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Atherosclerotic Cardiovascular Disease Novel and Traditional Risk Factors in Middle Eastern Young Women. The ANCORS-YW Study Cover

Atherosclerotic Cardiovascular Disease Novel and Traditional Risk Factors in Middle Eastern Young Women. The ANCORS-YW Study

Global Heart
Volume 19 (2024): Issue 1
By: Ayman J. Hammoudeh,  Majeda Jallad,  Yousef Khader,  Yahya Badaineh,  Ramzi A. Tabbalat,  Hasan Zammar,  Hanna Al-Makhamreh,  Asma Basha,  Liyan AlAtteili,  Raghad Abuhalimeh,  Taima Fkheideh,  Amr Ababneh,  Layan Ababneh,  Saad A. Mahmoud and  Imad A. Alhaddad  
Open Access
|Jul 2024
Figures & tables

Figures & Tables

Table 1

Baseline demographic, socioeconomic, and clinical characteristics of 624 young women with or without ASCVD.

VARIABLEASCVD GROUP N = 209 (n,%)CONTROL GROUP N = 418 (n,%)p-VALUE
Demographic and socioeconomic status, N (%)
Mean age ± SD (years)44.8 ± 5.243.8 ± 5.20.024
Age strata0.312
18–40 years37 (17.7)90 (21.5)
41–50 years172 (82.3)328 (78.5)
Race
Caucasian Arab209 (100)418 (100)–
Residence
Capital city78 (37.3)236 (56.4)<0.001
Urban315 (75.4)148 (70.8)0.263
Rural103 (24.6)61 (29.2)0.263
Education<0.001
None, school, and diploma156 (74.6)231 (55.3)
Graduate and postgraduate education53 (25.4)187 (44.7)
Health insurance149 (71.3)238 (56.9)<0.001
Traditional risk factors, N (%)
Hypertension118 (56.5)114 (27.3)<0.001
Type 2 diabetes mellitus83 (39.7)49 (11.7)<0.001
Elevated serum level of LDL-C114/129 (88.4)86/122 (70.5)<0.001
Low serum level of HDL-C96/122 (78.7)63/114 (55.3)<0.001
Family history of premature ASCVD101 (48.3)98 (23.4)<0.001
Smoking
Current cigarette smoking69 (33.0)89 (21.3)0.002
Past cigarette smoking13 (6.2)12 (2.9)0.076
Current water pipe smoking9 (4.3)41 (9.8)0.025
Current electronic cigarette smoking4 (1.9)12 (2.9)0.632
All current smokers82 (39.2)142 (34.0)0.233
Second-hand smoking38 (18.2)86 (20.6)0.545
Current cigarette smoking0.002
≤10 pack.years36/69 (52.2)69/89 (77.5)
>10 pack.years33/69 (47.8)20/89 (22.5)
Body mass index (kg/m2)0.361
<24.946 (22.0)97 (23.2)
25–29.968 (32.5)147 (35.2)
≥3095 (45.5)174 (41.6)
Metabolic syndrome83/160 (51.9)57/178 (32.0)<0.001
Regular physical activity0.279
Yes47 (22.5)110 (26.3)
No162 (77.5)308 (73.7)
Exercise duration per week0.077
<3 hours6/47 (12.8)30/110 (27.3)
3–7 hours30/47 (63.8)69/110 (62.7)
>7 hours11/47 (23.4)11/110 (10.0)
Novel risk factors, N (%)
Preterm delivery55 (26.3)70 (16.7)0.006
Hypertensive disease of pregnancy
All64 (30.6)95 (22.7)0.041
Gestational HTN25 (12.0)53 (12.7)0.903
Chronic HTN20 (9.6)9 (2.2)<0.001
Preecalmpsia19 (9.1)33 (7.9)0.719
Gestational DM35 (16.7)43 (10.3)0.031
Persistent weight gain after pregnancy31 (14.8)89 (21.3)0.053
Polycystic ovary syndrome14 (6.7)28 (6.7)0.865
Premature menopause20 (9.6)42 (10.0)0.987
Breast cancer1 (0.5)4 (0.1)0.920
Depression18 (8.6)36 (8.6)0.880
Autoimmune/collagen vascular disease14 (6.7)17 (4.1)0.223
Other comorbid diseases and procedures, N (%)
Metabolic syndrome63/160 (51.9)57/178 (32.0)<0.001
Heart failure26 (12.4)2 (0.5)<0.001
Chronic kidney disease6 (2.9)2 (0.5)0.033
Sleep apnea6 (2.9)2 (0.5)0.033
Hypercoagulable state and VTE6 (2.9)4 (1.0)0.151
Thyroid disease21 (10.0)56 (13.4)0.274
Malignancy3 (1.4)7 (1.7)0.956
Bilateral salpingo-oopherectomy3 (1.4)10 (2.4)0.595
Caesarian section21 (10.0)88 (21.1)<0.001

[i] ASCVD: atherosclerotic cardiovascular disease; DM: diabetes mellitus; HTN: hypertension; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SD: Standard deviation; VTE: Venous thromboembolism.

Figure 1

ASCVD Risk Factors in Middle Eastern Young Women.

*p < 0.05. HTN: hypertension, T2D: Type 2 diabetes, BMI: Body Mass Index, ASCVD: Atherosclerotic cardiovascular disease.

Figure 2

Novel risk factors for atherosclerotic cardiovascular disease in young women with or without disease.

*p < 0.05. HDP: Hypertension of pregnancy, GDM: Gestational diabetes, PCOS: Polycystic ovary syndrome.

Table 2

Classification and details of atherosclerotic cardiovascular disease in 209 young women.

DISEASEN%
Coronary artery disease18086.1
Acute coronary syndrome:
All17181.8
ST-segment elevation myocardial infarction56/17133.3
Non-ST-segment elevation acute coronary syndrome115/17167.3
Obstructive coronary artery disease118/18065.6
Non-obstructive coronary artery disease62/18034.4
Coronary revascularization in acute coronary syndrome:
All118/17169.0
Percutaneous coronary angioplasty113/17166.1
Coronary artery bypass graft surgery5/1712.9
Spontaneous coronary artery dissection6/1803.3
Coronary artery disease by computed tomography9/1805.0
Transient ischemic attack/Stroke4019.1
Peripheral artery disease62.9
Multiarterial beds involvement178.1

[i] ACS: acute coronary syndrome; CABG: coronary artery bypass graft; CAD: coronary artery disease; CCTA: coronary computed tomography angiography; NSTEMI: non-ST-segment elevation myocardial infarction; SCAD: spontaneous coronary dissection; STEMI: ST-segment elevation myocardial infarction.

Table 3

Use of medications in young women with atherosclerotic cardiovascular and the control group.

MEDICATIONASCVD GROUP N = 209CONTROL GROUP N = 418p-VALUE
Oral antiplatelet agents:
One agent76 (36.4)36 (8.6)<0.001
Aspirin and a second agent112 (53.6)2 (0.5)<0.001
Oral anticoagulant agents9 (4.3)6 (1.4)0.048
Lipid lowering agents:
All statins187 (89.5)65 (15.6)<0.001
High intensity statin116/187 (62.0)28/65 (43.1)0.012
Statin/ezetimibe combination8/187 (4.3)5/65 (7.7)0.459
Beta blockers152 (72.7)89 (21.3)<0.001
Renin angiotensin system inhibitors101 (48.3)68 (16.3)<0.001
Diuretics31 (14.8)32 (7.7)0.008
Antidiabetic agents65 (31.1)38 (9.1)<0.001
Table 4

Multivariate analysis of factors associated with ASCVD in young women.

ODDS RATIO95% CONFIDENCE INTERVALp-VALUE
Low level of education1.811.182.760.006
Urban residency0.900.571.400.629
No health insurance0.500.330.770.001
Hypertension2.151.413.30<0.000
Type 2 diabetes2.971.834.82<0.000
Family history of premature atherosclerotic cardiovascular disease2.681.804.00<0.000
Body mass index ≥ 30.0 kg/m20.880.591.330.554
Current cigarette smoking2.021.303.150.002
Physical inactivity0.960.611.520.868
Preterm delivery1.590.982.560.060
Hypertension disease of pregnancy1.190.751.870.464
Gestational diabetes mellitus1.190.662.140.567
Persistent weight gain after pregnancy0.570.340.970.040
Autoimmune disease1.730.734.120.216
Breast cancer0.400.044.240.445
Depression0.950.461.940.884
Premature menopause1.000.531.920.989
Polycystic ovary syndrome0.780.341.770.547
WOMEN WITH NO ASCVD N = 418WOMEN WITH ASCVD N = 209TOTAL N = 627p-VALUE
Education0.000
No school, school, diploma23155.3%15674.6%387
College and post graduate18744.7%5325.4%240
Place of Residence0.222
Rural10324.6%6129.2%164
Urban31575.4%14870.8%463
Health insurance0.000
No18043.1%5928.4%239
Yes23856.9%14971.6%387
Hypertension0.000
No30472.7%9143.5%395
Yes11427.3%11856.5%232
Type 2 diabetes mellitus0.000
No36988.3%12660.3%495
Yes4911.7%8339.7%132
High serum level of low-density lipoprotein cholesterol0.000
No3629.5%1511.6%51
Yes8670.5%11488.4%200
Low serum level of high-density lipoprotein cholesterol0.000
No5044.2%2621.3%76
Yes6355.8%9678.7%159
Family history of premature ASCVD0.000
No32076.6%10851.7%428
Yes9823.4%10148.3%199
Body mass index (kg/m2)0.361
<3024458.4%11454.5%358
≥3017441.6%9545.5%269
Smoking0.001
No32978.7%14067.0%469
Yes8921.3%6933.0%158
Regular physical activity0.297
No30873.7%16277.5%470
Yes11026.3%4722.5%157
Preterm delivery0.005
No34883.3%15473.7%502
Yes7016.7%5526.3%125
Hypertensive disease of pregnancy0.032
No32377.3%14569.4%468
Yes9522.7%6430.6%159
Gestational diabetes mellitus0.021
No37589.7%17483.3%549
Yes4310.3%3516.7%78
Persistent weight after pregnancy0.053
No32978.7%17885.2%507
Yes8921.3%3114.8%120
Autoimmune disease0.152
No40195.9%19593.3%596
Yes174.1%146.7%31
Breast cancer0.525
No41499.0%20899.5%622
Yes41.0%10.5%5
Depression1.000
No38291.4%19191.4%573
Yes368.6%188.6%54
Premature menopause0.850
No37690.0%18990.4%565
Yes4210.0%209.6%62
Polycystic ovary syndrome1.000
No39093.3%19593.3%585
Yes286.7%146.7%42
DOI: https://doi.org/10.5334/gh.1341 | Journal eISSN: 2211-8179
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Language: English
Submitted on: Jan 5, 2024
Accepted on: Jun 28, 2024
Published on: Jul 15, 2024
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
Atherosclerotic cardiovascular disease,
Cardiovascular disease in young women,
Novel cardiovascular risk factors,
Middle Eastern population,
Traditional cardiovascular risk factors

© 2024 Ayman J. Hammoudeh, Majeda Jallad, Yousef Khader, Yahya Badaineh, Ramzi A. Tabbalat, Hasan Zammar, Hanna Al-Makhamreh, Asma Basha, Liyan AlAtteili, Raghad Abuhalimeh, Taima Fkheideh, Amr Ababneh, Layan Ababneh, Saad A. Mahmoud, Imad A. Alhaddad, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

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