Cardiovascular Disease in Saudi Arabia - Report Example

Cardiovascular disease in Saudi Arabia) population health Introduction Cardiovascular disease or heart disease is the group of diseases that affect the blood vessels (veins and arteries) or the heart. Technically, the word refers to any type of disease that usually affects the cardiovascular system, (Hoffman, 1990). It is used to refer to those disease which are related to atherosclerosis or arterial disease. These states have same mechanisms, causes and treatments. Cardiovascular disease is usually treated by thoracic surgeons, cardiologists, interventional radiologists, neurologists and vascular surgeons. The specialist depends with the organ system that is being treated, (McMurray, 2007). There are various types of cardiovascular heart disease which include: Ischemic heart disease: it is the main type of cardiovascular disease. It is concerned with problems of blood circulation to the muscles of the heart, (Abbag, 1998). Lack of sufficient oxygenated blood can be caused by partial blockage of coronary arteries there by causing shortness of breath and chest pain. Necrosis is caused by absolute blockage of artery which can also be referred to as heart attack. Cerebrovascular disease is another kind of cardiovascular disease. it is a problem which is associated with blood circulation to the blood vessels of brain. Transient ischemic attack is an effect of blockage that lasts less than 24 hours. Cerebrovascular thrombosis (clot) is caused by a complete blockage. In some cases long term consequences can be caused by bursting of blood vessels in the brain, (Alabdulgader, 2001). Peripheral vascular disease usually affects circulation mainly in the legs. Pain in the calves while walking is a major symptom of the disease. Heart failure: this occurs when the heart fails to pump enough blood as required by the whole body. It is a consequence of damaged heart muscle which can be caused by a heart attack, heart muscle disease, or excessive consumption of alcohol. The disease is associated with swelling of legs and shortness of breath. Congenital heart disease: this is a predicament with the hearts structure and arises as a result of birth defect. The defects can be small holes in the heart or can be complex to affect the flow of blood in the lungs and the heart. Most of them are fatal unless medical attention is taken. Others may cause disabilities to various degrees and can be treated through surgery in future. Rheumatic heart disease is mostly common in the poor nations. Initially, the disease begins in childhood with bacterial infection which affects heart valves and joints. Heart problems are realized after along time and the heart valves can only be replaced through operation. Many countries are faced with high and rising rates of cardiovascular disease. For example in America, heart disease kills a large number of people compared to cancer. Study showed that, vascular injury accumulates from teenage years, there by making primary avoidance efforts important from childhood. At some levels when the heart problems are discovered, atherosclerosis, which is the underlying source, is usually fairly complex, having progressed for decades. As a result, prevention of atherosclerosis (it is a surplus build- up of pestilence on the interior wall of a big blood vessel, which limits the flow of blood) is emphasized by adjusting risk factors which include: exercise, healthy eating habits and avoidance of smoking, (Alabdulgader, 2001). Studies have shown that, predecessors of heart disease begin in teenage years. Atherosclerosis usually evolves over years and it starts during childhood. The studies demonstrated that intimal lacerations show in every aorta and that greater than a half of the right coronary arteries of the adolescent aged 7-9 years are also affected. Most people especially the youth’s concentrates on risks such as accidents, HIV and cancer more than cardiovascular disease. In a group of three people, one will die as a result of atherosclerosis complications. Primary prevention is required so as to reduce the effects of cardiovascular diseases. Education and awareness is the key to primary prevention. People need to know that cardiovascular disease creates the biggest risk and thus measure to reverse or prevent should be taken. Various biomarkers have offered an in depth threat of cardiovascular disease which include: elevated homocysteine, higher fibrinogen and PAI-1blood concentrations, high inflammation, elevated blood vessels, and elevated blood levels of brain natriuretic peptide. Cardiovascular disease can be improved by Mediterranean diet. Cardiovascular disease is also reversible and treatable unlike other medical conditions. The treatment is principally focused on stress reduction and diet. Some of the main messages in protecting heart health include: unhealthy diet, tobacco use and physical inactivity usually increases the threats of strokes and heart attacks, (Catherine, 2004). People are advised to engage in physical activities for at least half an hour daily such as games, jogging, athletics and check on their diets as this will help in preventing the risks of strokes and heart attacks. Some foods are rich in cholesterol and should be avoided as the cholesterol plagues the inner of veins and arteries preventing normal blood flows. Use of tobacco is prohibited as it affects the respiratory systems, (Alabdulgader, 2001). Diabetic people are in a high risk of heart attacks. Individuals are advised to check on their blood sugars and control their blood pressures so as to reduce the risks of heart attacks. Being overweight also raises the threat of heart strokes and heart attacks. Individuals are advised to maintain a perfect body weight through engaging in regular physical exercises and checking their diets. Individuals should eat food rich in vegetables and fruits every day and reducing on their salt intake. People are also encouraged to have their blood pressures regularly checked as it is another cause of heart attack, (Bhat, 1997). More than 80 percent of cardiovascular disease occurs in developing nations and affects women and men almost equally. Heart attacks can be deadly if aid is not sought after immediately. They are major diseases worldwide but they are preventable. Research shows that the initial studies of cardiovascular disease were carried out by Jerry Morris in 1949 by using the occupational health statistics and were there by published in 1958. The origins, treatment and prevention of cardiovascular disease have turned out to be active areas of biomedical research and many scientific studies are being published every week. In the early 2000s, studies have linked fast foods and the rise of heart diseases. Some of these studies include: studies conducted by Harvard University and the Sydney centre for cardiovascular health, and Ryan Mackey Memorial Research Institute. Currently, emphasis has been put on the link between interventions and low- grade inflammation that characterizes atherosclerosis. Literature review Specific literature review As per the Saudi heart association, about 30 percent of the causes of Saudi Arabians deaths are caused by atherosclerosis and heart disease. The association has discussed on the measures to take so as to reduce the risk factors of heart diseases. The ministry of health carried out a research which showed that 17 percent of deaths are caused by ischemic heart diseases while 9 percent are caused by hypertension and the remaining 4 percent is caused by strokes. Dr. John Deanfield, who is a professor of cardiology at the London University, said that hypertension is a major problem affecting not only the Saudi Arabians but the whole world. It can be as a result of people eating habits, living behaviors and lifestyles. Heart diseases are influenced by such risk factors as cholesterol, diabetes, smoking, obesity, stress, high blood pressure, alcohol, diet and lack of exercise, (Alabdulgader, 2001). According to Deanfield, these risk factors need to be treated collectively. For instance, high blood pressure and cholesterol can be treated at the same time. Doctors agreed among themselves that, in order to solve the problem, patients need to change their bad habits, such as smoking and improve on their lifestyles. In Saudi Arabia, passive smoking has become a problem especially among the youths where they smoke in indoor places. People start smoking as young as 12 years. Obesity is another problem facing the Saudi Arabians. The doctors advised people to modify their eating and introduce approaches to good healthy eating styles in schools so as to address school going children. Women are the most affected by obesity compared to men. Coronary heart diseases are mostly considered diseases for old people. However, Mahdi said that, the basis of the circumstance usually crops up at young age and the condition should thus be dealt with at the occurrence of the risk factors. As per the World Health Organization, cardiovascular disease will be the primary global cause of mortality and morbidity by the year 2020. Developing nations will be a main contributor to this rise. It is known that there are problems in the application of health care by clinical care centers and lack of better health care facilities. This problem is evidenced in various registries which have contributed to the definition of features of patients with coronary artery disease (CAD), assessing care and making it possible the realization of clinical guidelines, (Becker, Halees, Molina, and Paterson, 2001). In general, the occurrence of coronary artery disease in Saudi Arabia has been accounted to be 5.5 percent. Currently, data concerning the clinical administration and presentation of Saudi Arabian patients with acute coronary syndrome (ACS) is still missing. The Saudi project for Assessment of Coronary Events (SPACE) is a study for those patients with acute coronary syndrome and who are admitted to hospitals. Ethics was approved in these hospitals and participation was voluntary only for the government hospitals. These hospitals also lacked surgery facilities and cardiac catheterization. Report for each patient was summarized and the statistical results were analyzed. The Saudi Project for Assessment of Coronary Events had between December 2005 and July 2006 enrolled 435 patients. Their average age being 57.1 and of these77 percent (332 patients) were men. Ischemic heart disease had beforehand diagnosed in 140 patients. Diabetes mellitus which was present in 56 patients was the key risk factor for CAD while hypertension followed as one of the rick factors for coronary artery diseases which were present in 48 percent that is 208 patients, (Oxford Business Group, 2007). Saudi project of Assessment of Coronary events is the initial acute coronary syndrome in Saudi Arabia. Their report focused on an average age of 57.1 years and this was 8 years less than that of developed nations, (Mohsen, El-Hazmi and Arjumand, 2002). Worldwide, the Global Registry of Acute Coronary Events (GRACE) used a median age of 65 and 68 years. The valuation in years of age representation is due to the presence of younger population in developing nations compared to developed nation and also as a result of poorly controlled risk factors of coronary artery diseases, (Catherine, 2004). The reasons for these results are not clear. Various explanations say that the increased obesity rates, poor dietary habits, sedentary lifestyles and increasing rates of consanguinity as the key factors. The results showed that acute coronary syndrome affected people at a young age and that most patients were affected by more than one CAD risk factors, (Becker, Halees, Molina, and Paterson, 2001). The results draw attention to various challenging areas. As per this study, the restricted number of the hospitals taking part reduces the degree of generalization of the findings. There is need to increase the number of hospitals participating in the presentation so as to attain correct and reliable findings, (Alabdulgader, 2001). The sample size which has been used in the study is very small compared to the population in Saudi Arabia. As a result the findings may not reflect realism. There will be under reporting of the study and most of all absence of reported results for such patients in non space hospitals, (Oxford Business Group, 2007). A study to investigate the epidemiology of congenital heart disease was carried out in Saudi Arabia. It evaluated persons with congenital heart disease. 33.9 percent of these persons had ventricular septal defect, 18.1 percent had atrial septal defect, while 24.9 percent had neonatal congenital disease. The results showed that more males than females were affected, (Uyama and Bohlega, 2000). In Saudi Arabia, the epidemiology of congenital heart disease has not yet been concluded but some efforts have been made in several regions. Different methodologies were used and at diverse time periods, (Mohsen, El-Hazmi and Arjumand, 2002). The objective of the study was to find out the epidemiology of Saudi Arabia congenital heart disease. Various preceding reports show a modification of incidence and patterns of congenital heart disease in different regions. These epidemiologies are the roots of investigative efforts of identifying the major causes of cardiac dysmorphogenesis and their preventive measures, (Abbag, 1998). These studies were carried out in four main referral institutes with a total number of 2604 patients being investigated. This comprised of 1305 females and 1299 males aged between 0-13 years. This exercise was carried out by qualified specialists such as the cardiologist and paediatric. Congenital heart disease was divided into nine key lesion kinds which include: atrial septal defect, ventricular septal defect, pulmonary stenosis, , atrioventricular septal defect, aortic stenosis, coarctation of aorta, patent ductus arteriosus, fallot, detro-transposition of great arteries and others, (Alabdulgader, 2001). The results showed that, for the 2604 patients who were diagnosed, ventricular septal defect was the most common with 33.9 percent, followed by atrial septal defect with a percentage of 18.1. In the mid 80s, echocardiography had become a general diagnostics means for congenital heart diseases. Due to its rising precision as a diagnostic tool, there were increased standards for occurrence of heart diseases. It uncovered lesions such as patent ductus arteriosus, ventricular septal defects which were commonly overlooked, (Uyama and Bohlega, 2000). The causes of the congenital heart diseases may be understood by knowing their occurrence and their clustering in place or time. In order to know the true incidence of congenital heart disease, there is need to diagnose accurately all affected persons. In many cases, children are never counted leading to underestimation of the results. Among them are the babies who die immediately after birth and have undiagnosed complex, severe congenital heart diseases. Children who are suspected to having the disease are usually referred to the referral units. Thus in practice, the situation only reflects the prototype of congenital heart disease in Saudi Arabia rather than the incidence, (Ramahi, 2010). The varying occurrence in various reports is attributed to the varying explanation of the congenital heart disease, diagnostic accuracy, study methodology, calcium bioavailability, genetic predisposition, and other environmental factors. Precise calculation of incidence has been affected negatively by lack of precise definition of congenital heart disease. Inclusion of such defects as atrial septal defects, patent ductus, with no potential significance will lower the occurrence figures, (Abbag, 1998). The cause of congenital heart disease is not known but people suspects the chromosomal anomal. The most common cause of congenital heart disease is Down syndrome. There was enormous achievement in concentrating the cardiac critical areas in chromosomes 21 to 21q22.2-22.3 area. Cardiac lesion was found in 44 patients who had Down syndrome, (Catherine, 2004). Ischaemic heart disease is not common in Saudi Arabia. Although there are presence of risk factors such as obesity, diabetes mellitus, hypertension, tobacco smoking, alcohol consumption among others, most Saudi Arabians develop chest pains which are not related to ischaemic origin. Ischaemic heart diseases are usually caused by congestive cardiomyopathy among many Saudi Arabians and results to chronic congestive cardiac failure and cardiomegally. Most of the heart diseases which appear to be very common are very rare among Saudi Arabian patients. Some of these heart diseases include diabetic heart diseases, alcoholic cardiomypathy, obesity, and hypertensive heart disease, (Arfaj and Khalil, 2009). Recommendation The rate of cardiovascular disease in Saudi Arabia is increasing daily. As result, many people are losing their lives due to ignorance and illiteracy. The government should enact bylaws that will decrease smoking habits and alcohol consumption among adolescence, (Catherine, 2004). Conclusion The unexpected developments from Saudi Arabia in all areas have brought about significant progress in medicine and particularly cardiac medicine over the precedent few years. In spite of this, services are still distant from enough, (Abbag, 1998). The accessibility of paediatric cardic services from only three referrals within the same region and lack of sufficient referrals for examining congenital heart diseases in other areas in Saudi Arabia is a principle problem and it deserves concentration from Saudi Arabians policy makers, (Ramahi. 2010). The American Academy of Pediatrics recommended that, a country like Saudi Arabia that usually generates more than 30,000 live births annually should have access to paediatric cardiac centers. It was concluded that Saudi Arabia utmost needed 20 paediatric cardiology centers and at least seven, (Arfaj and Khalil, 2009). The primary health care should be concerned in controlling and preventing the risk factors which lead to cardiovascular diseases, (Uyama and Bohlega, 2000). These risk factors which include hypertension, diabetes mellitus and lack of exercise should be concentrated on. People need to be educated in order to improve their knowledge and also encourage healthy manner and behavior. Health care teams should partake in health education programmes so as to improve literacy and promote attitude and knowledge of individuals. In order for this to be effective, society wide education programmes should be initiated. References Alabdulgader AAA. Congenital heart disease in 740 subjects: epidemiological aspects. Annals of tropical paediatrics, 2001, 21(2):111–8. Abbag F. Pattern of congenital heart disease in the south-western region of Saudi Arabia. Annals of Saudi medicine, 1998, 18:393–5. Bhat BA et al. Pattern of congenital heart disease among children in Madinah Munawara. Journal of the Saudi Heart Association, 1997, 9:16–9. Jaiyesimi F, Ruberu DK, Misra VK. Pattern of congenital heart disease in King Fahad Specialist Hospital, Buraidah. Annals of Saudi medicine, 1993, 13:407–11. Hoffman JIE. 1990. Congenital heart disease: incidence and inheritance. Pediatric clinics of North America. McMurray, A. 2007. Community health and wellness: a socio-ecological approach, 3rd edn, Mosby, Sydney AS Al Arfaj and N Khalil. 2009. Clinical And Immunological Manifestations In 624 Sle Patients In Saudi Arabia. Lupus. pg 465 - 473. Mohsen A. F. El-Hazmi and Arjumand S. 2002. A Comparative Study of Prevalence of Overweight and Obesity in Children in Different Provinces of Saudi Arabia. J Trop Pediatr, pg; 172 - 177. Tarik M. Ramahi. 2010. Cardiovascular Disease in the Asia Middle East Region: Global Trends and Local Implications. Asia Pac J Public Health, pg 22: 83S - 89S. Catherine M. Otto. 2004. Valvular Heart Disease. Edition 2, illustrated. Elsevier Health Sciences, Publishers. ISBN: 0721697879, 9780721697871. Oxford Business Group. 2007. The Report: Emerging Saudi Arabia. Oxford Business Group, Publishers. ISBN: 1902339665, 9781902339665. Becker SM, Al Halees Z, Molina C, Paterson RM. 2001. Consanguinity and Congenital Heart Disease in Saudi Arabia. Retrieved From < http://www.ncbi.nlm.nih.gov/pubmed/11170087> (Accessed August 24, 2010). Eiichiro Uyama and Saeed Bohlega. 2000. Gaucher Disease With Oculomotor Apraxia And Cardiovascular Calcification. Neurology, pg 55: 735. Read More