Although it is believed that rapid improvement in socio-economic conditions are responsible for the high prevalence of heart disease in the Gulf states, cultural factors are also to blame according to researchers.

Professor Hani Najm, Vice-President of the Saudi Heart Association, whose yearly conference starts on Friday 27 January, explained:

“We’re sitting on a time bomb. We will see a lot of heart disease over the next 15 to 20 years. Already, services are saturated. We now have to direct our resources to the primary prevention of risk factors throughout the entire Middle East.”

According to figures from the World Health Organization, 70% of women and 60% of men in Arab countries are classified as overweight or obese. Furthermore, prevalence rates of high blood pressure and diabetes are approximately 25%, while inactivity rates among individuals over the age of 20 are even greater.

Professor Najm says that rapid urbanization is not solely responsible for the high prevalence of cardiovascular disease. There are several social and cultural barriers to exercise, particularly among women, who struggle to find the encouragement and opportunities to take organized exercise.

Further evidence suggests that another increasing risk factor for heart disease is the prevalent use of the water pipe (also known as the hooka or shisha). Currently, up to 34% of Middle Eastern teenagers and women use the water pipe. Despite the perception that the water pipe poses less risk than cigarettes, a recent study suggests that its “harmful effects are similar to those of cigarettes, and that the water pipe may offer “a bridge” to cigarette smoking.”

A study from the Gulf Registry of Acute Coronary Events (GRACE), which included 6,701 consecutive acute coronary patients in Kuwait, United Arab Emirates, Bahrain, Qatar, Yemen, and Oman, discovered that 38% of patients registered were cigarette smokers and 4.4% were waterpipe smokers. In addition, results showed that waterpipe smokers were older and more likely to be female than cigarette smokers.

Although the registry study showed a relatively low rate of waterpipe smoking among the patients, other investigations suggest that the use of watepipes throughout the region is more widespread, especially among younger age groups.

A 2004 study discovered that 22% of men in two villages of Egypt reported current or past use of waterpipes. Furthermore, the use of waterpipes is increasingly evident among student communities in Germany, Canada, and the United States.

Researchers from GRACE explained:

“Although the prevalence of waterpipe smoking in the current registry was low (4.4%), with the current trend of popularity it is expected that physicians and specifically cardiologists across the globe can expect increasing number of their patients with Acute Coronary Syndromes to be water pipe tobacco smokers.”

According to the researchers, the increasing popularity of water pipe use is due to the false belief that any harmful effect is less than that of cigarettes, as well as a dearth of healthy warnings (and dearth of data).

However, the researchers suggest that waterpipe smoking may be linked to higher toxin exposure, as smoke inhalation is up to 100 times more than from a cigarette. A single waterpipe episode can last between 30 and 60 minutes and may involve over 100 inhalations, each around 500 ml in volume (with the smoke passing first through water).

They explain:

“Thus, while smoking a single cigarette might produce a total of approximately 500-600 ml of smoke, a single water pipe use episode might produce about 50,000 ml of smoke.”

In this year’s Annual Conference of the Saudi Heart Association, which, for the second year, will also feature a one-day collaborative program with the European Society of Cardiology, an entire session will be devoted to the primary prevention of heart disease in the Middle East.

Professor Najm underlines the efforts the Association (as well as several regional health ministries) to create prevention programs. Furthermore, Najm regrets that the smoking policies of several nations – including Saudi Arabia – are not fully enforced.

Najm said:

“The basic messages still need to be delivered. With such a high prevalence of risk factors in our populations, especially among the young, I still expect rates of cardiovascular disease to increase even further over the next 20 years.”

Written by Grace Rattue