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Original article
peer-reviewed

Incidence of Coronary Artery Disease in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2019–2020: A Retrospective Cohort Study



Abstract

Background

Coronary artery disease (CAD) remains a significant cause of death and morbidity in people globally despite advances in treatment. Prevention of CAD risk factors is crucial to reducing its prevalence. We conducted this study to determine the incidence of CAD from 2019 to 2020 in King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), and its major risk factors among this population.

Method

This retrospective study involved all patients diagnosed with CAD at KAUH in 2019 and 2020. We analyzed validated hospital data to determine the incidence of CAD and identify the risk factors among participants. The incidence of CAD was calculated based on the total number of patients admitted to KAUH by gender, age group, and nationality (Saudi/non-Saudi).

Result

The study included 1,364 patients with a mean age of 49 years. Most patients were men (n=1,050; 77%), with fewer women (n=314; 23%), and 71.2% were non-Saudi. The incidence of CAD in 2019 was 220.98 per 10,000, and the incidence in 2020 was 3,030.52 per 10,000. However, the incidence for 2020 was confounded by the coronavirus disease 2019 pandemic-related restrictions affecting hospital admissions. The most common diagnosis was acute transmural myocardial infarction, and patients aged <60 years had a significantly high incidence of hypertension, high total cholesterol levels, low low-density lipoprotein levels, and high triglyceride levels. Patients ≥60 years had a significantly high incidence of chronic kidney disease, low hemoglobin levels, history of ischemic heart disease, and intensive care unit or critical care unit admission.

Conclusion

The study demonstrated a significant rise in CAD incidence associated with advanced age and male sex. Further prevention and control of these risk factors would be essential to decrease the incidence of CAD. A national community-based prevention effort should be implemented to avoid the expected CAD epidemic in KSA.

Introduction

Coronary artery disease (CAD) is one of the most common cardiovascular disorders worldwide. CAD is the leading cause of death in high-income and low-income countries [1]. Despite advances in preventing and managing this disease, CAD remains a challenge. By 2030, CAD will be the most serious and widespread human health hazard [2].

A decrease in blood flow to the myocardium is the final common pathway leading to death and other complications of CAD (e.g., myocardial infarction and angina). An increased prevalence of obstruction of coronary arteries due to atherosclerosis has been attributed to an age-related rise in disease severity [3]. According to World Health Organization data published in May 2014, CAD is one of the leading causes of death in Saudi Arabia, accounting for 19,569 deaths or 24.34% of total deaths [4].

According to a nationwide survey, Saudi Arabia has a CAD prevalence of 5.5%, which is higher than that in China (2%), India (3%), and Europe (5%) but lower than that in the USA (6.7%) and Egypt (8.3%) [5-8]. The body mass index (BMI) studies demonstrated that a waist-to-height ratio cutoff value of 0.5 was effective and that rising adiposity was substantially related to the risk of CAD [9].

Diabetes and hypertension (HTN) are two prominent risk factors that can, directly and indirectly, predict the more severe adverse outcome [10]. Although no definitive association has been shown between cigarette smoking and CAD, cigarette smoking has been connected to thrombocytic and atherogenic pathways and platelet behavior [11]. We conducted this study to assess the incidence of CAD from 2019 to 2020 in King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia, and to determine the significant risk factors for CAD.

Materials & Methods

This retrospective study involved all patients diagnosed with CAD at KAUH between 2019 and 2020. We analyzed validated hospital data to determine the incidence of CAD and related risk factors. The incidence of CAD in the present study was calculated based on the total number of patients admitted to KAUH by gender, age group, and nationality (Saudi/non-Saudi) in 2019 and 2020. The total number of patients with CAD was 1,802 of 46,574 admissions (573 per 10,000). The inclusion criteria were all patients, regardless of age and sex, diagnosed with CAD, and the exclusion criteria were all patients other than complaints of CAD or patients with incomplete medical records. A checklist was prepared to include patient demographic data, smoking habits, diabetes status, HTN, history of stroke, malignancy, chronic kidney disease (CKD), family history of CAD, past history of heart-related diseases or surgery, laboratory results, and electrocardiogram (ECG) findings.

The retrospective, noninterventional study was approved by the biomedical research unit at King Abdul Aziz University (Approval No. 629-20). The Unit of Biomedical Ethics is registered at the National Committee of Biomedical and Medical Ethics (Reg No. HA-02-J-008).

Statistical analysis

Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0. (IBM Corp., Armonk, NY). Qualitative data were expressed as numbers and percentages, and the chi-squared test (χ2) was used to test the relationship between variables. Quantitative data were expressed as mean and standard deviation (mean ± SD), where the independent sample t-test was used for parametric variables. A p-value of <0.05 was considered statistically significant.

Results

This study enrolled 1,802 patients initially and then we excluded the patients with missing data, leaving 1,364 patients in the study. Our patient population consisted of 1,050 men (77%) and 314 women (23%), with a mean age of 49 years (Table 1). Men were more commonly affected than women, and most were unemployed (n=1,030; 75.5%). A total of 917 (67.2%) participants were non-Saudi, and most were married (n=1,241; 90.9%). The mean BMI of the study population was 29.20 kg/m2 ± 17.597 kg/m2. Only 29.9% of the population of CAD patients had a healthy weight. The incidence of CAD in 2019 was 220.89 per 10,000 patients; in 2020, the incidence was 3,030.52 per 10,000 patients. However, hospital admissions were restricted in 2020 due to coronavirus disease 2019 (COVID-19) pandemic precautions, which confounded our data.

Variable N = 1364 Percent (%)
Gender    
Male 1050 77.0%
Female 314 23.0%
Marital status    
Married 1241 90.9%
Single 123 9.0%
Nationality    
Saudi 447 32.7%
Non-Saudi 917 67.2%
Occupation    
Employed 272 19.9%
Retirement 62 4.5%
unemployed 1030 75.5%
Body mass index    
Underweight 15 1.1%
Normal 408 29.9%
Overweight 526 38.6%
Obese 415 30.4%
Changing eating habits to help lower or control blood pressure    
Yes 114 8.4%
No 1250 91.6%
Exercise or physical activity    
Yes 451 33.1%
No 686 50.3%
Cannot move 226 16.6%
Age groups    
<60 years 765 56.1%
≥60 years 599 43.9%
Years of the study    
2019 783 57.41%
2020 581 42.51%

Table 2 presents the risk factor analysis. Most patients (n=878; 64.4%) were nonsmokers, 904 (66.3%) had HTN, and 836 (61.3%) had diabetes. Only 408 patients (29.9%) had a family history of CAD, stroke, and HTN. In addition, 67 patients had a history of stroke (4.9%), 36 had active malignancy (2.6%), and 87 had CKD (6.4%). More than half the population (n=814; 59.7%) had abnormal ECG findings, and 711 (52.1%) had low hemoglobin levels. Clotting factors were within the reference range in 78 patients (4%), and 714 (52.3%) had high levels of glycated hemoglobin (HbA1c), an indicator of diabetes. A total of 889 (65.2%) patients had high troponin levels, and 831 (60.9%) had cardiac enzyme levels within reference ranges. blood cholesterol levels were within the reference range in 884 (64.8 %) patients, and 696 (51.0%) had normal levels of high-density lipoprotein (HDL). Also, 356 (26.1 %) patients had high levels of low-density lipoprotein (LDL), and 904 (66.3%) had triglycerides within reference ranges.

Variable N = 1364 Percent (%)
Smoking habits    
Yes 264 19.4%
No 878 64.4%
Former (quit smoking) 222 16.3%
Hypertension    
Yes 904 66.3%
No 460 33.7%
Diabetes    
Yes 836 61.3%
No 528 38.7%
Stroke    
Yes 67 4.9%
No 1297 95.1%
Active malignancy    
Yes 36 2.6%
No 1328 97.4%
Chronic kidney disease    
Yes 87 6.4%
No 1277 93.6%
Others    
Yes 48 3.5%
No 1316 96.5%
Family history of coronary artery, stroke, or hypertension    
Yes 408 29.9%
No 949 69.6%
ECG finding    
Normal 97 7.1%
Abnormal 814 59.7%
Not found 453 33.2%
Hemoglobin    
High 30 2.2%
Normal 610 44.7%
Low 711 52.1%
Not found 13 1.0%
Clotting factors    
High 365 26.8%
Normal 781 57.3%
Low 53 3.9%
Not found 165 12.1%
HbA1c    
High 714 52.3%
Normal 330 24.2%
Low 10 0.7%
Not found 310 22.7%
Cardiac enzyme troponin    
High 889 65.2%
Normal 313 22.9%
Low 108 7.9%
Not found 54 4.0%
Cardiac enzyme CK    
High 435 31.9%
Normal 831 60.9%
Low 20 1.5%
Not found 78 5.7%
Blood cholesterol    
High 275 20.2%
Normal 884 64.8%
Low 4 0.3%
Not found 201 14.7%
HDL    
High 43 3.2%
Normal 696 51.0%
Low 303 22.2%
Not found 322 23.6%
LDL    
High 356 26.1%
Normal 713 52.3%
Low 3 0.2%
Not found 292 21.4%
Triglycerides    
High 212 15.5%
Normal 904 66.3%
Low 4 0.3%
Not found 244 17.9%

Table 3 shows that 494 (36.2%) patients had a history of past angina pectoris, 389 (28.5%) had a myocardial infarction, and 228 (16.7%) had heart failure. Only 159 patients (11.7%) had a history of ischemic heart disease (IHD), 500 (36.7%) had a history of cardiac catheterization, and 214 (15.7%) had a history of coronary artery angioplasty. In addition, 313 (22.9%) patients had a history of percutaneous coronary intervention. Most patients (n=1267; 92.9%) had inpatient episodes, of whom 916 (67.2%) had their episodes in the coronary care unit (CCU). The most common diagnoses were acute transmural myocardial infarction (n=652; 47.8%), acute subendocardial myocardial infarction (n=377; 27.6%), and unstable angina (n=220; 16.1%).

Variable N=1364 Percent (%)
Episode location    
CCU 916 67.2%
Female section 67 4.9%
Male section 117 8.5%
ERU 34 2.5%
MIC 49 3.6%
DCU 9 0.7%
PT 6 0.4%
SIC and ERO 48 3.5%
Other 10 0.7%
Diagnosis    
Unstable angina 220 16.1%
Acute subendocardial myocardial infarction 377 27.6%
Acute transmural myocardial infarction 652 47.8%
Angina pectoris 70 5.1%
Acute ischemic heart disease 37 2.7%
Chronic ischemic heart disease 8 0.6%
Previous angina pectoris    
Yes 494 36.2%
No 870 63.8%
Previous myocardial infraction    
Yes 389 28.5%
No 975 71.5%
Previous heart failure    
Yes 228 16.7%
No 1136 83.3%
Past IHD    
Yes 159 11.7%
No 1205 88.3%
History of cardiac catheterization    
Yes 500 36.7%
No 864 63.3%
Coronary angioplasty    
Yes 214 15.7%
No 1150 84.3%
Coronary artery bypass surgery    
Yes 62 4.5%
No 1302 95.5%
PCI    
Yes 313 22.9%
No 1051 77.1%
Episode type    
Inpatient 1267 92.9%
Emergency 97 7.1%
History of ICU admission or CCU    
Yes 345 26%
No 1010 74%

In our study population, 646 (84.4%) patients younger than age 60 years were males, and 195 patients aged 60 or older (32.6%) were females (Table 4). In addition, 272 (19.9%) patients were employed (p<0.05), while a significant number of those aged 60 or older were Saudi (p<0.05). A total of 311 (40.7%) patients younger than 60 years were overweight, and significantly more patients younger than 60 were smokers than those older than age 60 (p<0.05). We found no significant difference between the two age groups regarding changes in eating habits to help lower or control blood pressure, exercise, physical activity, or diagnoses (p>0.05).

Variable Age < 60 years (n=765) Age ≥ 60 years (n=599) p-Value
Gender      
Male 646 (84.4%) 404 (67.4%) 0.00
Female 119 (15.6%) 195 (32.6%) 0.00
Nationality      
Saudi 220 (28.8%) 227 (37.9%) 0.00
Non-Saudi 545 (71.2%) 372 (62.1%) 0.00
Marital status      
Married 687 (89.8%) 554 (92.5%) 0.08
Unmarried 78 (10.2%) 45 (7.5%) 0.08
Occupation      
Employed 170 (22.2%) 102 (17.0%) 0.03
Retirement 566 (74.0%) 464 (77.5%) 0.03
Uunemployed 29 (3.8%) 33 (5.5%) 0.03
BMI      
Underweight 5 (0.7%) 10 (1.7%) 0.05
Normal weight 232 (30.3%) 176 (29.4%) 0.05
Overweight 311 (40.7%) 215 (35.9%) 0.05
Obesity 217 (28.4%) 198 (33.1%) 0.05
Smoking habits      
Yes 180 (23.5%) 84 (14.0%) 0.00
No 458 (59.9%) 420 (70.1%) 0.00
Former smoker 127 (16.6 %) 95 (15.9%) 0.00
Exercise       
Yes 266 (34.8%) 185 (30.9%) 0.00
No 387 (50.6%) 299 (49.9%) 0.00
Rest 112 (14.6%) 114 (19.0%) 0.00
Changing eating habits to help lower or control blood pressure      
Yes 59 (7.7%) 55 (9.2%) 0.33
No 706 (92.3%) 544 (90.8%) 0.33

Patients aged 60 or older (i.e., older patients) had a significantly higher mean height compared to those younger than 60 years (i.e., younger patients; p<0.05; Table 5). However, younger patients had a significantly higher mean weight than older patients.

Variable Age group p-Value
<60 years (n=765) >60 years (n=599)
Mean height ± SD 165.94 ± 9.93 cm 163.02 ± 9.42 cm 0.00
Mean weight ± SD 80.36 ± 49.90 kg 75.32 ± 15.41 kg 0.02

Significantly more older patients had low hemoglobin levels (n=342; 57.1%) than younger patients (p<0.05; Table 6). Significantly more younger patients had high cholesterol levels (24.2%), lower LDL levels (0.3%), and higher triglyceride levels (17.9%; p<0.05) than the older patients. More younger patients were smokers and had HTN than older patients (p≤0.05). However, CKD was significantly more common in older patients than the younger patients (p<0.05). We found no significant difference in BMI, ECG findings, clotting factors, HbA1c, HDL, cardiac enzyme troponin, and CK.

Variable Age <60 years (n=765); N (%) Age ≥60 years (n=599); N (%) P-Value
ECG finding      
Normal 62 (8.1%) 35 (5.8%) 0.36
Abnormal 454 (59.3%) 360 (60.1%) 0.36
Not found 249 (32.5%) 204 (34.1%) 0.36
Hemoglobin      
High 15 (2.0%) 15 (2.5%) 0.00
Normal 373 (48.8%) 237 (39.6%) 0.00
Low 369 (48.2%) 342 (57.1%) 0.00
Not found 8 (1.0%) 5 (0.8%) 0.00
Clotting factors      
High 189 (24.7%) 176 (29.4%) 0.10
Normal 444 (58.0%) 337 (56.3%) 0.10
Low 36 (4.7%) 17 (2.8%) 0.10
Not found 96 (12.5%) 69 (11.5%) 0.10
HbA1c      
High 398 (52.0%) 316 (52.8%) 0.23
Normal 199 (26.0%) 131 (21.9%) 0.23
Low 6 (0.8%) 4 (0.7%) 0.23
Not found 162 (21.2%) 148 (24.7%) 0.23
Cardiac enzyme troponin      
High 506 (66.1%) 383 (63.9%) 0.76
Normal 168 (22.0%) 145 (24.2%) 0.76
Low 63 (8.2%) 45 (7.5%) 0.76
Not found 28 (3.7%) 26 (4.3%) 0.76
Creatine kinase      
High 249 (32.5%) 186 (31.1%) 0.95
Normal 462 (60.4%) 369 (61.6%) 0.95
Low 11 (1.4%) 9 (1.5%) 0.95
Not found 43 (5.6%) 35 (5.8%) 0.95
Blood cholesterol      
High 185 (24.2%) 90 (15.0%) 0.00
Normal 476 (62.2%) 408 (68.1%) 0.00
Low 1 (0.1%) 3 (0.5%) 0.00
Not found 103 (13.5%) 98 (16.4%) 0.00
HDL      
High 26 (3.4%) 17 (2.8%) 0.46
Normal 398 (52.0%) 298 (49.7%) 0.46
Low 174 (22.7%) 129 (21.5%) 0.46
Not found 167 (21.8%) 155 (25.9%) 0.46
LDL      
High 231 (30.2%) 125 (20.9%) 0.00
Normal 384 (50.2%) 329 (54.9%) 0.00
Low 2 (0.3%) 1 (0.2%) 0.00
Not found 148 (19.3%) 144 (24.0%) 0.00
Triglycerides      
High 137 (17.9%) 75 (12.5%) 0.04
Normal 497 (65.0%) 407 (67.9%) 0.04
Low 3 (0.4%) 1 (0.2%) 0.04
Not found 128 (16.7%) 116 (19.4%) 0.04
Hypertension      
Yes 471 (61.6%) 433 (72.3%) 0.00
No 294 (38.4%) 166 (27.7%) 0.00
Diabetes      
Yes 451 (59.0%) 385 (64.3%) 0.05
No 314 (41.0%) 214 (35.7%) 0.05
Stroke      
Yes 30 (3.9%) 37 (6.2%) 0.06
No 735 (96.1%) 562 (93.8%) 0.06
Active malignancy      
Yes 21 (2.7%) 15 (2.5%) 0.88
No 744 (97.3%) 584 (97.5%) 0.88
CKD      
Yes 38 (5.0%) 49 (8.2%) 0.02
No 727 (95.0%) 550 (91.8%) 0.02
Others      
Yes 22 (2.9%) 26 (4.3%) 0.15
No 743 (97.1%) 573 (95.7%) 0.15
Family history of the coronary artery, stroke, or hypertension      
Yes 216 (28.2%) 192 (32.1%) 0.13
No 549 (71.8%) 407 (67.9%) 0.13
Previous angina pectoris      
Yes 277 (36.2%) 217 (36.2%) 0.11
No 488 (63.8%) 382 (63.8%) 0.11
Previous myocardial infraction      
Yes 209 (27.3%) 180 (30.1%) 0.37
No 556 (72.7%) 419 (69.9%) 0.37
Previous heart failure      
Yes 117 (15.3%) 111 (18.5%) 0.11
No 648 (84.7%) 488 (81.5%) 0.11
Past IHD      
Yes 77 (10.1%) 82 (13.7%) 0.04
No 688 (89.9%) 517 (86.3%) 0.04
History of cardiac catheterization      
Yes 269 (35.2%) 231 (38.6%) 0.21
No 496 (64.8%) 368 (61.4%) 0.21
Coronary angioplasty      
Yes 118 (15.4%) 96 (16.0%) 0.86
No 647 (84.6%) 503 (84.0%) 0.86
Coronary artery bypass surgery      
Yes 34 (4.4%) 28 (4.7%) 0.84
No 731 (95.6%) 571 (95.3%) 0.84
PCI      
Yes 181 (23.7%) 132 (22.0%) 0.58
No 584 (76.3%) 467 (78.0%) 0.58
Episode type      
Inpatient 63 (8.2%) 0 (0.0%) 0.00
Emergency 702 (91.8%) 599 (100.0%) 0.00
Episode location      
CCU 562 (73.5%) 354 (59.1%) 0.00
Female section 31 (4.0%) 36 (6.0%) 0.00
Male section 50 (6.5%) 67 (11.2%) 0.00
ERU 17 (2.2%) 17 (2.8%) 0.00
MIC 8 (1.0%) 41 (6.8%) 0.00
DCU 2 (0.3%) 7 (1.2%) 0.00
PT 1 (0.1%) 5 (0.8%) 0.00
SIC and ERO 23 (3.0%) 25 (4.1%) 0.00
Others hospital department 65 (8.5%) 43 (7.2%) 0.00
History of ICU admission or CCU      
Yes 174 (22.7%) 180 (30.1%) 0.00
No 591 (77.3%) 419 (69.9%) 0.00
Diagnosis      
Unstable angina 120 (15.7%) 100 (16.7%) 0.05
Acute subendocardial myocardial infarction 190 (24.8%) 187 (31.2%) 0.05
Acute transmural myocardial infarction 392 (51.2%) 260 (43.4%) 0.05
Angina pectoris 41 (5.4%) 29 (4.8%) 0.05
Acute IHD 19 (2.5%) 18 (3.0%) 0.05
Chronic IHD 3 (0.4%) 5 (0.8%) 0.05

History of IHD was significantly more common in older patients (13.7%; p≤0.05) than in younger patients. Inpatient care was significantly more common in younger patients (8.2%) than in older patients, whose care more often occurred in the CCU or ICU (p<0.05). We found no significant differences between the two age groups regarding past angina pectoris, myocardial infarction, cardiac catheterization, coronary artery bypass surgery, percutaneous coronary intervention, diabetes, stroke, malignancy, family history of CAD stroke, or HTN (p>0.05).

Discussion

We found an incidence of CAD in 2019 of 220.89 per 10,000. The 2020 COVID-19 pandemic-related restrictions on hospital admissions confounded our data for 2020 because only critical cases were admitted (such as CAD patients). However, for reporting purposes, the CAD incidence was 3,030.52 per 10,000 patients that year. According to a United Arab Emirates study, the incidence rate of major CAD per 10,000 person-years was 127, and higher systolic blood pressure (SBP) strongly predicted CAD in both men and women [12]. This agrees with the findings of our study, which revealed that the frequency rate of CAD among patients with high blood pressure was 66.3% per 1,364 patients in all age groups. The correlation between higher SBP and CAD in both men and women has been documented in previous studies [13,14].

CAD incidence rates vary globally among different high-risk populations. A recent five-year study in a neighboring Arab country found that the incidence rate of CAD among patients with diabetes was 17.6 per 10000 person-years, which is lower than the frequency rate determined in our study [12]. A study of Italian patients with diabetes found that men and women had higher CAD incidence rates of 288 and 233 per 10,000 person-years, respectively, than our study [15]. The prevalence rate of CAD among patients with diabetes was 61.3% in our study. In India, an 11-year population-based study of diabetes patients found a CAD incidence rate of 5.6 cases per 1000 person-years, which is lower than our study's frequency rate of CAD [16].

Previous studies reported that age is a major nonmodifiable risk factor linked to significant CAD occurrence [17,18]. In our study, age was a significant predictor of major CAD in men but not women, considering other risk variables [18,19]. In Europe and North America, the average age of patients with CAD is 60 to 65 years [3], higher than the average age of 56 years reported in a multicenter Middle Eastern population-based study [20]. The average age of the participants in our study was 59 years, indicating that the population at risk of CAD is younger than 60 years. This emphasizes the need for early detection of CAD and its risk factors.

Our findings revealed that younger patients with a smoking history (23.5% of the population) had a considerably greater risk of CAD than nonsmokers. Other classic cardiovascular risk variables (e.g., diabetes and serum lipids) are negatively influenced by cigarette smoking, and HTN has a multiplier effect on the incidence of CAD [21]. Smokers younger than 50 have a 10-fold increased risk of CAD compared to nonsmokers of the same age [22]. In our study, 19.4% of the participants were current smokers, and 16.3% were ex-smokers. In two previous studies, current smoking was significantly associated with increased risk, while ex-smokers had a higher risk than nonsmokers but lower than current smokers [23,24].

Risk factors analysis in this study found that 59% of patients under 60 have diabetes and 52.3% had a high HbA1c level. HbA1c reflects glucose control and is a significant predictor of CAD incidence in both sexes; CAD risk increases in patients as their HbA1c levels increase [23,24]. Diabetes is a significant risk factor for CAD [25].

In our study, 30.4% of the participants were obese. Being obese or overweight exacerbates or aggravates all atherogenic risk factors that predispose people to coronary events, regardless of age [26]. Current evidence suggests that BMI is independently related to CAD in patients with established coronary atherosclerosis and that the risk is enhanced even at mildly raised BMI levels [27].

The prevalence of high cholesterol and triglyceride levels in the present study were 20.2% and 15.5%, respectively. Previous research shows that a single risk factor (e.g., hypercholesterolemia or HTN) is responsible for the development of CAD [28]. Previous studies showed that a triglyceride level of 90 mg/dL raises the risk of CAD [22].

Studies in other countries showed positive connections between CAD and changes in population mean risk factors [23]. A longitudinal study may be required to demonstrate the effect of lifestyle changes by losing weight, increasing physical activity, quitting smoking, controlling HTN, controlling diabetes, and actively managing the metabolic syndrome in reducing the risk of CAD in Saudi Arabia [23,29].

Our study had several important limitations. First, this was a single-center study, and therefore a more extensive multicenter study is warranted to support our results. Secondly, restrictions due to COVID-19 precautions confounded our 2020 data. A repeat study where such pandemic-related restrictions are appropriately absent would strengthen the data.

Conclusions

We conducted this study to assess the incidence of CAD from 2019 to 2020 in KAUH and to determine the major risk factors for CAD. We found a significant increase in the incidence of CAD. The increase was markedly observed among older male patients. Therefore, monitoring these variables in patients with CAD is advisable. Based on our results, a national community-based prevention effort should be implemented to avoid the expected CAD epidemic in Saudi Arabia. Measures to modify lifestyle and address metabolic syndrome management are required.


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Original article
peer-reviewed

Incidence of Coronary Artery Disease in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2019–2020: A Retrospective Cohort Study


Author Information

Fatma Albeladi

Nephrology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU

Iman Wahby Salem

Community Medicine, King Abdulaziz University, Jeddah, SAU

Mohammed Zahrani

Internal Medicine, King Abdulaziz University, Jeddah, SAU

Layal Alarbedi

Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU

Abdulrahman Abukhudair Corresponding Author

Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU

Huda Alnafei

Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU

Abeer Alraiqi

Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU

Nourah Alyoubi

Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained or waived by all participants in this study. Unit of Biomedical Ethics Research Committee at King AbdulAziz University. issued approval Reference No 629-20. This study was approved by the Institutional Review Board of King Abdulaziz University (Reference No 629-20) Non-Intervention (Retrospective, Cohort Study).
. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

We gratefully acknowledge Nawaf Ibrahim Alhindi, Hassan Aziz Alsulami, Shahad Hussain Shawish, Turki Ayesh Almuzaini, Asim Abdullah Alandijani, Amjad Mohammed Saad Alluhaybi, Abdulrahman Hussan Bagais, Abdullah Ahmed Halawani, Fatimah Ahmed Alshamrani, and Ahmad Samir Momina for their meticulous skills in data collection.



Original article
peer-reviewed

Incidence of Coronary Artery Disease in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2019–2020: A Retrospective Cohort Study


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