Cardiovascular Health among Adults in Syria: A Model from Developing Countries
Introduction
Cardiovascular disease (CVD) (coronary heart disease, stroke) is the leading cause of morbidity and mortality worldwide and is increasing alarmingly in developing countries. Currently, CVD is responsible for about 30% of all deaths worldwide and is projected to cause 24 million deaths by 2020 1, 2, 3. While the developing world bears most of the burden of these deaths, there are still no signs of success in halting the CVD epidemic there 1, 2, 3. Moreover, deaths from CVD in developing countries occur at a younger age compared to developed ones, further hindering their social and economic development (4).
Four of the 10 leading risk factors to health are related to CVD: hypertension, smoking, high cholesterol levels, and obesity (5). These risk factors explain at least 75% of new cases of coronary heart disease, reflecting in part a population shift in the energy intake-consumption balance 5, 6. Cardiovascular risk factors tend to cluster together, leading to multiplication of risks, but also providing an opportunity to reduce multiple risk factors by addressing their common behavioral roots 7, 8.
Addressing the epidemic of CVD in developing countries requires acting on the root causes of its risk factors, an approach that is likely feasible across diverse socioeconomic settings 5, 7, 8, 9, 10. However, many developing countries lack reliable surveillance data regarding the size, composition, and trends in CVD and their risk factors in their societies. Collecting these data is a crucial initial step for planning and monitoring the success of CVD intervention strategies (11). For example, the Eastern Mediterranean Region (EMR) is recognized as a hot spot for CVD, where projections of its burden exceed those of other regions; however, local data to inform health policy are inadequate 12, 13, 14. Specifically, as of 2005, the global cardiovascular InfoBase of the World Health Organization had no CVD-related morbidity and mortality estimates for Syria (15). Therefore establishing reliable surveillance for CVD and related risk factors seems an essential first step toward devising an action plan to curb the CVD epidemic in the EMR 16, 17. This study, based on the Aleppo Household Survey (AHS) conducted in 2004 by the Syrian Center for Tobacco Studies (SCTS), aims to provide the first population estimates of CVD morbidity and mortality in Syria, as well as to characterize the population distribution of CVD and their determinants.
Section snippets
Population, Sampling, Procedures
AHS is a population-based survey conducted among a representative sample of households in Aleppo (second largest city in Syria with a population of approximately 2,500,000). AHS aims to characterize major health problems/risks among adults in Syria and is described in details elsewhere 18, 19. AHS employed stratified cluster sampling, whereby Aleppo was divided into two strata; formal and informal residential neighborhoods based on the official enumeration of the municipal registry. Informal
Results
Full sociodemographic characteristics of the study sample are shown in Table 1. The study sample included 2038 household representatives (45.2% men, mean age [+ standard deviation], 35.3 + 12.1 years; age range, 18–65 years, response rate 86%). Prevalence of CVD was 4.8% (95% CI, 3.5–6.8) for heart disease, and 1.0% (95% CI, 0.6–1.7) for stroke (see Table 2). Mortality data were collected on all household members older than 20 years (n = 6252; 49.5% men), whereby 209 deaths were reported in the
Discussion
This study puts Syria on the map for the first time in terms of population-derived estimates of CVD burden and its risk factors in this society. This cross-sectional survey was conducted in Aleppo, which is the second largest city in Syria with a population of approximately 2,500,000. It shows that CVD/risks are the leading cause of morbidity and mortality in the society. The CVD profile in Aleppo is characterized by a predominance of heart disease compared with stroke, and greater morbidity
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