Recognizing that this was not consistent with the international data, the authors set out on a comprehensive quality assessment project to reduce the number of equivocal and false positive cases. In patients who initially underwent SPECT only (Group A; n = 78), the addition of SPECT/CT fusion resulted in the net reclassification of 73% of cases: 100% of equivocal cases (n = 35) were reclassified to not suggestive (n = 34) or strongly suggestive (n = 1). 73% of strongly suggestive cases (n = 30) were reclassified to not suggestive (n = 22) while 8 strongly suggestive cases were confirmed as true positives. 13 not suggestive cases remained negative after SPECT/CT fusion. In cases where SPECT/CT fusion was utilized from the beginning (Group B; n = 98), there were no reclassification of any of the cases when these cases were reprocessed as a control group. Conclusion Addition of SPECT/CT imaging reduces the false positive or equivocal studies and increases the diagnostic accuracy of the test. All false positive and equivocal studies were eliminated using the fusion technique. Utilizing the fusion imaging technique increases the spatial resolution, with the ability to localize myocardial uptake and accurately differentiate from blood pool, which is a major source of error.

Published
2023

20. Pearls from the First Gulf Cardiac Amyloidosis Summit 2021

Author

Abdullah Shehab, Albena Todorova, Aysha Ahmed, Esther Gonzalez-Lopez, Fabian Knebel, Haluk Alibazoglu, Hani Sabbour, Ingy Romany, Isabel Krsnik, Juwairiah Al Ali, Khaldoon Al Humood, Marianna Fontana, Matlooba Al Zidjali, and Nishant R. Shah

Subjects
General Medicine
Abstract

Abstract: These proceedings from the First Gulf Cardiac Amyloidosis Summit held in June 2021 aimed to increase awareness of cardiac amyloidosis among the wider medical community in the region. Although the clinical presentation of cardiac amyloidosis is highly variable, a number of ‘red flags’ have been identified to raise suspicion of the disease and prompt further investigation. Accurate diagnosis of cardiac amyloidosis is challenging and relies on the integration of clinical, imaging and laboratory investigations. Recent imaging techniques, including bone scintigraphy together with a complete serum and urine workup, allow, in the majority of patients, accurate non-invasive diagnosis without the need for confirmatory endomyocardial biopsies. Early differential diagnosis between light-chain (AL) amyloidosis and amyloid transthyretin amyloidosis (ATTR) is critical for timely delivery of appropriate therapy. AL amyloidosis is a medical emergency requiring chemotherapy and supportive care. Treatment for ATTR-amyloidosis is most effective when administered early, before development of significant symptoms or cardiac dysfunction. Optimal management of patients involves close collaboration between multidisciplinary specialists, which may include hematologists, cardiologists, and other subspecialists, ideally at a designated specialty center with interest and expertise in amyloidosis.

Published
2022

21. Author response for 'A cross‐sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa ( <scp>PACT‐MEA</scp> ): study design and rationale'

Author

null Subodh Verma, null Hani Sabbour, null Naji Alamuddin, null Fatheya Alawadi, null Hessa Alkandari, null Wael Almahmeed, null Samir H. Assaad‐Khalil, null Jihad Haddad, null Landman Lombard, null Rayaz A Malik, null Emel Mashaki Ceyhan, null Preethy Prasad, null Gamze Tombak, and null Sam Salek

Published
2023

23. The First Pulmonary Hypertension Registry in the United Arab Emirates (UAEPH): Clinical Characteristics, Hemodynamic Parameters with Focus on Treatment and Outcomes for Patients with Group 1-PH

Author

Khaled Saleh, Naureen Khan, Kelly Dougherty, Govinda Bodi, Miriam Michalickova, Samiuddin Mohammed, Theodora Kerenidi, Ziad Sadik, Jihad Mallat, Samar Farha, and Hani Sabbour

Subjects
Riociguat, treprostenil, ambrisentan, selexipeg, sildenafil, General Medicine, outcomes, congenital heart disease, idiopathic pulmonary hypertension, connective tissue disease, UAE, pulmonary hypertension, hemodynamic parameters, iloprost
Abstract

Background: The aim of this study is to present the first United Arab Emirates pulmonary hypertension registry of patients’ clinical characteristics, hemodynamic parameters and treatment outcomes. Method: This is a retrospective study describing all the adult patients who underwent a right heart catheterization for evaluation of pulmonary hypertension (PH) between January 2015 and December 2021 in a tertiary referral center in Abu Dhabi, United Arab Emirates. Results: A total of 164 consecutive patients were diagnosed with PH during the five years of the study. Eighty-three patients (50.6%) were World Symposium PH Group 1-PH; nineteen patients (11.6%) were Group 2-PH due to left heart disease; twenty-three patients (14.0%) were Group 3-PH due to chronic lung disease; thirty-four patients (20.7%) were Group 4-PH due to chronic thromboembolic lung disease, and five patients (3.0%) were Group 5-PH. Among Group 1-PH, twenty-five (30%) had idiopathic, twenty-seven (33%) had connective tissue disease, twenty-six (31%) had congenital heart disease, and five patients (6%) had porto-pulmonary hypertension. The median follow-up was 55.6 months. Most of the patients were started on dual then sequentially escalated to triple combination therapy. The 1-, 3- and 5-year cumulative probabilities of survival for Group 1-PH were 86% (95% CI, 75–92%), 69% (95% CI, 54–80%) and 69% (95% CI, 54–80%). Conclusions: This is the first registry of Group 1-PH from a single tertiary referral center in the UAE. Our cohort was younger with a higher percentage of patients with congenital heart disease compared to cohorts from Western countries but similar to registries from other Asian countries. Mortality is comparable to other major registries. Adopting the new guideline recommendations and improving the availability and adherence to medications are likely to play a significant role in improving outcomes in the future.

Published
2023

25. A Review on the State of the Art in Atrial Fibrillation Detection Enabled by Machine Learning

Author

Hani Sabbour, Akram Alomainy, Ali Rizwan, Ahmed Zoha, Qammer H. Abbasi, Muhammad Imran, Ameena Saad Al-Sumaiti, and Ismail Ben Mabrouk

Subjects
Male, Computer science, Biomedical Engineering, Wearable computer, 02 engineering and technology, 030204 cardiovascular system & hematology, Machine learning, computer.software_genre, Timely diagnosis, Machine Learning, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Low energy, Atrial Fibrillation, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, Diagnosis, Computer-Assisted, business.industry, Cardiac arrhythmia, Signal Processing, Computer-Assisted, 020206 networking & telecommunications, Atrial fibrillation, medicine.disease, Female, State (computer science), Artificial intelligence, business, computer
Abstract

Atrial Fibrillation (AF) the most commonly occurring type of cardiac arrhythmia is one of the main causes of morbidity and mortality worldwide. The timely diagnosis of AF is an equally important and challenging task because of its asymptomatic and episodic nature. In this paper, state-of-the-art ECG data-based machine learning models and signal processing techniques applied for auto diagnosis of AF are reviewed. Moreover, key biomarkers of AF on ECG and the common methods and equipment used for the collection of ECG data are discussed. Besides that, the modern wearable and implantable ECG sensing technologies used for gathering AF data are presented briefly. In the end, key challenges associated with the development of auto diagnosis solutions of AF are also highlighted. This is the first review paper of its kind that comprehensively presents a discussion on all these aspects related to AF auto-diagnosis in one place. It is observed that there is a dire need for low energy and low cost but accurate auto diagnosis solutions for the proactive management of AF.

Published
2021

26. Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations

Author

Alper Sonmez, Hani Sabbour, Akram Echtay, Abbas Mahdi Rahmah, Amani Matook Alhozali, Fahad Sulman al Sabaan, Fares H. Haddad, Hinde Iraqi, Ibrahim Elebrashy, Samir N. Assaad, Zaheer Bayat, Zeynep Osar Siva, and Mohamed Hassanein

Subjects
Middle East, Africa, Northern, Diabetes Mellitus, Type 2, Endocrinology, Diabetes and Metabolism, Humans, Hypoglycemic Agents, Referral and Consultation, Sodium-Glucose Transporter 2 Inhibitors
Abstract

The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.2型糖尿病是中东及北非(MENA)和非洲(AFR)地区的一大公共卫生问题，心肾并发症(CRC)是过早发病和死亡的主要原因。心脏代谢危险因素的高发、患者和医生缺乏认识、基础设施不足以及经济限制导致MENA和AFR患者的CRC年龄显著提前。在这篇综述中，我们提出了MENA和AFR地区专家的共识和建议，强调了区域特有的挑战和潜在的区域控制中心管理解决方案。了解社会文化障碍的卫生专业人员可以通过简单的教育工具显著提高患者的意识并鼓励寻求健康的行为。增加医生在早期识别CRC和基于风险分层的个性化治疗方面的知识，同时更好地控制血糖，从而减轻治疗的惰性。必须对高危人群进行早期诊断，对心肾功能进行定期和系统的监测，制定特定区域的护理路径，及时转诊至专家，然后根据指南建议的治疗，使用新型抗糖尿病药物。遵循指南推荐的治疗可以使用钠葡萄糖共转运体2抑制剂和胰高血糖素样肽1受体激动剂，它们已被证明对心肾有好处，从而以经济高效的方式为治疗技术的鸿沟铺平道路。利用数字技术，如电子病历，可以辅助生成真实世界的数据，以填补对较新的抗糖尿病药物效果观察的空白。以患者为中心的方法、不同专科医生之间的协作护理以及政策制定者的参与是改善MENA和AFR地区患者结局和治疗质量的关键。.

Published
2022

28. Comprehensive description of the prevalence, serological and clinical characteristics, and visceral involvement of systemic sclerosis (scleroderma) in a large cohort from the United Arab Emirates Systemic Sclerosis Registry

Author

Rajaie Namas, Mohamed Elarabi, Saniya Khan, Asia Mubashir, Esat Memisoglu, Mahmoud El-Kaissi, Abhay Joshi, Jeffrey Chapman, Imad Jassim, Hiba Khogali, Nada Hassan, Hani Sabbour, Khaled Saleh, Khalid A. Alnaqbi, Ahmed S Zayat, Sehriban Diab, Zyiad Awir, Nehad Abu Taha, Amel Ginawi, Atheer Al Ansari, Hazem Rifaai, Zaid Alrawi, Afra Al Dhaheri, Gamal Ibrahim, Ahmed Abogamal, Waleed Al Shehhi, Jamal Teir, Tahir Khan, Maisam Musgrave, Beena Hameed, Bhavna Khan, Nagwa Mosallam, Nahla Hussien, Iman Hussein, Abeer Abdulelhamid, Ahmed Ali, Suad Hannawi, Mustafa Al Izzi, Humeira Badsha, and Jamal Al Saleh

Subjects
Rheumatology, Immunology, Immunology and Allergy
Abstract

Systemic sclerosis is an autoimmune condition characterized by a wide range of clinical presentations. Registries may serve to expand understanding about systemic sclerosis and aid in patient care and follow-up. The objective of this study was to analyze the prevalence of systemic sclerosis in a large cohort from the United Arab Emirates Systemic Sclerosis Registry and find the significant similarities and differences between the different subsets. All scleroderma patients in the United Arab Emirates were included in this multicenter national retrospective analysis. Data on demographics, comorbidities, serological characteristics, clinical aspects, and treatment were collected and analyzed, highlighting the most common traits identified. A total of 167 systemic scleroderma patients from diverse ethnic backgrounds were enrolled. Overall, 54.5% (91/167) of the patients were diagnosed with diffuse cutaneous systemic sclerosis, and 45.5% (76/167) with limited cutaneous systemic sclerosis. The prevalence of systemic sclerosis was 1.66 per 100,000 for the total registry and 7.78 per 100,000 for United Arab Emirates patients. Almost all patients in the diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis groups tested positive for the immunofluorescence antinuclear antibody. Antibodies against Scl-70 were significantly more associated with diffuse cutaneous systemic sclerosis, whereas anticentromere antibodies were significantly more associated with the limited cutaneous systemic sclerosis group ( p

Published
2023

29. The Gulf Familial Hypercholesterolemia Registry (Gulf FH): Design, Rationale and Preliminary Results

Author

Mohammed A. Batais, Ibrahim Al-Zakwani, Hani Sabbour, Khalid Al-Rasadi, Khalid Al-Waili, Abdulhalim Jamal Kinsara, Ahmad Al-Sarraf, Nasreen Al-Sayed, Turky H. Almigbal, Hani Altaradi, Mohammad Alghamdi, Wael Almahmeed, Zuhier Awan, Omer A. Elamin, Khalid F. AlHabib, Fahad Alnouri, Ashraf Hammouda, Mohammed Al-Jarallah, Haitham Amin, Faisal A. Al-Allaf, Heba Kary, Abdullah Shehab, and Fahad Zadjali

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Adolescent, Adult population, Consanguinity, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Hyperlipoproteinemia Type II, Middle East, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Prevalence, Humans, Medicine, Genetic Predisposition to Disease, Longitudinal Studies, Registries, 030212 general & internal medicine, Lipid clinic, Aged, Retrospective Studies, Genetic testing, Pharmacology, medicine.diagnostic_test, business.industry, Middle Aged, Prognosis, medicine.disease, Lipids, Cross-Sectional Studies, Phenotype, Research Design, Clinical diagnosis, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Lipid profile, Biomarkers, Preliminary Data
Abstract

Aim: To determine the prevalence, genetic characteristics, current management and outcomes of familial hypercholesterolaemia (FH) in the Gulf region. Methods: Adult (18-70 years) FH patients were recruited from 9 hospitals and centres across 5 Arabian Gulf countries. The study was divided into 4 phases and included patients from 3 different categories. In phase 1, suspected FH patients (category 1) were collected according to the lipid profile and clinical data obtained through hospital record systems. In phase 2, patients from category 2 (patients with a previous clinical diagnosis of FH) and category 1 were stratified into definitive, probable and possible FH according to the Dutch Lipid Clinic Network criteria. In phase 3, 500 patients with definitive and probable FH from categories 1 and 2 will undergo genetic testing for 4 common FH genes. In phase 4, these 500 patients with another 100 patients from category 3 (patients with previous genetic diagnosis of FH) will be followed for 1 year to evaluate clinical management and cardiovascular outcomes. The Gulf FH cohort was screened from a total of 34,366 patients attending out-patient clinics. Results: The final Gulf FH cohort consisted of 3,317 patients (mean age: 47±12 years, 54% females). The number of patients with definitive FH is 203. In this initial phase of the study, the prevalence of (probable and definite) FH is 1/232. Conclusion: The prevalence of FH in the adult population of the Arabian Gulf region is high. The Gulf FH registry, a first-of-a-kind multi-national study in the Middle East region, will help in improving underdiagnosis and undertreatment of FH in the region.

Published
2019

30. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East: 2021 update

Author

Nasreen Alsayed, Wael Almahmeed, Fahad Alnouri, Khalid Al-Waili, Hani Sabbour, Kadhim Sulaiman, Mohammad Zubaid, Kausik K. Ray, and Khalid Al-Rasadi

Subjects
Risk, Dyslipidaemia, Consensus, Lipid disorder, 1103 Clinical Sciences, Cholesterol, LDL, Treatment, Middle East, Cholesterol, Cardiovascular System & Hematology, Cardiovascular Diseases, Risk Factors, Humans, lipids (amino acids, peptides, and proteins), Consensus recommendations, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine, 1102 Cardiorespiratory Medicine and Haematology, Triglycerides, Dyslipidemias, Hypolipidemic Agents
Abstract

BACKGROUND AND AIMS: Disorders of plasma lipids remain key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) in the Middle East and are estimated to increase more dramatically in the next decade than in any other global region except Africa. This statement is an update to the 2016 consensus clinical recommendations for the management of plasma lipid disorders in the Middle East, following the evaluation of newer cholesterol-lowering agents in randomised controlled cardiovascular outcome trials, as well as the publication of revised international guidelines. METHODS: A multidisciplinary panel of regional experts was convened to update the consensus clinical recommendations for the management of plasma lipids in the Middle East. The recommendations constructed in 2016 were reviewed against emerging research since publication. RESULTS: Newly developed Middle East ASCVD risk categories were established using the multiple risk group categories from the recently updated international guidelines and the epidemiological evidence from the Gulf Region. These consensus recommendations support a more intensive reduction of LDL-C across cardiovascular risk categories. Alongside low-density lipoprotein cholesterol, we recommend non-high-density lipoprotein cholesterol as a primary treatment target. Lifestyle modifications remain the first-line treatment recommendation for all patients. The first-line pharmacological treatment in patients with dyslipidaemia is statin therapy, with a number of second-line agents available. The selection of a second lipid-lowering agent for combination therapy with statin should be based on the lipid-lowering target of the patient. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. New therapies have emerged from research that found positive outcomes in reducing low-density lipoprotein cholesterol levels. The initial results of these newly researched drugs strongly indicate their inclusion as future therapies in dyslipidaemia management in the Middle East. CONCLUSIONS: These updated consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.

Published
2021

31. Prevalence of Cardiovascular Risk Factors and 10-Years Risk for Coronary Heart Disease in the United Arab Emirates

Author

Abdulla Shehab, Sherif Bakir, Hani Sabbour, Asim A. Elnour, Wael Al Mahmeed, Amar M. Salam, and Doaa El Kholy

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism
Abstract

Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. Aim: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. Objective: The main objective was to report the 10-years risk for CHD in a sample of the UAE population. Methods: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). Results: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. Conclusion: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.

Published
2021

32. Patient Adherence to Novel Oral Anticoagulants (NOACs) for the Treatment of Atrial Fibrillation and Occurrence of Associated Bleeding Events: A Systematic Review and Meta-analysis

Author

Tamrat Befakadu Abebe, Abdulla Shehab, Tadessa Melaku Abegaz, Masood Uzzafer, Hani Sabbour, Ahmad Hersi, Asim Ahmed Elnour, Akshaya Srikanth Bhagavathula, and Adel Khalifa Hamad

Subjects
Male, medicine.medical_specialty, Psychological intervention, Administration, Oral, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, Medication Adherence, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Stroke, Aged, Pharmacology, Rivaroxaban, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Observational Studies as Topic, Treatment Outcome, Meta-analysis, Female, Apixaban, Observational study, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background:Real-world evidence from published observational studies of adherence to Novel Oral Anticoagulants (NOACs) medications and associated clinical outcome events in Atrial Fibrillation (AF) patients, was reviewed systematically.Methods:Observational studies assessing patient adherence to NOACs conducted on AF patients between September 2010 and June 2016 were identified by systematic searching keywords to locate eligible studies, in accordance with Cochrane guidelines. PubMed, Scopus and Google Scholar databases were searched to identify the studies. Meta-analysis was performed using a random effects model with DerSimonian-Laird weighting to obtain pooled effect sizes.Results:From 185 potentially relevant citations, 6 studies, comprising 1.6 million AF patients, were included. Among these, successful adherence to NOACs occurred in 75.6%. Adherence levels were higher in patients treated with dabigatran (72.7%) compared with those treated with apixaban (59.9%) or rivaroxaban (59.3%). However, adherence was still suboptimal (relative to an expected 80% adherence rate). Bleeding events in non-adherent patients were found to be 7.5%.Conclusion:Suboptimal adherence to NOACs among AF patients was highlighted as a significant risk factor that may affect clinical outcomes, with a higher percentage of non-adherent patients having bleeding events. There is an urgent need for research on the effects of specific interventions to improve patient adherence to NOACs and to assess the related outcome factors that may be associated with adherence.

Published
2019

33. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Author

Jie Lin, Snejana Tisheva, Ishwar C. Verma, Francesco Cipollone, Liam R. Brunham, Florentina Predica, Perla A.C. Gonzalez, Jocelyne Inamo, André R. Miserez, Belma Pojskic, Michel Farnier, Avishay Ellis, Katia Bonomo, Ibrahim Al-Zakwani, Maria Grazia Zenti, Humberto A. Lopez, Khairul Shafiq Ibrahim, Erkin M. Mirrakhimov, Alexey Meshkov, Jose P. de Moura, Muthukkaruppan Annamalai, Raul D. Santos, F. Paillard, Maria Del Ben, Jan Lacko, Miguel T. Rico, Ximena Reyes, Laura E.G. de Leon, Noor Shafina Mohd Nor, Ulrich Julius, Mohammed A. Batais, Dieter Böhm, Ta-Chen Su, Takuya Kobayashi, Magdalena Chmara, Marco Gebauer, Marcos M. Lima-Martínez, Ravshanbek D. Kurbanov, Daisaku Masuda, Amro El-Hadidy, Melanie Schüler, Francisco Fuentes, Florian J. Mayer, Helena Vaverkova, F. Ulrich Beil, Juraj Bujdak, Mario Stoll, Isabelle Ruel, Elena Dorn, Thomas M. Stulnig, Abubaker Elfatih, Rano B. Alieva, Jiri Vesely, Valérie Carreau, Cristina M. Sibaja, Sophie Béliard, Olivier Ziegler, Adriana Branchi, Daniel Schurr, G.B. John Mancini, Tai E. Shyong, Eric L.T. Siang, Mafalda Bourbon, Zerrin Yigit, Meral Kayıkçıoğlu, Jacques Genest, Wei Yu, Michal Vrablík, Shavkat U. Hoshimov, Dan Gaita, Antonio Pipolo, Ashraf H.A. AlQudaimi, Walter Speidl, Gianfranco Parati, Zaliha Ismail, Victoria M. Zubieta, René Valéro, Tomas Salek, Hana Halamkova, Gustavs Latkovskis, Nicole Allendorf-Ostwald, Agnes Perrin, Vladimir Soska, Anastasia Garoufi, Francisco Araujo, Nacu C. Portilla, Thomas Segiet, Charalambos Koumaras, Hila Knobler, Fatih Sivri, Hani Altaradi, Ivan Pećin, Long Jiang, Alexander Dressel, Marlena Woś, Jana Franekova, D. Agapakis, Quitéria Rato, Dirk J. Blom, Marcin A. Bartlomiejczyk, Krzysztof Dyrbuś, Maurizio Averna, Phivos Symeonides, Yung A. Chua, Asim Rana, András Nagy, Juan C.G. Cuellar, Alexander Jäkel, Maya Safarova, Neama Luqman, Amalia-Despoina Koutsogianni, Patrick Tounian, Jose A. Alvarez, Ada Cuevas, Corinna Richter, Sybil Charrieres, Vitaliy Zafiraki, Michalis Doumas, Angela Lux, Thanh Huong Truong, Elaine Chow, José Luis Díaz-Díaz, Jesus R.H. Almada, Sabine Füllgraf-Horst, Gustavo G. Retana, Claudio Borghi, Gianni Biolo, Ivajlo Tzvetkov, Patrícia Pais, Mehmet Akbulut, Kumiko Nagahama, Oner Ozdogan, Frank Leistikow, Jianxun He, Alexander R.M. Lyons, Poranee Ganokroj, Luis E.S. Mendia, Ann-Cathrin Koschker, Gabriela A.G. Ramirez, Dainus Gilis, Karin Balinth, José Ramiro Cruz, Paolo Calabrò, Alberico L. Catapano, Emmanouil Skalidis, Hamida Al-Barwani, Genovefa Kolovou, Carolyn S.P. Lam, Yoto Yotov, Yaacov Henkin, Gabriella Iannuzzo, Aimi Z. Razman, Alma B.M. Rodriguez, Hans Dieplinger, Darlington E. Obaseki, Ursulo J. Herrera, Arcangelo Iannuzzi, Christoph Säly, Elena Olmastroni, Francisco G. Padilla, S.A. Nazli, Ioanna Gouni-Berthold, Miriam Kozárová, Urh Groselj, Igor Shaposhnik, Lorenzo Iughetti, Nawal Rwaili, Cinthia E. Jannes, Andrea Bartuli, Mikhail Voevoda, Marat V. Ezhov, Yanyu Duan, Alper Sonmez, Mustafa Yenercag, Ariane Sultan, Natasza Gilis-Malinowska, Tavintharan Subramaniam, Mohamed Ashraf, Jing Pang, Kota Matsuki, Tao Jiang, Gerald Klose, Eduardo A.R. Rodriguez, Lucie Solcova, Riccardo Sarzani, Mahmoud Traina, Alejandra Vázquez Cárdenas, Gordon A. Francis, Adolat V. Ziyaeva, Ronen Durst, Maciej Banach, Francisco Silva, Heribert Schunkert, Børge G. Nordestgaard, Ziyou Liu, Ahmad Bakhtiar Md Radzi, Hana Rosolova, Andrea Bäßler, Abdulhalim Jamal Kinsara, Noël Peretti, Victor Gurevich, Margarita T. Tamayo, Abdullah Tuncez, Florian Höllerl, Ljubica Stosic, Jianguang Qi, Anja Kirschbaum, Jitendra P.S. Sawhney, Michael Scholl, Kausik K. Ray, Mohamed Bendary, Hapizah Nawawi, Adrienne Tarr, Barbora Nussbaumerova, B.C. Brice, Kurt Huber, Noor Alicezah Mohd Kasim, A. Rahman A. Jamal, Vaclava Palanova, Giacomo Biasucci, Pucong Ye, Eva Cubova, Roopa Mehta, Rüdiger Schweizer, Veronica Zampoleri, Jacek Jóźwiak, Alyaa Al-Khateeb, Jing Hong, Katarina Raslova, Kirsten B. Holven, Tatiana Rozkova, Reinhold Busch, Alexander Klabnik, Konrad Hein, Eloy A.Z. Carrillo, Robin Urbanek, Livia Pisciotta, Fatma Y. Coskun, Jose J.G. Garcia, Valerio Pecchioli, Azra D. Nalbantic, Weerapan Khovidhunkit, Jernej Kovac, Michaela Kadurova, Mohammed Al-Jarallah, Vita Saripo, Christos V. Rizos, Jie Peng, Ang L. Chua, Dorothee Deiss, Nor A.A. Murad, Aneta Stróżyk, See Kwok, Gökhan Alici, Gillian J. Pilcher, John J.P. Kastelein, Dmitry Duplyakov, Calin Lengher, Milena Budikova, C. Azzopardi, Christina Antza, Luis E.V. Arroyo, Khalid Al-Jumaily, Ahmad Al-Sarraf, Carlos A. Aguilar-Salinas, Erkayim Bektasheva, Arta Upena-RozeMicena, Qian Wang, Xumin Wang, Leah Leavit, Radzi Rahmat, Selim Topcu, Željko Reiner, Lorenzo Maroni, Matija Cevc, Elizabeth R. Cooremans, Masatsune Ogura, Tevfik Sabuncu, Ruy D Arjona Villicaña, Andrea Giaccari, Xuesong Fan, Auryan Szalat, Sanjaya Dissanayake, Etienne Khoury, Anja Vogt, Hermann Toplak, Alexis Baass, Isabel Palma, Gaelle Sablon, Dana A. Hay, Ya Yang, Margus Viigimaa, Erik S.G. Stroes, Dror Harats, Konstantin Krychtiuk, Zesen Liu, Aleksandra Parczewska, Yves Cottin, Yichen Qu, Mathilde Di-Fillipo, Agnieszka Konopka, Lamija Pojskic, Guadalupe J. Dominguez, Ahmet Temizhan, Roberto C. Chacon, Ibrahim E. Dural, Qiang Yong, G. Kees Hovingh, Kang Meng, Sandra Kutkiene, Julie Lemale, Reinhold Innerhofer, Alexandros D. Tselepis, Handrean Soran, Wolfgang König, Bassam Atallah, Olena Mitchenko, Jana Cepova, Eduardo M. Rodriguez, Ulrich Laufs, Norhidayah Rosman, Alena Lubasova, V. Durlach, Frederick J. Raal, Elyor Khodzhiboboev, Cristina Pederiva, Hui Yuan, Ashraf Reda, Fahad Alnouri, Konstantinos Tziomalos, Thanh T. Le, Jana Sirotiakova, Régis Hankard, Hector E.A. Cazares, Betsabel Rodriguez, Lenka Pavlickova, Assen Goudev, Julius Katzmann, Diana Boger, Wael Almahmeed, Katarina T. Podkrajsek, Sabina Zambon, Fahri Bayram, Nadia Citroni, Samir Rafla, Vincent Rigalleau, Aleksandr B. Shek, Hani Sabbour, Berenice G. Guzman, Shoshi Shpitzen, Eric Tarantino, Ahmed Bendary, Fedya Nikolov, Jean Bergeron, Stefan Kopf, Iva Rasulic, Gerald F. Watts, Muhammad I.A. Hafidz, Mehmet B. Yilmaz, Kathrin Biolik, Ira A. Haack, Robert A. Hegele, Sonia Dulong, Bartosz Wasąg, Osama Sanad, Susana Correia, Zhenjia Wang, Dana Biedermann, Christel König, Helena Podzimkova, Ihab Daoud, Mohammad Alghamdi, Dražen Perica, László Márk, Iosif Koutagiar, Volkan Dogan, Vladimir Blaha, Chandrashekhar K. Ponde, Katerina Valoskova, Amer A. Jabbar, Azhari Rosman, Sazzli Kasim, Mesut Demir, Ulugbek I. Nizamov, Aldo Ferreira-Hermosillo, Dilek Yesilbursa, Atef Elbahry, Arshad Abdulrasheed, Omer A. Elamin, Vasileios Athyros, Joanna Lewek, Gergely Nagy, Ursula Kassner, Jian Jiao, Klaus G. 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J., Stevens, C. A. T., Lyons, A. R. M., Dharmayat, K. I., Freiberger, T., Hovingh, G. K., Mata, P., Raal, F. J., Santos, R. D., Soran, H., Watts, G. F., Abifadel, M., Aguilar-Salinas, C. A., Alhabib, K. F., Alkhnifsawi, M., Almahmeed, W., Alnouri, F., Alonso, R., Al-Rasadi, K., Al-Sarraf, A., Al-Sayed, N., Araujo, F., Ashavaid, T. F., Banach, M., Beliard, S., Benn, M., Binder, C. J., Bogsrud, M. P., Bourbon, M., Chlebus, K., Corral, P., Davletov, K., Descamps, O. S., Durst, R., Ezhov, M., Gaita, D., Genest, J., Groselj, U., Harada-Shiba, M., Holven, K. B., Kayikcioglu, M., Khovidhunkit, W., Lalic, K., Latkovskis, G., Laufs, U., Liberopoulos, E., Lima-Martinez, M. M., Lin, J., Maher, V., Marais, A. D., Marz, W., Mirrakhimov, E., Miserez, A. R., Mitchenko, O., Nawawi, H., Nordestgaard, B. G., Panayiotou, A. G., Paragh, G., Petrulioniene, Z., Pojskic, B., Postadzhiyan, A., Raslova, K., Reda, A., Sadiq, F., Sadoh, W. E., Schunkert, H., Shek, A. B., Stoll, M., Stroes, E., Su, T. -C., Subramaniam, T., Susekov, A. V., Tilney, M., Tomlinson, B., Truong, T. H., Tselepis, A. D., Tybjaerg-Hansen, A., Vazquez Cardenas, A., Viigimaa, M., Wang, L., Yamashita, S., Kastelein, J. J. P., Bruckert, E., Vohnout, B., Schreier, L., Pang, J., Ebenbichler, C., Dieplinger, H., Innerhofer, R., Winhofer-Stockl, Y., Greber-Platzer, S., Krychtiuk, K., Speidl, W., Toplak, H., Widhalm, K., Stulnig, T., Huber, K., Hollerl, F., Rega-Kaun, G., Kleemann, L., Maser, M., Scholl-Burgi, S., Saly, C., Mayer, F. J., Sablon, G., Tarantino, E., Nzeyimana, C., Pojskic, L., Sisic, I., Nalbantic, A. D., Jannes, C. E., Pereira, A. C., Krieger, J. E., Petrov, I., Goudev, A., Nikolov, F., Tisheva, S., Yotov, Y., Tzvetkov, I., Baass, A., Bergeron, J., Bernard, S., Brisson, D., Brunham, L. R., Cermakova, L., Couture, P., Francis, G. A., Gaudet, D., Hegele, R. A., Khoury, E., Mancini, G. B. J., Mccrindle, B. W., Paquette, M., Ruel, I., Cuevas, A., Asenjo, S., Wang, X., Meng, K., Song, X., Yong, Q., Jiang, T., Liu, Z., Duan, Y., Hong, J., Ye, P., Chen, Y., Qi, J., Li, Y., Zhang, C., Peng, J., Yang, Y., Yu, W., Wang, Q., Yuan, H., Cheng, S., Jiang, L., Chong, M., Jiao, J., Wu, Y., Wen, W., Xu, L., Zhang, R., Qu, Y., He, J., Fan, X., Wang, Z., Chow, E., Pecin, I., Perica, D., Symeonides, P., Vrablik, M., Ceska, R., Soska, V., Tichy, L., Adamkova, V., Franekova, J., Cifkova, R., Kraml, P., Vonaskova, K., Cepova, J., Dusejovska, M., Pavlickova, L., Blaha, V., Rosolova, H., Nussbaumerova, B., Cibulka, R., Vaverkova, H., Cibickova, L., Krejsova, Z., Rehouskova, K., Malina, P., Budikova, M., Palanova, V., Solcova, L., Lubasova, A., Podzimkova, H., Bujdak, J., Vesely, J., Jordanova, M., Salek, T., Urbanek, R., Zemek, S., Lacko, J., Halamkova, H., Machacova, S., Mala, S., Cubova, E., Valoskova, K., Burda, L., Bendary, A., Daoud, I., Emil, S., Elbahry, A., Rafla, S., Sanad, O., Kazamel, G., Ashraf, M., Sobhy, M., El-Hadidy, A., Shafy, M. A., Kamal, S., Bendary, M., Talviste, G., Angoulvant, D., Boccara, F., Cariou, B., Carreau, V., Carrie, A., Charrieres, S., Cottin, Y., Di-Fillipo, M., Ducluzeau, P. H., Dulong, S., Durlach, V., Farnier, M., Ferrari, E., Ferrieres, D., Ferrieres, J., Gallo, A., Hankard, R., Inamo, J., Lemale, J., Moulin, P., Paillard, F., Peretti, N., Perrin, A., Pradignac, A., Rabes, J. P., Rigalleau, V., Sultan, A., Schiele, F., Tounian, P., Valero, R., Verges, B., Yelnik, C., Ziegler, O., Haack, I. A., Schmidt, N., Dressel, A., Klein, I., Christmann, J., Sonntag, A., Stumpp, C., Boger, D., Biedermann, D., Usme, M. M. N., Beil, F. U., Klose, G., Konig, C., Gouni-Berthold, I., Otte, B., Boll, G., Kirschbaum, A., Merke, J., Scholl, J., Segiet, T., Gebauer, M., Predica, F., Mayer, M., Leistikow, F., Fullgraf-Horst, S., Muller, C., Schuler, M., Wiener, J., Hein, K., Baumgartner, P., Kopf, S., Busch, R., Schomig, M., Matthias, S., Allendorf-Ostwald, N., Fink, B., Bohm, D., Jakel, A., Koschker, A. -C., Schweizer, R., Vogt, A., Parhofer, K., Konig, W., Reinhard, W., Bassler, A., Stadelmann, A., Schrader, V., Katzmann, J., Tarr, A., Steinhagen-Thiessen, E., Kassner, U., Paulsen, G., Homberger, J., Zemmrich, C., Seeger, W., Biolik, K., Deiss, D., Richter, C., Pantchechnikova, E., Dorn, E., Schatz, U., Julius, U., Spens, A., Wiesner, T., Scholl, M., Rizos, C. V., Sakkas, N., Elisaf, M., Skoumas, I., Tziomalos, K., Rallidis, L., Kotsis, V., Doumas, M., Athyros, V., Skalidis, E., Kolovou, G., Garoufi, A., Bilianou, E., Koutagiar, I., Agapakis, D., Kiouri, E., Antza, C., Katsiki, N., Zacharis, E., Attilakos, A., Sfikas, G., Koumaras, C., Anagnostis, P., Anastasiou, G., Liamis, G., Koutsogianni, A. -D., Karanyi, Z., Harangi, M., Bajnok, L., Audikovszky, M., Mark, L., Benczur, B., Reiber, I., Nagy, G., Nagy, A., Reddy, L. L., Shah, S. A. V., Ponde, C. K., Dalal, J. J., Sawhney, J. P. S., Verma, I. C., Altaey, M., Al-Jumaily, K., Rasul, D., Abdalsahib, A. F., Jabbar, A. A., Al-ageedi, M., Agar, R., Cohen, H., Ellis, A., Gavishv, D., Harats, D., Henkin, Y., Knobler, H., Leavit, L., Leitersdorf, E., Rubinstein, A., Schurr, D., Shpitzen, S., Szalat, A., Casula, M., Zampoleri, V., Gazzotti, M., Olmastroni, E., Sarzani, R., Ferri, C., Repetti, E., Sabba, C., Bossi, A. C., Borghi, C., Muntoni, S., Cipollone, F., Purrello, F., Pujia, A., Passaro, A., Marcucci, R., Pecchioli, V., Pisciotta, L., Mandraffino, G., Pellegatta, F., Mombelli, G., Branchi, A., Fiorenza, A. M., Pederiva, C., Werba, J. P., Parati, G., Carubbi, F., Iughetti, L., Iannuzzi, A., Iannuzzo, G., Calabro, P., Averna, M., Biasucci, G., Zambon, S., Roscini, A. R., Trenti, C., Arca, M., Federici, M., Del Ben, M., Bartuli, A., Giaccari, A., Pipolo, A., Citroni, N., Guardamagna, O., Bonomo, K., Benso, A., Biolo, G., Maroni, L., Lupi, A., Bonanni, L., Zenti, M. G., Matsuki, K., Hori, M., Ogura, M., Masuda, D., Kobayashi, T., Nagahama, K., Al-Jarallah, M., Radovic, M., Lunegova, O., Bektasheva, E., Khodzhiboboev, E., Erglis, A., Gilis, D., Nesterovics, G., Saripo, V., Meiere, R., Upena-RozeMicena, A., Terauda, E., Jambart, S., Khoury, P. E., Elbitar, S., Ayoub, C., Ghaleb, Y., Aliosaitiene, U., Kutkiene, S., Kasim, N. A. M., Nor, N. S. M., Ramli, A. S., Razak, S. A., Al-Khateeb, A., Kadir, S. H. S. A., Muid, S. A., Rahman, T. A., Kasim, S. S., Radzi, A. B. M., Ibrahim, K. S., Razali, S., Ismail, Z., Ghani, R. A., Hafidz, M. I. A., Chua, A. L., Rosli, M. M., Annamalai, M., Teh, L. K., Razali, R., Chua, Y. A., Rosman, A., Sanusi, A. R., Murad, N. A. A., Jamal, A. R. A., Nazli, S. A., Razman, A. Z., Rosman, N., Rahmat, R., Hamzan, N. S., Azzopardi, C., Mehta, R., Martagon, A. J., Ramirez, G. A. G., Villa, N. E. A., Vazquez, A. V., Elias-Lopez, D., Retana, G. G., Rodriguez, B., Macias, J. J. C., Zazueta, A. R., Alvarado, R. M., Portano, J. D. M., Lopez, H. A., Sauque-Reyna, L., Herrera, L. G. G., Mendia, L. E. S., Aguilar, H. G., Cooremans, E. R., Aparicio, B. P., Zubieta, V. M., Gonzalez, P. A. C., Ferreira-Hermosillo, A., Portilla, N. C., Dominguez, G. J., Garcia, A. Y. R., Cazares, H. E. A., Gonzalez, J. R., Valencia, C. V. M., Padilla, F. G., Prado, R. M., De los Rios Ibarra, M. O., Villicana, R. D. A., Rivera, K. J. A., Carrera, R. A., Alvarez, J. A., Martinez, J. C. A., de los Reyes Barrera Bustillo, M., Vargas, G. C., Chacon, R. C., Andrade, M. H. F., Ortega, A. F., Alcala, H. G., de Leon, L. E. G., Guzman, B. G., Garcia, J. J. G., Cuellar, J. C. G., Cruz, J. R. G., Garcia, A. H., Almada, J. R. H., Herrera, U. J., Sobrevilla, F. L., Rodriguez, E. M., Sibaja, C. M., Rodriguez, A. B. M., Oyervides, J. C. M., Vazquez, D. I. P., Rodriguez, E. A. R., Osorio, M. L. R., Saucedo, J. R., Tamayo, M. T., Talavera, L. A. V., Arroyo, L. E. V., Carrillo, E. A. Z., Isara, A., Obaseki, D. E., Al-Waili, K., Al-Zadjali, F., Al-Zakwani, I., Al-Kindi, M., Al-Mukhaini, S., Al-Barwani, H., Rana, A., Shah, L. S. U., Starostecka, E., Konopka, A., Lewek, J., Bartlomiejczyk, M., Gasior, M., Dyrbus, K., Jozwiak, J., Gruchala, M., Pajkowski, M., Romanowska-Kocejko, M., Zarczynska-Buchowiecka, M., Chmara, M., Wasag, B., Parczewska, A., Gilis-Malinowska, N., Borowiec-Wolna, J., Strozyk, A., Wos, M., Michalska-Grzonkowska, A., Medeiros, A. M., Alves, A. C., Silva, F., Lobarinhas, G., Palma, I., de Moura, J. P., Rico, M. T., Rato, Q., Pais, P., Correia, S., Moldovan, O., Virtuoso, M. J., Salgado, J. M., Colaco, I., Dumitrescu, A., Lengher, C., Mosteoru, S., Meshkov, A., Ershova, A., Rozkova, T., Korneva, V., Yu, K. T., Zafiraki, V., Voevoda, M., Gurevich, V., Duplyakov, D., Ragino, Y., Safarova, M., Shaposhnik, I., Alkaf, F., Khudari, A., Rwaili, N., Al-Allaf, F., Alghamdi, M., Batais, M. A., Almigbal, T. H., Kinsara, A., Alqudaimi, A. H. A., Awan, Z., Elamin, O. A., Altaradi, H., Rajkovic, N., Popovic, L., Singh, S., Stosic, L., Rasulic, I., Lalic, N. M., Lam, C., Le, T. J., Siang, E. L. T., Dissanayake, S., I-Shing, J. T., Shyong, T. E., Jin, T. C. S., Balinth, K., Buganova, I., Fabryova, L., Kadurova, M., Klabnik, A., Kozarova, M., Sirotiakova, J., Battelino, T., Kovac, J., Mlinaric, M., Sustar, U., Podkrajsek, K. T., Fras, Z., Jug, B., Cevc, M., Pilcher, G. J., Blom, D. J., Wolmarans, K. H., Brice, B. C., Muniz-Grijalvo, O., Diaz-Diaz, J. L., de Isla, L. P., Fuentes, F., Badimon, L., Martin, F., Lux, A., Chang, N. -T., Ganokroj, P., Akbulut, M., Alici, G., Bayram, F., Can, L. H., Celik, A., Ceyhan, C., Coskun, F. Y., Demir, M., Demircan, S., Dogan, V., Durakoglugil, E., Dural, I. E., Gedikli, O., Hacioglu, A., Ildizli, M., Kilic, S., Kirilmaz, B., Kutlu, M., Oguz, A., Ozdogan, O., Onrat, E., Ozer, S., Sabuncu, T., Sahin, T., Sivri, F., Sonmez, A., Temizhan, A., Topcu, S., Tuncez, A., Vural, M., Yenercag, M., Yesilbursa, D., Yigit, Z., Yildirim, A. B., Yildirir, A., Yilmaz, M. B., Atallah, B., Traina, M., Sabbour, H., Hay, D. A., Luqman, N., Elfatih, A., Abdulrasheed, A., Kwok, S., Oca, N. D., Reyes, X., Alieva, R. B., Kurbanov, R. D., Hoshimov, S. U., Nizamov, U. I., Ziyaeva, A. V., Abdullaeva, G. J., Do, D. L., Nguyen, M. N. T., Kim, N. T., Le, T. T., Le, H. A., Tokgozoglu, L., Catapano, A. L., Ray, K. K., and EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Borghi C

Subjects
Male, Settore MED/09 - Medicina Interna, Arterial disease, Cross-sectional study, Adult population, Coronary Disease, Disease, Global Health, Medical and Health Sciences, Doenças Cardio e Cérebro-vasculares, Anticholesteremic Agent, Monoclonal, Prevalence, Registries, Familial Hypercholesterolemia, Humanized, Stroke, 11 Medical and Health Sciences, LS2_9, Studies Collaboration, Anticholesteremic Agents, General Medicine, Heart Disease Risk Factor, Middle Aged, FHSC global registry data, Europe, Treatment Outcome, Lower prevalence, Guidance, lipids (amino acids, peptides, and proteins), Female, Proprotein Convertase 9, Familial hypercholesterolaemia, Life Sciences & Biomedicine, Human, Adult, medicine.medical_specialty, Combination therapy, FHSC global registry, heterozygous familial hypercholesterolaemia, Cardiovascular risk factors, Antibodies, Monoclonal, Humanized, Insights, Antibodies, NO, Hyperlipoproteinemia Type II, Clinician, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Health Sciences, medicine, Humans, EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Cross-Sectional Studie, Science & Technology, Global Perspective, business.industry, Cholesterol, LDL, medicine.disease, Cross-Sectional Studies, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53.6%] women) from 56 countries were included in the study. Of these, 31 798 (75.4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84.2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46.2 years (IQR 34.3-58.0); median age at diagnosis of familial hypercholesterolaemia was 44.4 years (32.5-56.5), with 40.2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17.4% (2.1% for stroke and 5.2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81.1%) were receiving statins and 3691 (21.2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5.43 mmol/L (IQR 4.32-6.72) among patients not taking lipid-lowering medications and 4.23 mmol/L (3.20-5.66) among those taking them. Among patients taking lipid-lowering medications, 2.7% had LDL cholesterol lower than 1.8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1.8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p, Pfizer Independent Grant for Learning Change [16157823]; Amgen; Merck Sharp Dohme; Sanofi-Aventis; Daiichi Sankyo; Regeneron; National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK; NIHR; Czech Ministry of Health [NU20-02-00261]; Canadian Institutes of Health Research; Austrian Heart Foundation; Tyrolean Regional Government; Gulf Heart Association, The EAS FHSC is an academic initiative that has received funding from a Pfizer Independent Grant for Learning & Change 2014 (16157823) and from investigator-initiated research grants to the European Atherosclerosis Society-Imperial College London from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK. KID acknowledges support from a PhD Studentship from NIHR under the Applied Health Research programme for Northwest London, UK (the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health). TF was supported by a grant from the Czech Ministry of Health (NU20-02-00261). JG receives support from the Canadian Institutes of Health Research. The Austrian Familial Hypercholesterolaemia registry has been supported by funds from the Austrian Heart Foundation and the Tyrolean Regional Government. The Gulf Familial Hypercholesterolaemia registry was done under the auspices of the Gulf Heart Association.

Published
2021

34. From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis

Author

Firas Al Badarin, Haluk Alibazoglu, Khwaja Yousuf Hasan, Hani Sabbour, Stefano Perlini, Andrew L. Rivard, and Ingy Romany

Subjects
medicine.medical_specialty, Specialty, Disease, ATTR, transthyretin amyloid cardiomyopathy, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Immunoglobulin Light-chain Amyloidosis, 03 medical and health sciences, 0302 clinical medicine, immunoglobulin light chain amyloidosis, differential diagnosis, medicine, Diseases of the circulatory (Cardiovascular) system, Medical diagnosis, Intensive care medicine, Original Research, amyloidosis, business.industry, Amyloidosis, medicine.disease, Cardiac amyloidosis, RC666-701, Differential diagnosis, Cardiology and Cardiovascular Medicine, Amyloid cardiomyopathy, business, 030217 neurology & neurosurgery
Abstract

Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic “red flags” associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis. A diagnostic algorithm centered around the use of non-invasive imaging and laboratory analysis is presented. The algorithm generates four differential diagnoses for patients presenting with signs and symptoms consistent with cardiac amyloidosis. Case examples are presented, representing the four potential outcomes of diagnosis using the algorithm. The review provides a guide on how to recognize the often-overlooked presentations of this disease in clinical practice. Non-invasive imaging techniques and diagnostic tools that do not require the involvement of a specialty center have allowed for the improved diagnosis of cardiac amyloidosis. Timely diagnosis of this life-threatening disease is essential for optimal management and it is imperative that clinicians have a high index of suspicion for patients presenting with “red flag” symptoms.

Published
2020

35. Abstract 16240: Knowledge of Clinical Presentation and Diagnostic Pathways for Cardiac Amyloidosis Among Physicians in the Middle East-Gulf Region: on Behalf of the Gulf Cardiac Amyloidosis Working Group

Author

Basma Alzadjali, Abdulla Shehab, Said AlSaid, Amr Badr, Khaldoon Al Humood, K. Sulaiman, Adel Khalifa, Stefano Perlinin, Juwairia Al Ali, Firas Al Badarin, Feras Bader, Haluk Alibazoglu, Nooshin Bazargani, and Hani Sabbour

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, Amyloidosis, medicine.disease, Cardiac amyloidosis, Physiology (medical), Internal medicine, Heart failure, medicine, Cardiology, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, business
Abstract

Background: There is a growing interest in raising awareness about amyloidosis as an under-recognized cause of heart failure and preserved ejection fraction (HFpEF). Recently, the prevalence of cardiac amyloidosis in the United States has increased, which may partly be attributed to initiatives from major professional societies aimed to improve patient identification and disease detection. Whether this has also impacted physicians’ knowledge about cardiac amyloidosis in the Middle East-Gulf region is unknown but critical to assess, as it would identify a need for dedicated regional educational activities. Methods: Physicians practicing in 5 Gulf countries (UAE, Bahrain, Qatar, Oman and Kuwait) were invited to participate in this anonymous, online survey by receiving a unique survey link by email. We assessed awareness of cardiac amyloidosis, knowledge of disease manifestations and approach to diagnosis. Responses to the survey were recorded using a 4- or 5-point Likert scale. Results: A total of 272 physicians participated in the survey. Most participating physicians were men (82%) and have been practicing cardiology (71%) for >10 years (65%). Whereas 83% of responders considered themselves to be somewhat or extremely familiar with signs and symptoms of cardiac amyloidosis, only 63% would consider cardiac amyloidosis as a cause of HFpEF, 59% would consider it in patients with heart failure and orthostatic hypotension while only 39% consider cardiac amyloidosis in patients with low-flow, low-gradient severe aortic stenosis. Furthermore, cardiac MRI was found to be useful for diagnosis of cardiac amyloidosis by 92% of responders, while echocardiography, cardiac scintigraphy with bone-seeking radiotracers and biomarkers were felt to be useful by only 81%, 60% and 31% of survey participants, respectively. Conclusion: Despite perceived familiarity with cardiac amyloidosis among a group of mid-career cardiologists, there is need to raise awareness about the heterogenous manifestations of the disease and about the respective roles of testing modalities in making this diagnosis.

Published
2020

36. Defying challenges: mid-term outcomes of international collaborations for a successful heart transplantation program in the middle east

Author

Guirgis Gabra, Richard Ferrer, Medhat Soliman, Bassam Atallah, Feras Bader, Iman Hamour, and Hani Sabbour

Subjects
Transplantation, Heart transplantation, Economic growth, Middle East, business.industry, Donor selection, medicine.medical_treatment, Treatment outcome, Coronary arteriosclerosis, Medicine, Cardiology and Cardiovascular Medicine, business, Term (time)
Abstract

Introduction Heart transplantation (HTx) is a successful treatment strategy for advanced heart failure. Survival rates exceed those achieved by medical therapy alone. Lack of suitable donors and cultural perception remain obstacles for receiving this novel therapy. Methods Overcoming challenges we adopted a first-of-a-kind multicenter HTx program, collaborating between Cardiac Centers in India and the United Arab Emirates (UAE). Patients were worked up as part of our newly established HTx program in the UAE, then referred to India for successful HTx. All post HTx follow-up care was continued in the UAE thereafter. Results We assessed 10 HTx recipients, [90% male; mean age 34 yrs]. Five patients required inotropes while one LVAD support pre transplant. Our data outline short waiting-list time and excellent 3 years clinical outcomes. All patients are maintained on Tacrolimus and Mycophenolate Mofetil. Two patient developed acute rejection (celluar and humoral) with graft dysfunction within 18 months. Seventy percent had non-ischemic cardiomyopathy pre-transplant. Three acquired donor transmitted coronary vascular disease. One patient developed aggressive allograft vasculopathy requiring coronary artery bypass grafting. Acute kidney injury requiring renal replacement therapy occurred in 1 patient. Conclusion Defying logistic challenges, donor availability and long HTx waiting list times, we have established a successful multi-center new concept HTx program with excellent mid-term outcome result. Diverse genetic background is evident in the presence of early coronary vascular disease in young donor hearts, requiring extra care in donor screening. This international collaboration has a promising future for new programs in the Middle East. Funding Acknowledgement Type of funding source: None

Published
2020

37. Familial Hypercholesterolemia in the Arabian Gulf Region: Clinical results of the Gulf FH Registry

Author

Mahmoud Traina, Khalid Al-Rasadi, Ahmad Al-Sarraf, Haitham Amin, Mohammad Alghamdi, Faisal A. Al-Allaf, Fahad Alnouri, Khalid Al-Waili, Turky H. Almigbal, Hani Sabbour, Khalid F. AlHabib, Fahad Zadjali, Hani Altaradi, Mohammed Al-Jarallah, Abdulhalim Jamal Kinsara, Wael Almahmeed, Bassam Atallah, Nasreen Al-Sayed, Zuhier Awan, Ahmed AlQudaimi, Ibrahim Al-Zakwani, and Mohammed A. Batais

Subjects
Male, Oman, Epidemiology, Cardiovascular Procedures, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Biochemistry, Vascular Medicine, 0302 clinical medicine, Medical Conditions, Risk Factors, Prevalence, Medicine and Health Sciences, Outpatient clinic, Coronary Heart Disease, 030212 general & internal medicine, Registries, Familial Hypercholesterolemia, Lipid clinic, education.field_of_study, Multidisciplinary, Coronary Artery Bypass Grafting, medicine.diagnostic_test, Atherosclerotic cardiovascular disease, Serine Endopeptidases, Drugs, Middle Aged, Lipids, Cholesterol, Kuwait, Genetic Diseases, Cardiovascular Diseases, Bahrain, Medicine, Female, Statin therapy, medicine.drug, Research Article, medicine.medical_specialty, Science, Population, Saudi Arabia, Cardiology, United Arab Emirates, Surgical and Invasive Medical Procedures, Hyperlipoproteinemia Type II, 03 medical and health sciences, Ezetimibe, Internal medicine, medicine, Humans, education, Genetic testing, Clinical Genetics, Pharmacology, business.industry, Autosomal Dominant Diseases, Statins, Biology and Life Sciences, Cholesterol, LDL, Cardiovascular Disease Risk, medicine.disease, Medical Risk Factors, business
Abstract

Background and aims Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain). Methods The multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up. Results Among 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p Conclusions This snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a “call-to-action” for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.

Published
2020

39. P281 Factors influencing apixaban dosing in the middle east gulf region

Author

Hani Sabbour, W. S. El Nekidy, Bassam Atallah, S Alsolh, Wael Almahmeed, and K Almuti

Subjects
medicine.medical_specialty, Middle East, business.industry, Pharmacy, Atrial fibrillation, medicine.disease, Pharmacy (field), Stroke prevention, CHA2DS2–VASc score, Emergency medicine, Medicine, Apixaban, Dosing, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background Approved dose adjustment criteria for apixaban are based on the clinical trial. Adjustments require presence of 2 of 3 criteria. In the ARISTOTLE trial, 4.7% of patients met those criteria. Real world data show much higher utilization of the lower dose. Accurate statistics on the prevalence and predictors of such dosing in the Middle East Gulf region are lacking. Purpose We sought to explore the appropriateness of apixaban dosing and to predict the factors influencing physician dosing strategies at a tertiary care center in our United . Methods We performed a retrospective chart review of patients receiving apixaban for atrial fibrillation from our hospital-based outpatient pharmacy between April 1, 2015 and October 1, 2018. Patients with missing data or on apixaban for other indications were excluded. Results A total of 232 patients were included with a mean follow-up of 400 ± 271 days. The mean age was 66.0 ± 13.2 years, 45.5% female, mean weight 82.4 ± 44.7 kg, mean serum creatinine 1.0 ± 0.4 mg/dL, CHA2DS2VASc 3.7 ± 1.8, and 30.1% were on at least 1 concomitant antiplatelet drug. Seventy three patients (31.3%) received a reduced apixaban dose of 2.5 mg twice daily. Deviation from recommended criteria was seen in a total of 62 patients (26.6%), most being under-dosed (93.5%). The significant predictors of underdosing in our model were older age (risk of under-dosing increases by 7.2% for each additional year of age) and eGFR 30 to 60 mL/min/1.73 m2. Conclusion Under-dosing of apixaban is prevalent in the Middle East Gulf region. Advancing age and eGFR are the main predictors of under-dosing. More education is needed to optimize dosing of apixaban for stroke prevention in AF. Table 1 % Change in Odds Ratio Variables coef. std. error p expected min max Intercept -1.563 0.223 0.000 Age 0.069 0.022 0.002 7.2% 2.5% 12.1% eGFR (30-60 relative to >60) 1.583 0.625 0.011 386.9% 39.6% 1597.8% Table 1. Stepwise logistic regression model for predictors of apixaban underdosing. Adjusted for serum creatinine, weight, BMI, gender, CHADS2-VASc score, concomitant antiplatelets, and eGFR < 30 or > 60 mL/min/m2

Published
2020

40. Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa

Author

Sameh Shaheen, Yahya Alhebaishi, Taher Hassan, Omar Hamoui, Hani Sabbour, Ahmad Hersi, Mohamed Magdy, and Adel Khalifa Hamad

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, business.industry, medicine.drug_class, Incidence (epidemiology), Atrial fibrillation, Review Article, macromolecular substances, Guideline, 030204 cardiovascular system & hematology, Vitamin K antagonist, medicine.disease, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Systematic review, lcsh:RC666-701, Physical therapy, Medicine, 030212 general & internal medicine, Dosing, business, Intensive care medicine, Stroke
Abstract

Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across the MENA region. The incidence of stroke secondary to atrial fibrillation in patients across the MENA region is higher than rates reported globally, and this might be attributed to a higher incidence of vascular risk factors and underuse of anticoagulants in patients in the MENA. The available evidence supports the established role of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of stroke in patients with NVAF. There is a consistent body of clinical trial and real-world evidence supporting their efficacy for stroke prevention in NVAF, with more favorable bleeding risk profiles relative to vitamin K antagonists, such that guidelines now recommend the use of NOACs in preference over vitamin K antagonists. There are important opportunities to improve the management of NVAF outcomes for patients with NVAF by applying evidence-based guidelines for stroke prevention. Growing experience with NOACs in the MENA region will help guide patient selection and elucidate optimal dosing strategies to maximize the clinical benefits of the NOACs. Keywords: Non-valvular atrial fibrillation, NOACs, Stroke prevention, Middle East and North Africa

Published
2018

41. The Changing Landscape for Stroke Prevention in AF

Author

Mercedes Samson, Siegfried Frickel, Hirosi Meno, Niels Gadsbøll, Sébastien Prévôt, Sorin Alexandru Antonescu, Xiaodong Li, Tetsuya Haruna, Zicheng Li, Catarina Fonseca, Ralf Zahn, Shahid Aziz, Takashi Tsutsui, Galal Kerfes, Elisabeth Louise Zeuthen, Lluís Mont, Angelika Tamm, Bogdan Minescu, Eric Lo, Gerardo Ansalone, Malcolm Foster, Tristan Mirault, Nabil Andrawis, Apostolos Katsivas, Imad Kreidieh, Juliano Novaes Cardoso, Margaret Ikpoh, Dimitar Raev, Said Chaaban, Dan Tesloianu, Philippe Loiselet, Joachim Gmehling, Joseph Hakas, Steven Forman, Ernst Günter Vester, Bettina Schmitz, Hassan El-Sayed, Hiroshi Tsutsui, Salvatore Pirelli, Jens Taggeselle, Arnljot Tveit, David Smith, Manuel De Los Rios Ibarra, Rafael Salguero, Jindrich Spinar, Vanja Bašić Kes, Jose Walter Cabrera Honorio, Adrien Salem, Gavino Casu, Jean Michel Quedillac, Ana Fruntelata, Peter Siostrzonek, Dmitry Napalkov, Luthando Adams, Valeria Calvi, Jeff S. Healey, Magnus Forsgren, Larisa Kalinina, Ratika Parkash, P. F.M.M. Bergen van, Carmen Manuela Muresan, H. Gorka, Andreas Mügge, Gustavo Maid, Serge Yvorra, Alexander Paraschos, Bernhard Witzenbichler, Viktor Peršić, Jeong Su Kim, Dong Jin Oh, Yutaka Furukawa, Steve Compton, Ravikiran Korabathina, Tammam Al-Joundi, Muzahir H. Tayebjee, Robert Betzu, David J. Cislowski, Alon Steinberg, Carisi Anne Polanczyk, Sanjiv Petkar, Andy Lam, Mingsheng Wang, Galina Ivanchura, Ruediger Seebass, Thomas Guarnieri, Seth H. Baker, Paula Carvalho, Brian First, Konstantinos Makaritsis, Alex C. Spyropoulos, Mohiburrahman Sirajuddin, Richard Bala, David Goldscher, G. Larsen Kneller, Ki Seok Kim, Sherman Tang, Venkat Iyer, Payman Sattar, Yamile Porro, Gregory Y.H. Lip, Christa Raters, Olivier Gartenlaub, Elizaveta Panchenko, Niccolo' Marcionni, Ole Nyvad, Sibel Zehra Aydin, Kenji Kawajiri, Dipankar Dutta, Gabriel Contreras Buenostro, Shaival Kapadia, Harry J.G.M. Crijns, Miroslav Rubacek, Myriam Brunehaut, Igor Diemberger, Kyle Rickner, Katsumi Tanaka, Moon Hyoung Lee, Pamela Nerheim, Jose Carlos Moura Jorge, Michael Gumbley, Katie Randall, Francesco Melandri, Sunil Chand, Harukazu Iseki, Thalie Traissac, Ningfu Wang, Ghiath Mikdadi, Peter D. Schellinger, Andrew M. Rubin, Conrad Genz, Karl Heinz Seidl, Maurice Pye, Giorgio Annoni, Adalberto Menezes Lorga Filho, William H. Pentz, Lisa Schmitz, Gary Miller, Didier Smadja, Elena Khludeeva, David Hargroves, Hans-Christoph Diener, Tiziano Moccetti, Azlisham Mohd Nor, Kai Koenig, F. A. Rooyer, Kiyoo Mori, Carlos Gonzalez Juanatey, Jan Beyer-Westendorf, Charles Landau, Steven B Eisenberg, Hugh F. McIntyre, Emilio Gonzalez Cocina, Erik May, Gyo-Seung Hwang, Alberto Giniger, Karl-Heinz Kuck, Yan Carlos Duarte Vera, Vladimir Gorbunov, Priya Nair, Shih Ann Chen, Beat J. Meyer, Donghui Zhang, Feng Wang, Richard J.H. Smith, Michele Massimo Gulizia, Darko Pocanic, Abul Azim, Jose Maria Lobos, Patrick Leprince, Peter Vanacker, Marica Bracic Kalan, James Crenshaw, Ewa Nowalany-Kozielska, Ayham Al-Zoebi, Eiji Hishida, Louis Essandoh, Younghoon Kim, Yanmin Yang, Dhiraj Gupta, Fausto J. Pinto, Arnold Pinter, Stanley Koch, Luis Felipe Pezo, Dzifa Wosornu Abban, Martin S. Green, Chrystalenia Kafkala, Zhitao Liu, Jose Luis Llisterri, Su Mei Angela Koh, Lin Chih-Chan, Ruth Davies, Ursula Rauch-Kroehnert, Julio Tallet, Juan Benezet-Mazuecos, Andreas Kastrup, Rohit Malhotra, Serge Timsit, Thierry Frappé, Kostas Oikonomou, Ameer Kabour, Kishor Vora, Douglas Roberts, Carlos Scherr, Pedro Dionísio, Nicoleta Violeta Miu, Eve Gillespie, Petr Povolny, F.R. Grondin, Philippe Lyrer, Raymond Fisher, Philip O'Donnell, Nima Amjadi, Juan Vazquez, Lynn Corbett, Patrick Peters, Jing Zhou, Thomas Kümler, Danny H.K. Wong, Evaldas Giedrimas, William McGarity, Frank L. Silver, Emmanuel Touzé, Ana Leitão, Suk keun Hong, Marwan Salfity, Constantin Militaru, S T Matskeplishvili, Johannes A. Kragten, Sam Henein, Anthony D'Souza, B. J. Krenning, Francesco Chiarella, Rene Casanova, Stephan Willems, Yong Keun Cho, Tae Joon Cha, Stewart Pollock, Rajendra Moodley, Rosa Ysabel Cotrina Pereyra, Volker Laske, Zhanquan Li, Kenneth B. Harris, Johnny Dy, Gabriele Guardigli, Hisham Kashou, Norberto Matadamas Hernandez, Zdravka Poljaković, E. Decoulx, Paul Wakefield, Sung Ho Her, Fatma Qaddoura, Giuseppe Boriani, Younus Ismail, Franz Goss, Shigeru Fujii, J. R. Groot de, Ming Shien Wen, Rui Candeias, Thomas Rebane, Juan Carlos Arias, Robert Jobe, Nicolas Ley, Taishi Sasaoka, Luigi Ria, Jonathan Banayan, Paul McLaughlin, Sergei Zenin, Luis E. Martinez, Thuraia Nageh, Fabrizio Ammirati, M. E.W. Hemels, Yutaka Shimizu, Elina Trendafilova, Maxime Fayard, Randeep Suneja, Attilia Maria Pizzini, Mark B. Abelson, Rabih R. Azar, Jian Zhou, Valerie Bockisch, Martin Koschutnik, James Hitchcock, Vlad Ciobotaru, Didier Irles, Patrik Michel, Witold Streb, John F. Corrigan, Ajit Singh Khaira, Marco Antônio Mota Gomes, Richard Tytus, Christian Hall, Antonius Ziekenhuis, Catherine Mallecourt, David J. Williams, Doo Il Kim, Brian Gordon, Salvatore Novo, Soufian Al Mahameed, Anil Shah, N. Joseph Deumite, Brent T. McLaurin, Ruth H. Strasser, Somnath Kumar, Genshan Ma, Aurel Cracan, Rajiv Mallik, Anthony Vlastaris, Francesco Perticone, Julio Alberto Aguilar Linares, Angel Moya, William Ashcraft, Steven Lupovitch, Renate Weinrich, Ralph F. Bosch, Gerald Ukrainski, Jon Arne Sparby, Norbert Schön, Pierre Jean Scala, Steven E. Hearne, Mark Roman, Ramin Farsad, Werner Rieker, Guillaume Cayla, Ramon Freixa, Hidemitsu Nakagawa, Kunihiro Nishida, Thomas J. Mulhearn, Tak W. Kwan, Jeffrey Shanes, Tiziana Tassinari, Ka Sing Lawrence Wong, Kneale Metcalf, Dominique Lejay, Daniel Savard, Pierre Chevallereau, Gilles O'Hara, Milan Mikus, Hiroshi Fukunaga, Olga Korennova, Xavier Ducrocq, Edvard Berngard, Mario Bo, Hoi Fan Chow, E. Ronner, Yuriy Grinshstein, Amparo Mena, Sidiqullah Rahimi, Axel Brandes, Shigenobu Bando, Freddy Del-Carpio Munoz, Jonathan L. Halperin, Ronald D. Jenkins, Carlos Rodríguez Pascual, Alain Lacroix, Sergio Agosti, Franklin Handel, Aylmer Tang, Nan Jiang, Diana A. Gorog, Dimitrios Stakos, Gerald Greer, Dudley Goulden, Martin Grond, Oran Corey, Stellan Bandh, Efrain Gonzalez, Alexander Klein, Jacques Scemama, Amelie Elsaesser, Nathan Foster, Francesco Fedele, Dinesh Mistry, Alberto Caccavo, Bjørn Bratland, Jean Marc Davy, D. J. Boswijk, Abdullah Al Ali, Muhammad Khalid, Terry McCormack, Clare Seamark, Enrico Passamonti, Zoran Olivari, Simon W Dubrey, Wlodzimierz Musial, Antonio Martín Santana, Jianqiu Liang, Manuel de Mora, Dmitry Dupljakov, Nicholas Jones, Mohamed Alshehri, Paul Charbel, John Bullinga, Petr Polasek, Hossein Almassi, Reza Mehzad, Gamal Hussein, Marcus Wiemer, Ali Sharareh, Alexandra Finsen, David Huckins, Denis Angoulvant, Matthias Leschke, Craig Vogel, Stefan Schuster, Juan E. Mesa, Yong Seog Oh, Axel De La Briolle, Jacek Kowalczyk, Louise Shaw, Eduardo de Teresa, Stefan Naydenov, Hubert Vial, Ian I Joffe, Christoph Kleinschnitz, Takeshi Yamashita, A. Salvioni, Aman M. Shah, Michael Renzi, Claude Brunschwig, Ioannis Styliadis, Ravi Bhagwat, Julian Coronel, Asok Venkataraman, Zayd Eldadah, Dinesh Singal, Byung Chun Jung, Michael Lillestol, Mirza S. Baig, Jose Polo, Ira Dauber, Olga Barbarash, Kristina Zint, Pavel Galin, P. J. A. M. Brouwers, Ki Byeong Nam, Andrey Ezhov, Kevin F. Browne, Iveta Sime, Tetsuo Sakai, Jean Louis Georges, Manish Jain, Alexey Nizov, Jean Dillinger, Arif Elvan, John Barton, Rainer Zimmermann, Junji Kanda, Clare Holmes, Werner Jung, Aurélien Miralles, Tatiana Novikova, Steven Georgeson, Yorihiko Higashino, Akira Yamada, David Sprigings, Haroon Rashid, J. W.M. Eck van, Bernard Erickson, Barry Seidman, Koji Kajiwara, Kannappan Krishnaswamy, Daniel Ferreira, Sébastien Armero, Brian Wong, Dong Gu Shin, Ludovic Chartier, Priit Kampus, Francisco Marín, Rickey Manning, Martin Köhrmann, Edward J. Kosinski, Bengt Johansson, Y. S. Tuininga, Simon Cattan, Sergio Dubner, Imran Dotani, Wenchi Kevin Tsai, Gregorio Sanchez, Edwin Blumberg, Charles Crump, Frank Jäger, Christoforos Olympios, Matthew Hoghton, Xinwen Zhao, Derek Muse, Alexandre Guignier, Toby Black, Yuichiro Takagi, Phil Keeling, Richard A. Bernstein, Omar Elhag, Jean Ernst Poulard, Fernando Gabriel Manzur Jattin, James Hampsey, Shahid Mahmood, Steffen Behrens, Tianlun Yang, Elena Dotcheva, Krishnan Challappa, Nam Ho Kim, Claudio Cavallini, Eric Espaliat, Martin James, June Soo Kim, Marc Roelke, Harold Thomas, Charles A. Shoultz, Rami El Mahmoud, José Francisco Kerr Saraiva, Jürgen vom Dahl, Xuebo Liu, Dong Ju Choi, Sergio Mondillo, Ian Parker, Kazuya Yamamoto, Rafael Martin Suarez, Karla M. Kurrelmeyer, Akber Mohammed, Nikitas Moschos, Benoit Coutu, Georgios Hananis, Hamed M. Zuhairy, Giovanni Baula, Suchdeep Bains, Menno V. Huisman, Heng Jiang, Jaroslaw Sek, Yoto Yotov, Malik Ali, Dalmo Antonio Ribeiro Moreira, Torben Larsen, Raed Osman, Marie Paule Houppe Nousse, Shulin Wu, Arturo Raisaro, Efrain Alonso Gomez Lopez, Violeta Cindea Nica, Eduardo Julián José Roberto Chuquiure Valenzuela, Wladmir Faustino Saporito, Changsheng Ma, Francesco Romeo, Jorge Martínez, M. Shakil Aslam, Kenneth J. Rothman, Kamal Al Ghalayini, Magdy Mikhail, Charles Augenbraun, Andreas Wilke, Peter Goethals, John D. McClure, Humberto Rodriguez Reyes, Peter Schoeniger, Nabil Jarmukli, Elizabeth S. Kaufman, Nathalie Duvilla, Jens Wicke, Kausik Chatterjee, Philippe Audouin, Dragan Kovacic, Xingwei Zhang, Brad Frandsen, Alberto Conti, Francisco Aguilar, Sasalu Deepak, Geir Heggelund, David S. Rosenbaum, Sergey P. Golitsyn, Alessandro Capucci, Rodolfo Sotolongo, Begoña Sevilla, François Poulain, Thomas Ronzière, Naseem Jaffrani, Dominik Michalski, Jose Lopez-Sendon, Silvia Di Legge, Bernard Jouve, Chang Sheng Ma, Robert Parris, Sumeet K. Mainigi, Jing Yao, Lars Udo Krause, Ulrich Tebbe, Quansan Zhang, Mathieu Amelot, Peter Crean, Benzy J. Padanilam, Nicolas Breton, Fernando Tomas Lanas Zanetti, Subhash Banerjee, Andrew I. Cohen, Michel Galinier, Jacek Miarka, Gerian Grönefeld, Vicente Bertomeu, Mariusz Gierba, Danny, Anna Ferrier, Luciano Marcelo Backes, Lianqun Cui, Eun-Seok Shin, Andreas Meinel, Jay Koons, Jen Yuan Kuo, Brett Graham, Antonio Garcia Quintana, Michael Hill, Sylvain Destrac, Janko Szavits-Nossan, Shanglang Cai, Joaquín Osca, Luis Aguinaga, Hemal M. Nayak, Chander Arora, Shinji Tayama, Diana Delić Brkljačić, Tiemin Jiang, Miguel Agustin Reyes Rocha, Ronan Collins, Davide Imberti, Kwang Soo Cha, Matthias Gabelmann, Alfredo Astesiano, Christian Weimar, William Eaves, Tatiana Ionova, Khalid Almuti, Thierry Schaupp, Bernhard Paul Lodde, Darlene Elias, Yuichiro Nakamura, Raed Al-Dallow, Eric Parrens, Weihua Li, Alan Bell, Noah Israel, Nadezda Rozkova, Nediljko Pivac, Nooshin Bazargani, Armando Pineda-Velez, Hyung Wook Park, Amin Karim, Clemens Steinwender, Davor Milicic, Gonzalo Barón, Robert Topkis, Mehrdad Ariani, Craig S. Barr, Paulo Bettencourt, Roberto Zanini, Andrew Moriarty, Pascal Goube, Fausto Rigo, Irene Madariaga, Atsushi Sueyoshi, Małgorzata Lelonek, Kevin R. Wheelan, Richard Huntley, Donald Brautigam, Jacek Gniot, Ido Lori, Dragos Vinereanu, Daniel Lee, Kouki Watanabe, Michael Vargas, Natalya Koziolova, James S. Zebrack, Basel Hanbali, Cesare Greco, José Luis Zamorano, Rajesh Patel, Fernando Carvalho Neuenschwander, Sergio Luiz Zimmermann, Shuiping Zhao, Pedro Adragão, Karl Heinz Schmitz, Abdelfatah Alasfar, Olga Ferreira de Souza, David N. Pham, Mark Dayer, Thomas Davee, Yoshiki Hata, Mika Skeppholm, Martin O'Donnell, David Molony, Joe Hargrove, Hani Sabbour, Pascal Defaye, Jochen Bott, Dora Ines Molina de Salazar, Anthony Clay, Giancarlo Landini, Michael McGuire, Dae Kyeong Kim, A. Shekhar Pandey, Bouziane Benhalima, Serge Cohen, Aamir Cheema, Matthias Claus, Marcus L. Williams, Qiangsun Zheng, Karim Bakhtiar, Hailong Lin, Sergio Berti, David Hartley, Libor Nechvatal, Rami Mihail Chreih, Domingo Pozzer, James Capo, John Floyd, Bhola Rama, Harald Darius, Ioannis Mantas, Pareed Aliyar, Carlos Barrera, Galina Ketova, Mark Chang, Alan J. Bank, José Ferreira Santos, Samir Turk, Lakshmanan Sekaran, Adam Ellery, Aurélie Buhl, Naomasa Miyamoto, Kuo Ho Yeh, Nicolas Mousallem, Hassan Soda, Dimitrios J. Richter, Zhaohui Wu, Tim Edwards, Kai Sukles, Koji Maeno, Huanyi Zhang, Paolo Verdecchia, Alexandros Gkotsis, Joe Pouzar, Philippe Berdagué, Edoardo Gronda, Olesya Rubanenko, Cristian Podoleanu, Mariano Ruiz Borret, Guillermo Llamas Esperon, Iveta Mintale, Hideki Shimomura, Dadong Zhang, Angelo Amato Vicenzo de Paola, Kenneth Butcher, Pascal Tessier, Minang Turakhia, Peter Svensson, Shabbir Reza, Herbert Pardell, Wilfried Lang, Holger Poppert, Alan Ackermann, Olivier Citerne, Emil Hayek, Yang Zheng, Jin bae Kim, Lorenzo Fácila, Tetsuo Hisadome, Li Sun, Panagiotis Vardas, Angel Grande, Piers Clifford, C. Zwaan van der, Nicki Law, Ilsbe Salecker, Steven Isserman, Shozo Tanaka, Dorothee B. Bartels, Yann Hemery, Susanna Cary, Mehiar El-Hamdani, Indira Natarajan, Miney Paquette, C. Wilson Sofley, Charles C. Gornick, Fu-Tien Chiang, Ellen Bøhmer, Hiroki Yamanoue, Toru Nakayama, Chakri Yarlagadda, Ciro Indolfi, Narendra Singh, Juan Carlos Nunez Fragoso, Eisho Kyo, Laurent Deluche, Andreas Götte, Stephen Phlaum, Jong Sung Park, Paresh Mehta, Terrence C. Hack, Fred Cucher, Olivier Dibon, Chia Theng Daniel Oh, Shannon Twiddy, Sean Connors, Edo Bottacchi, Beata Wożakowska-Kapłon, Ronald B. Goldberg, Jordi Bruguera, James J. Kmetzo, Jeanne Wei, John Kazmierski, Pilar Mazón, M Frais, Kazuya Kawai, Dimitrios Alexopoulos, Abayomi Osunkoya, Wanda Sudnik, Ramon Horacio Limon Rodriguez, William J. French, Ira Lieber, Rajesh Aggarwal, Stuart W. Zarich, John A. Puleo, David Cudmore, Jost Henner Wirtz, Ute Altmann, Kyung Tae Jung, Jennifer Litchfield, Jei Keon Chae, Rainer Dziewas, James Neiman, Karin Rybak, Galina Chumakova, Riccardo Pini, Richard Oliver, Benoit Lequeux, Athanasios J. Manolis, Luisa Fonseca, César A. Jardim, Katsuhiro Matsuda, Paul Hermany, Ming Luo, Ronnie Garcia, Oscar Pereira Dutra, John Culp, Amrit Pal Singh Takhar, Victor Howard, Oyidie Igbokidi, Kuo Yang Wang, Britta Goldmann, Thomas Walter, Mohamed K. Al-Obaidi, Antonio Pose, Christine Teutsch, Arthur J. Labovitz, Thomas Folk, Nell Wyatt, A. Huizenga, Benhur Henz, Konstantin Protasov, Petra Maskova, Ioannis Goudevenos, Kier Huehnergarth, Elena Kinova, Georgios Stergiou, Guohai Su, Hüseyin Ince, Chi Hung Huang, Winfried Haerer, Saad Al Ismail, Michael Gabris, Brian Carlson, Feng Liu, Yansheng Li, Luis Gustavo Gomes Ferreira, Radosław Lenarczyk, Ruben Omar Iza Villanueva, Nandkishore Ranadive, Yong Xu, Oscar Saenz Morales, Wayne Turner, Aleksey Khripun, Paul G. Grena, Yusuke Fujino, Abraham Salacata, Aleksandar Knezevic, Fouad Elghelbazouri, Hamid Bayeh, Mikhail Torosoff, Martin Cooper, Alenka Mavri, Marina Freydlin, Vassilios Vassilikos, Naresh Ranjith, Laurent Prunier, E. Hoffer, George Mitchell, Javier León Jiménez, S.S. Kabbani, Waldemar Krysiak, Emmanuel Nsah, John Ip, Charles B. Eaton, Jérome Thevenin, Dimitrios Chrysos, Asaad Bakbak, L. Steven Zukerman, Maria Grazia Bongiorni, Matthias von Mering, Lisa Alderson, Jean Joseph Muller, Yann Jamon, Roger Moore, Harinath Chandrashekar, Athanasios Pras, Venkatesh Nadar, B. J. Berg van den, Tomas Ripoll, Eric Van De Graaff, Patrick Dary, Peter L. Schwimmbeck, James Poock, Robert Schnitzler, Rohit Arora, Vuong DuThinh, Uwe Gremmler, Nuno Raposo, Chirag Sandesara, Ping Yen Bryan Yan, Junya Shite, Andrea Berz, Isabel Egocheaga, Karine Lavandier, Jose M. Teixeira, Ewart Jackson-Voyzey, Mayar Jundi, Ignacio Iglesias, Stephen Bloom, Hans Rickli, Rudolph Evonich, Giulio Molon, Vinay Shah, Salvador Bruno Valdovinos Chavez, Walter Ageno, Mauro Esteves Hernandes, Ali Ghanbasha, Stefan Regner, Luc De Wolf, Abdel El Hallak, Mohammad Shoukfeh, Francesco Musumeci, Pablo Andres Sepulveda Varela, Gershan Davis, Xianyan Jiang, Matthew Ebinger, Xiangdong Xu, Andreas Winkler, T. A. Simmers, Olivier Dascotte, Dominique Magnin, Karen Mahood, Carolina Guevara Caiedo, Zulu Wang, Hung-Fat Tse, John Camm, Didier Cadinot, Javier Aguila Marin, Juan Jose Olalla, Tamara Everington, Sherryn Roth, Feliz Alvaro Medina Palomino, Gregg Coodley, Wenhui Liu, G. Y. H. Lip, Ricky Ganim, Paul Ainsworth, Luiz Eduardo Fonteles Ritt, Yalin Liu, Sung Won Jang, Percy Berrospi, Dhananjai Menzies, Julien Pineau, Robert J. Jeanfreau, Hervé Buathier, John D. Osborne, Ted S. N. Lo, Li Fern Hsu, Xi Su, Beate Wild, Alvaro Rabelo Alves, Tomas Cieza-Lara, Neeraj Prasad, Yoshinori Seko, Jaydutt Patel, Malte Kuniss, Guy Chouinard, Jacek Morka, Frank Rubalcava, Fran Adams, Ignacio Rodriguez Briones, Vivek Sharma, Xinhua Wang, Amir Malik, Walid Amara, Adnan El Jabali, José Arturo Maldonado Villalon, Frederic Georger, Hong Ma, Steffen Schnupp, Nolan Mayer, Adam Sokal, Nasser Abdul, Gérald Phan Cao Phai, Jorge Hugo Blanco Ibaceta, Ramakrishnan Iyer, Yves Cottin, Barry Troyan, Achim Küppers, Anastas Stoikov, Jasjit Walia, Bruce Iteld, Abdul Alawwa, Christos Milonas, Frank Mibach, Mahfouz El Shahawy, H.William Stites, Neerav Shah, Clifford Ehrlich, Zia Ahmad, Furio Colivicchi, and Laszlo Karolyi

Subjects
medicine.medical_specialty, business.industry, Atrial fibrillation, 030204 cardiovascular system & hematology, medicine.disease, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Stroke prevention, Antithrombotic, Emergency medicine, medicine, In patient, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, Prospective cohort study, business, Stroke, Fibrinolytic agent, medicine.drug
Abstract

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

Published
2017

42. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East

Author

Mohamed Hassanein, Philip J. Barter, Wael Al Mahmeed, Mona Al Rukhaimi, Nasreen Al Sayed, Khalid Al Waili, Fatheya Alawadi, Mohamed Farghaly, Fahad Alnouri, Zuhier Awan, Mohammad Zubaid, Hani Sabbour, Khalid Al-Rasadi, and Saeed Al-Ghamdi

Subjects
Dyslipidaemia, medicine.medical_specialty, Consensus, Lipid disorder, Guidelines, 030204 cardiovascular system & hematology, End stage renal disease, Middle East, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Humans, 030212 general & internal medicine, Disease management (health), Intensive care medicine, Dyslipidemias, Hypolipidemic Agents, biology, business.industry, Case-control study, Disease Management, Lipoprotein(a), Cardiovascular disease, medicine.disease, Endocrinology, Cardiovascular Diseases, Case-Control Studies, Practice Guidelines as Topic, biology.protein, lipids (amino acids, peptides, and proteins), Hydroxymethylglutaryl-CoA Reductase Inhibitors, Metabolic syndrome, Cardiology and Cardiovascular Medicine, Risk assessment, business, Body mass index
Abstract

Background Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. Methods A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. Results The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. Conclusions These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.

Published
2016

43. Incidental finding of pulmonary artery aneurysm revealing a congenital heart defect

Author

Samar Farha, Hani Sabbour, Kelly Alice Drivdahl Dougherty, and Mahmoud ElKaissi

Subjects
0301 basic medicine, medicine.medical_specialty, Images In…, Pulmonary disease, Computed tomography, Heart defect, 030105 genetics & heredity, Pulmonary Artery, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Internal medicine, medicine, Humans, Medical history, Familial Primary Pulmonary Hypertension, Ductus Arteriosus, Patent, Pulmonary artery aneurysm, COPD, Incidental Findings, medicine.diagnostic_test, business.industry, Idiopathic Pulmonary Arterial Hypertension, General Medicine, Middle Aged, medicine.disease, Former Smoker, Aneurysm, respiratory tract diseases, Cardiology, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract

A middle-aged former smoker with a medical history of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary arterial hypertension (IPAH) was transferred to our facility for management of a pulmonary artery aneurysm (PAA) found on CT scan of the chest. The patient was diagnosed with

Published
2019

44. Identification and Treatment of Patients with Homozygous Familial Hypercholesterolaemia: Information and Recommendations from a Middle East Advisory Panel

Author

Nasreen Al-Sayed, Khalid Al-Waili, Maryam Razzaghy-Azar, Jacques Genest, Fahad Alnouri, Hani Sabbour, Abdulraof Al-Mahfouz, Abdullah Alashwal, Raul D. Santos, Yajnavalka Banerjee, Khalid Al-Rasadi, and Faisal A. Al-Allaf

Subjects
medicine.medical_specialty, diagnosis, prevalence, Population, Prevalence, Disease, Article, Hyperlipoproteinemia Type II, Middle East, Ezetimibe, Homozygous familial hypercholesterolaemia, Risk Factors, medicine, Humans, genetics, Disease management (health), education, Pharmacology, education.field_of_study, treatment, Plasma Exchange, business.industry, Anticholesteremic Agents, Incidence (epidemiology), Confounding, medicine.disease, Family medicine, Practice Guidelines as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Metabolic syndrome, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

We present clinical practice guidelines for the diagnosis and treatment of homozygous familial hypercholesterolaemia (HoFH) in the Middle East region. While guidelines are broadly applicable in Europe, in the Middle East we experience a range of confounding factors that complicate disease management to a point whereby the European guidance cannot be applied without significant modification. Specifically, for disease prevalence, the Middle East region has an established epidemic of diabetes and metabolic syndrome that can complicate treatment and mask a clinical diagnosis of HoFH. We have also a high incidence of consanguineous marriages, which increase the risk of transmission of recessive and homozygous genetic disorders. This risk is further augmented in autosomal dominant disorders such as familial hypercholesterolaemia (FH), in which a range of defective genes can be transmitted, all of which contribute to the phenotypic expression of the disease. In terms of treatment, we do not have access to lipoprotein apheresis on the same scale as in Europe, and there remains a significant reliance on statins, ezetimibe and the older plasma exchange methods. Additionally, we do not have widespread access to anti-apolipoprotein B therapies and microsomal transfer protein inhibitors. In order to adapt existing global guidance documents on HoFH to the Middle East region, we convened a panel of experts from Oman, Saudi Arabia, UAE, Iran and Bahrain to draft a regional guidance document for HoFH. We also included selected experts from outside the region. This panel statement will form the foundation of a detailed appraisal of the current FH management in the Middle Eastern population and thereby provide a suitable set of guidelines tailored for the region.

Published
2015

45. The gulf implantable cardioverter-defibrillator registry: Rationale, methodology, and implementation

Author

Mohammad Mehdi Amin, Raed Sweidan, Fayez Bokhari, Omer Elhag, Yahya Al Hebaishi, Abdulmohsen Almusaad, Faisal M Al-Samadi, Azam Shafquat, Alawi A. Alsheikh-Ali, Mohammad Al Meheiri, Hosam A Zaky, Fawzia Al-Kandari, Nidal Asaad, Khaled Dagriri, Adel Khalifa Hamad, Hani Sabbour, Salem Alkaabi, Haitham Alanazi, David Chase, Ismail Al Abri, Ahmad Hersi, Amin Daoulah, Adil Ahmed, Ahmed Al Fagih, Najib Al Rawahi, Shahul Hameed Ahmad Khan, and Bandar Al-Ghamdi

Subjects
implantable defibrillator, lcsh:Diseases of the circulatory (Cardiovascular) system, Adult patients, business.industry, medicine.medical_treatment, Implantable defibrillator, registry, Implantable cardioverter-defibrillator, medicine.disease, Icd therapy, Sudden cardiac death, Arabian Gulf, lcsh:RC666-701, Baseline characteristics, medicine, Original Article, Observational study, Medical emergency, business, Target Enrollment, geographic locations
Abstract

Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Results: Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute

Published
2015

46. PO199 Diabetes and Mortality In Acute Coronary Syndrome: Findings From Gulf Coast Registry

Author

Abdulla Shehab, K.A. Rasadi, Hani Sabbour, and Akshaya Srikanth Bhagavathula

Subjects
Community and Home Care, 030213 general clinical medicine, medicine.medical_specialty, Acute coronary syndrome, Epidemiology, business.industry, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, Diabetes mellitus, Medicine, Cardiology and Cardiovascular Medicine, business
Published
2018

47. Beyond Borders: Our Middle Eastern Experience of International Collaboration to Run a Successful Heart Transplantation Program

Author

Sandra ElHajj, Saif AbuBaker, Iman Hamour, Mosaad El-Banna, Feras Bader, Hani Sabbour, Gurjyot Bajwa, and Richard Ferrer

Subjects
Heart transplantation, Waiting time, medicine.medical_specialty, business.industry, medicine.medical_treatment, Mean age, Immunosuppression, medicine.disease, 030226 pharmacology & pharmacy, Coronary artery disease, 03 medical and health sciences, Management strategy, 0302 clinical medicine, Baseline characteristics, Heart failure, Emergency medicine, Medicine, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Introduction Heart transplantation (HT) is a highly successful management strategy for end-stage heart failure, and survival rates exceed those achieved by medical therapy. Factors such as donor availability, social and legislative boundaries limit the expansion of high volume HT programs. Methods We adopted a one-of-a-kind multicenter HT program operation in collaboration between our center in the United Arab Emirates (UAE) and 3 active HT centers in India. Patients completed their pretransplant evaluations within our program and were then sent to India to be on the HT waiting list. Once transplanted, they were sent back to the UAE where all post HT follow-up and care took place. This included surveillance endomyocardial biopsies and immunosuppression monitoring. Results Over two years, 10 HT recipients [9 males; mean age 34 yrs (range 14-62)] went through this arrangement. Fifty percent of patients were referred on inotropes and one with an LVAD. Mean waiting time was 41±8 days. Table 1 highlights baseline characteristics and table 2 summarizes our clinical outcomes after a mean follow up of 421 days. One year survival was 90%. Only one patient developed biopsy proven acute rejection requiring therapy, and 3 were found to have significant donor transmitted coronary artery disease. All patients were maintained on tacrolimus and mycophenolate mofetil, with corticosteroids tapered within the first year. The cost for HT to our patients was between $60,000 and $75,000. Conclusion International collaborations can be ideal to operate effective HT programs with excellent outcomes. Not only is this strategy is an excellent alternative while building fully independent programs, but it is also a way to overcome donor inavailability, long waiting times and inadequate financial support.

Published
2018

48. Impact of a Multidisciplinary Heart Failure Inpatient Service on 30-day Readmission at a Tertiary Care Center in a Developing Country

Author

Richard Ferrer, Mohammed E. Khalil, Ziad G. Sadik, Feras Bader, Judy Stapleton, Hani Sabbour, Bassam Atallah, and Rama Nasef

Subjects
medicine.medical_specialty, business.industry, Developing country, medicine.disease, Tertiary care, Multidisciplinary approach, Heart failure, Emergency medicine, Medicine, Center (algebra and category theory), Medical emergency, Cardiology and Cardiovascular Medicine, business, Inpatient service
Published
2017

50. APSC2015-1327 Cardiac Catheterization for Adults With Congenital Heart Disease in the United Arab Emirates: A Large Referral Center Experience

Author

Omer Elhag, Hani Sabbour, Basem Mora, Hazem El Badaoui, Masood A Ghori, Alawi A. Alsheikh-Ali, Mohammad Daud Khan, Magdi Tofeig, Csaba Tamás, Alessandro Salustri, Javed Khan, Neerod Kumar Jha, Wael Almahmeed, Haitham Talo, László Király, Abdulmajeed Alzubaidi, and Samir Aljabbari

Subjects
Community and Home Care, medicine.medical_specialty, Heart disease, Epidemiology, business.industry, medicine.medical_treatment, medicine, Referral center, Cardiology and Cardiovascular Medicine, Intensive care medicine, medicine.disease, business, Cardiac catheterization
Published
2015

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