Research Article: Epidemiology of coronary artery disease and stroke and associated risk factors in Gaza community –Palestine

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Amal Jamee Shahwan, Yehia Abed, Ileana Desormais, Julien Magne, Pierre Marie Preux, Victor Aboyans, Philippe Lacroix, Liwei Chen.


To determine the prevalence of cardiovascular disease and associated risk factors in the population of Gaza strip in Palestine.

A cross-sectional stratified cluster sample design was applied in this study. A sample of 2240 participant (1121 males and 1119 females) aged ≥25 years participated in the study. For each individual, trained staff administered a questionnaire, where all variables of interest followed WHO’s STEP wise approach to surveillance chronic disease risk factors (STEPS) (WHO, 2001). Sociodemographic data, anthropometric measure (body mass index, blood pressure), and biochemical test (blood sugar and lipids profiles) were measured. Short International Physical Activity (IPAQ) questionnaire form was used. Bivariate analysis and logistic regression were used with SPSS (version 22.0) to analyze the data.

The most common condition was coronary artery disease (8.3%), followed by stroke events (3%). The associated risk factors were obesity (47.8%), hypertension (28.4%), current smoking account for (23.2%), diabetes mellitus (19.1%), high cholesterol level (8.8%), and high triglycerides level (40.2%). Additionally, the proportion of being physical active was found to be low (48.3%); particularly with increasing age. More than 30% of the population has less than 4 days of consumption of fruit and vegetables per week and 65.9% has less than 2 servings per day.

The burden of CVDs and their associated risk factors is considerable in Gaza and represents a major public health concern. Effective strategies in management, education and healthcare centers are required for an accurate management and implementation of preventive measure in this area.

Partial Text

In the previous years, there were dramatic changes in the occurrence of the major manifestations of cardiovascular disease (CVDs), mainly coronary artery disease (CAD) as well as cerebrovascular disease (CBVD). Cardiovascular diseases are now recognized as the leading cause of death and disability worldwide [1]. In 2015, it was estimated that 17.7 million people died from CVD worldwide, representing 31% of all global deaths; out of whom, 7.4 million were due to CAD, and 6.7 million were due to stroke [2]. In the United States (US), 92.1 million adults experienced at least one type of CVD. By 2030, 43.9% of the US adult population is projected to have some form of CVD. However from 2004 to 2014, death rates attributable to CVD declined by 25.3% in that country [3]. Three quarters of global CVD deaths occur in Low and Middle-Income Countries (LMIC). In 2015, among 17 million premature deaths (under the age of 70) was due to Non-Communicable diseases (NCDs); 82% of them took place in LMIC and 37% of the deaths are caused by CVDs, almost equal in males and females [4–6]. Arab countries in the Middle East have undergone rapid and dramatic socioeconomic changes. In these countries which have young populations, CVD mortality accounts for 45% of deaths [7]. The rates of CVDs deaths were up to 42%,38%,32% and 23% respectively in Saudi Arabia, the United Arabic Emirates, Bahrain and Qatar [8].

The Gaza strip is a small 365 square kilometers area of Palestinian occupied territories; it is a very crowded place as around 1.9 million Palestinians live in. Gaza strip consists of 5 governorates with fourteen villages and eight refugee camps [11]. We conducted a cross-sectional study using stratified cluster sample, with the advantage of covering a wide geographic area, in 5 governorates spanning both urban and rural spaces between July and October 2017. The target population include 673 523 inhabitants, almost 35.8% of the total Gaza strip population.

A total of 2240 participant were included into the study. Sociodemographic profiles and the burden of Cardiovascular risk factors of the participants are displayed in “Table 1”. No significant difference was seen according to age group distribution and gender. The mean age of study population is 47.4 years (47.1 in male and 47.8 in female). Forty percent of participants lived in refugee camps. Furthermore, 7% of the females did not have any formal schooling, while 25.8% of the study population completed university education, and 7.6% achieved postgraduate degree. The monthly income was less than $150 for 36.8% of the participants. Regarding CVD risk factors hypertension and diabetes were higher among females. BMI was ≥ 30kg/m2 in 47.8% of the cases. Obesity was more common in females than males, 60.2%, 35.5% respectively. Conversely The overweight was more common in males than females 39.1% vs 26.7% (p value <0.001). In addition, 8.8% and 40.2% of study population had high levels of total cholesterol and triglycerides respectively. Our study is the first to report the prevalence of CVDs among Gazans in Palestine. Previous surveys were hospital based or on United Nation Relief and Work Agency (UNRWA) report. The prevalence of CVDs nears 10% of the population above the age of 25years in this area. There are few limitations to our study. First, the cross-sectional nature of this study design limits the interference of causal relation-ships between risk factors and CAD or stroke. Also, the prevalence of high blood pressure and raised blood glucose have been over estimated because these two risk factors were evaluated once (no reevaluation during another visit, and no three consecutive measures of BP according to WHO step). Further, possible bias could have been introduced since study was conducted at home and data concerning more risk factors and history of CAD and stroke were self- reported. Also, the wide age range of participants, 25 years and more is both a strength and a weakness of this study. However, 32% of the population was aged 55 years and more, who have a greatest prevalence of CVD and risk factors. Even so we found considerable charge of risk factors in young population. Also, this study has strengths points: women were well represented, with a male: female ratio of 1, and it was performed in a large mixed area with representative sample, and good response rate; making it the first study in Palestine to report a national estimate for CVD prevalence. This study was the first nationwide endeavor that provides information about the prevalence of CVDs and the level of cardio vascular risk factors among palestinian community in Gaza.   Source:


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