Acute coronary syndrome in the Middle East.

Heart disease is the major cause of death worldwide. Many individuals with heart disease present with acute coronary syndrome (ACS), which puts them at significant risk of morbidity and mortality. Current understanding of the risk factors, pathogenesis, and treatment has resulted in remarkable improvement in the outcome of these patients. Most of these studies were performed in the Western world and clearly demonstrated differences among different ethnicities, specifically among blacks, Hispanics, and Asians. Over the past century, in most populations including the Middle East, there has been a dramatic shift in the causes of death and disability, with a decrease in deaths from nutritional deficiencies and infectious diseases and an increase in deaths from noncommunicable diseases such as cardiovascular disease [1]. Understanding the epidemiology and outcome of treating ACS patients is paramount. The Gulf Heart Association has launched two multicenter, multinational registries of ACS: the Gulf Registry of Acute Coronary Events (Gulf RACE), which was conducted in 2007 and included 8,169 patients with ACS from six adjacent Middle Eastern countries (Bahrain, Kuwait, Qatar, Oman, the UnitedArab Emirates, andYemen) [2], and the Gulf RACE-2, which was conducted in 2009 and included 7,939 patients with ACS from 6 Middle eastern countries (Bahrain, Kingdom of Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen) [3]. These two registries provided valuable information to health care officials that is summarized in this commentary. The observations from these two registries when compared to observations from registries in the developed world demonstrated similarities as well as differences. For example, Middle Eastern women presenting with ACS were 9 years older and more likely to have diabetes mellitus, hypertension, and dyslipidemia when compared to Middle Eastern men. They were also more likely to have atypical presentation and unstable angina rather than myocardial infarction. When compared to men, women were significantly less likely to be appropriately treated with β-blockers and antiplatelet therapy, and women had significantly higher in-hospital mortality when compared to men. All these observations are comparable to results of western observations [4]. Similar findings were observed in regard to systemic hypertension, where 49.4% of ACS patients were hypertensive [5]. Middle Eastern patients with ACS also have a high prevalence of diabetes mellitus and metabolic syndrome (MetS); however, this high prevalence is perhaps much higher when compared to other ethnicities, specifically whites and blacks. Using the criteria fir MetS that was recently approved in a joint statement of the International Diabetes Federation, American Heart Association, World Heart Federation, and others, we reported a 46% prevalence of MetS among Middle Eastern ACS patients [6]. The prevalence of MetS was consistently higher among women when compared to men and was >70% among women in the age group of 50 to 79 years; 37% of patients were cigarette smokers, which is comparable to many western studies. Furthermore, consistent with the world literature, cigarette smokers were younger, had fewer cardiovascular risk factors, and were more likely to present early with typical ischemic symptoms. Cigarette smokers were also more likely to receive evidence-based therapy and had the J. Al Suwaidi (*) Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation (HMC) and Weill Cornell Medical School, P.O Box 3050, Doha, Qatar e-mail: jha01@hmc.org.qa