Coronary artery disease in Africa and the Middle East

Figures & data

Figure 1 Death rates from cardiovascular disease in selected countries in Africa and the Middle East. Drawn from data presented by the World Health Organization.¹

Figure 2 Trends in total cigarette consumption in the World Health Organization Eastern Mediterranean and Americas regions. Drawn from data presented by Guindon et al.⁸

Table 1 Hypertension and adverse cardiovascular outcomes in the Egyptian National Hypertension Project¹⁰

	Hypertension (n = 1559)	No hypertension (n = 754)	P
Coronary heart disease (%)	19.5	11.6	<0.01
Heart failure (%)	13.3	5.8	<0.0001
Renal failure (%)	5.3	1.9	0.0002
Left ventricular hypertrophy (%)	20	5	<0.001

Note: Compiled from data presented by Sharraf et al.¹⁰

Figure 3 Demographic shift in North Africa: increased burden of ischemic heart disease (IHD) and decreasing burden of rheumatic heart disease (RHD) in hospitals in Tunisia.²⁶

Table 2 Summary of European guideline recommendations on the use of beta-blockers in patients with selected manifestations of established cardiovascular disease

Indication	Recommended use of beta-blocker therapya	Summary of potential benefit
Acute MI	All patientsa,b	Limitation of infarct size, ↓ life-threatening cardiac arrhythmias, relief of pain, reduced mortality (including sudden cardiac death)
Post-MI	Long-term use in all survivors of MI	20%–25% improvement in survival through reductions in cardiac mortality, sudden cardiac death and reinfarction
NSTEMI-ACS	Use acutely and long-term after the acute phase has passed	Control myocardial ischemia and prevent acute myocardial infarction or reinfarction
Stable coronary artery disease	Long-term use for all patients	Control ischemia, prevent infarction, improve survival
HF with reduced LV systolic function	Stable, mild-to-severe chronic heart failure (ischemic or non-ischemic) and ↓LV ejection fraction, in NYHA class II–IV; use with ACEI for systolic dysfunction post-MI irrespective of presence/absence of HF symptoms	Long-term reduction in total and cardiovascular mortality, sudden cardiac death and death due to progression of HF
HF with preserved LV systolic function	No pharmacologic intervention has been shown to reduce morbidity and mortality in this population; managing cardiac ischemia and hypertension is considered of importance
Supraventricular arrhythmias	Atrial fibrillation, of atrial ectopic activity; use in selected individuals with sinus tachycardia (investigate primary cause)	Slow heart rate, improve control of ventricular rhythm
Ventricular arrhythmias	Patients with ventricular arrhythmias related to sympathetic activation (eg, stress-induced arrhythmias, MI, perioperative, heart failure, catecholaminergic polymorphic ventricular tachycardia)	Improve control of ventricular rhythm, including reduced risk of sudden cardiac death
Cardiomyopathy	Dilated cardiomyopathy (no specific recommendation for the use of beta-blockers in hypertrophic cardiomyopathy)	Beta-blockers reduce mortality similarly in HF of ischemic or nonischemic etiology

Notes:

a Without contraindications;

b consider intravenous use for ischemic pain resistant to opiates.^3,42

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; HF, heart failure; LV, left ventricular; NYHA, New York Heart Association; MI, myocardial infarction; NSTEMI, non-ST elevation myocardial infarction.

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