Cardiovascular Research Institute, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Cardiovascular Research Institute, Hypertension Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
PLoS One. 2023 Sep 5;18(9):e0290286. doi: 10.1371/journal.pone.0290286. eCollection 2023.
It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.
据估计，在未来十年，与世界上任何其他地区相比，EMR 的缺血性心脏病（IHD）患病率、残疾调整生命年（DALYs）和死亡人数将显著增加。本研究旨在全面描述 1990 年至 2019 年期间东地中海地区（EMR）国家 IHD 负担的趋势。IHD 患病率、残疾调整生命年（DALYs）、死亡率、归因于危险因素的 DALYs、医疗保健获取和质量指数（HAQ）和全民健康覆盖（UHC）的数据从 EMR 国家的全球疾病负担（GBD）数据库中提取。数据根据社会人口指数（SDI）进行分层。心脏康复信息来自心血管预防和康复国际理事会（ICCPR）的出版物，通过高级搜索方法获得了其他国家的特定数据。年龄标准化使用直接法进行，应用 2019 年全球人口的估计年龄结构。通过 1000 次迭代计算不确定性区间，并从这些计算中得出第 2.5 和第 97.5 个百分位数。1990 年至 2019 年间，EMR 中 IHD 的年龄标准化患病率从 5.0%上升到 5.5%，而全球水平则下降。在 EMR 中，IHD 死亡率和 DALYs 的年龄标准化率在研究期间分别下降了 11.4%和 15.4%，尽管这两个比率仍高于全球比率。与女性相比，IHD 负担在男性中更高。在 EMR 国家中，巴林的年龄标准化患病率（-3.7%）、死亡率（-65.0%）和 DALYs（-69.1%）下降幅度最大。相比之下，阿曼的患病率（14.5%）增幅最高，而巴基斯坦的死亡率（30.0%）和 DALYs（32.0%）增幅最大。2019 年 EMR 中导致 IHD DALYs 的前三大危险因素是收缩压高、低密度脂蛋白胆固醇高和颗粒物污染。29 年期间（1990-2019 年）的趋势分析显示，高空腹血糖（64.0%）和高体重指数（23.4%）作为 EMR 中 IHD DALYs 的归因危险因素呈上升趋势。我们的研究结果表明，EMR 中 IHD 的患病率呈上升趋势，死亡率和 DALYs 呈下降趋势。这些结果强调需要制定和实施针对 IHD 相关危险因素的有计划的预防和治疗策略。该地区各国必须优先制定和实施以促进健康、教育、预防和医疗为重点的方案。
