Prevalence and correlates of coronary heart disease: first population-based study in Lebanon

Figures & data

Table 1 Characteristics of the study participants

Characteristics	Study participants (n=1,362)
Age, in years, median (IQR)	54 (46–65)
Age groups
40–50 years	506 (37.2)
50–60 years	351 (25.8)
60–70 years	234 (17.2)
≥70 years	270 (19.8)
Sex
≥Males	674 (49.4)
Females	689 (50.6)
Region type
Urban	733 (55.6)
Rural	587 (44.4)
Marital status
Married	1,064 (78.6)
Single/widowed/divorced	290 (21.4)
Work status
Working	704 (51.7)
Not working	539 (39.6)
Retired	118 (8.7)
Education level
Complementary level or less	678 (50.3)
Secondary level or more	671 (49.7)
Income for each person of the household (in Lebanese pounds), median ± (IQR)	375,000 (187,500–750,000)

Note: Data are presented as n (percentage) unless indicated otherwise.

Abbreviation: IQR, interquartile range.

Figure 1 Prevalence estimates of CHD, adjusted to the WHO world standard population.

Note: The error bars represent the 95% CI.
Abbreviations: CHD, coronary heart disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; CI, confidence interval; WHO, World Health Organization.

Table 2 Age- and sex-specific CHD prevalence adjusted for the Lebanese population

Coronary heart diseases	40–49 years % (95% CI)	50–59 years % (95% CI)	60–69 years % (95% CI)	≥70 years % (95% CI)	Total % (95% CI)
MI
Male	5.7 (3.4–9.3)	12.8 (8.7–18.4)	12.3 (7.6–19.3)	12.3 (7.9–18.6)	10.1 (8.0–12.5)
Female	0.4 (0.1–2.0)	2.1 (0.8–5.3)	1.7 (0.5–5.9)	6.2 (3.3–11.3)	2.2 (1.4–3.5)
P (χ^2)	<0.001	<0.001	0.001	0.069	<0.001
Overall	2.9 (1.8–4.7)	7.3 (5.0–10.4)	7.0 (4.4–11.0)	9.2 (6.4–13.1)	6.0 (4.9–7.4)
P trend	<0.001
Angina
Male	5.7 (3.4–9.3)	8.4 (5.2–13.2)	11.2 (6.8–17.9)	9.7 (5.8–15.9)	8.2 (6.4–10.5)
Female	1.8 (0.8–4.2)	3.9 (1.9–7.8)	4.0 (1.7–9.1)	4.7 (2.3–9.4)	3.3 (2.2–4.9)
P (χ^2)	0.021	0.071	0.033	0.104	<0.001
Overall	3.7 (2.4–5.7)	6.2 (4.2–9.2)	7.6 (4.9–11.6)	7.1 (4.6–10.7)	5.7 (4.6–7.0)
P trend	0.012
PCI
Male	1.2 (0.4–3.6)	12.3 (8.3–17.9)	17.6 (11.8–25.5)	11.6 (7.4–17.9)	9.2 (7.2–11.6)
Female	1.5 (0.6–3.8)	1.6 (0.6–4.6)	5.0 (2.3–10.6)	11.8 (7.5–18.1)	4.2 (3.0–5.9)
P (χ^2)	0.794	<0.001	0.002	0.966	<0.001
Overall	1.4 (0.7–2.8)	6.8 (4.7–9.9)	11.3 (7.9–16.0)	11.7 (8.5–15.9)	6.6 (5.4–8.1)
P trend	<0.001
CABG
Male	0.8 (0.2–2.9)	6.7 (3.9–11.4)	5.1 (2.4–10.7)	13.7 (9.0–20.2)	5.8 (4.3–7.8)
Female	0	0.5 (0.1–3.0)	3.3 (1.3–8.1)	6.8 (3.6–12.5)	2.0 (1.2–3.3)
P (χ^2)	0.141	0.001	0.476	0.061	<0.001
Overall	0.4 (0.1–1.4)	3.6 (2.1–6.0)	4.1 (2.3–7.5)	10.4 (7.4–14.6)	3.9 (3.0–5.0)
P trend	<0.001
Any CHD
Male	7 (4.4–11.0)	22.7 (17.2–29.5)	22.9 (16.2–31.2)	26.3 (19.6–34.2)	17.8 (15.1–20.9)
Female	3.4 (1.8–6.4)	6.9 (4.0–11.6)	12.0 (7.3–19.1)	20.3 (14.3–27.9)	9.0 (7.1–11.4)
P (χ^2)	0.066	<0.001	0.027	0.246	<0.001
Overall	5.1 (3.5–7.4)	14.8 (11.5–18.9)	17.4 (13.1–22.8)	23.3 (18.7–28.7)	13.4 (11.7–15.3)
P trend	<0.001

Abbreviations: CHD, coronary heart disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; CI, confidence interval.

Table 3 Differences in sociodemographic characteristics, and lifestyle and biological RFs according to coronary heart disease status

Variables	CHD − (n=1179)%	CHD + (n=182)%	P-value	OR (95% CI)	Significance level
Age, in years, median (IQR)	53 (45–63)	61 (54–74)	<0.001	1.04 (1.03–1.06)	*
Age categories			<0.001
40–50 years	40.7	14.3		1
50–60 years	25.4	28.6		3.24 (1.98–5.29)	*
60–70 years	16.4	22.5		3.93 (2.34–6.61)	*
≥70 years	17.6	34.6		5.59 (3.44–9.08)	*
Male (vs female)	46.8	66.5	<0.001	2.25 (1.62–3.13)	*
Rural (vs urban)	43.7	49.4	0.165	1.26 (0.91–1.73)
Single/widowed/divorced (vs married)	21.6	20.6	0.762	0.94 (0.64–1.39)
Work status			<0.001
Working	53.0	43.4		1
Not working	40.1	36.3		1.10 (0.78–1.56)
Retired	6.9	20.3		3.59 (2.28–5.65)	*
Lower than secondary level	48.0	60.7	0.002	1.67 (1.21–2.30)	**
Income/person of the household lower than the first quartile of the sample	25.8	38.6	<0.001	1.81 (1.29–2.53)	*
Smoking status			0.001
Never smoker	39.4	34.1		1
Previous smoker	11.6	22.4		2.19 (1.39–3.45)	*
Current smoker	49.0	43.5		1.01 (0.70–1.46)
Cigarette smoking			<0.001
Non-cigarette smoker	53.5	41.7		1
0.1–14.9 cigarette-pack-years	17.7	13.1		0.94 (0.56–1.56)
15–29.9 cigarette-pack-years	9.3	8.9		1.22 (0.67–2.23)
≥30 cigarette-pack-years	19.5	36.3		2.39 (1.64–3.49)	*
Waterpipe smoking			0.482
Non-waterpipe smoker	80.2	83.6		1
0.1–19.9 WP-years	8.9	5.5		0.57 (0.28–1.17)
20–39.9 WP-years	3.0	3.6		1.25 (0.53–2.95)
≥40 WP-years	7.9	7.3		0.87 (0.46–1.64)
BDS-22, median (IQR)	4.0 (1.0–10.0)	4.0 (1.0–11.7)	0.954	1.01 (1.00–1.03)
LMDS, m ± SD	31.8±4.1	32.5±4.2	0.071	1.04 (1.00–1.08)
Insufficient physical activity	70.9	74.0	0.407	1.17 (0.81–1.68)
BMI, median (IQR)	27.27 (24.34–30.23)	28.37 (25.51–31.46)	0.002	1.05 (1.02–1.08)	**
BMI categories			0.079
Normal weight	30.9	23.0		1
Overweight	42.5	45.4		1.44 (0.97–2.14)
Obese	26.7	31.7		1.61 (1.05–2.47)	***
WC, m ± SD	94.8±15.5	102.0±16.0	<0.001	1.03 (1.02–1.04)	*
Hypertension	39.4	81.3	<0.001	6.69 (4.53–9.89)	*
SBP, median (IQR)	12.75 (11.30–14.00)	13.75 (12.00–14.50)	<0.001	1.15 (1.06–1.24)	*
DBP, median (IQR)	8 (7–8.5)	7.75 (7–8.5)	0.130	0.96 (0.83–1.10)
Diabetes	14.6	42.6	<0.001	4.35 (3.11–6.08)	*
RCBG, median (IQR)	110 (97–131)	126 (102–161.88)	<0.001	1.01 (1.00–1.01)	*
Hypercholesterolemia	24.0	58.7	<0.001	4.50 (3.18–6.38)	*
Hypertriglyceridemia	17.8	44.6	<0.001	3.72 (2.59–5.33)	*
Family history of premature CVD	13.2	21.0	0.006	1.75 (1.17–2.61)	**

Notes:

* ≤0.001,

** ≤0.01,

*** ≤0.05.

Abbreviations: CHD, coronary heart disease; OR, crude odds ratio; CI, confidence interval; IQR, interquartile range; BDS-22, Beirut Distress Scale; LMDS, Lebanese Mediterranean Diet Score; BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; RCBG, random capillary blood glucose; CVD, cardiovascular disease; RFs, risk factors; WP, waterpipe; m, mean; SD, standard deviation.

Table 4 Profile of patients with prevalent CHD

Variables	Model 1a	Significance level	Model 2b	Significance level	Model 3c	Significance level
	aOR (95% CI)		aOR (95% CI)		aOR (95% CI)
Age, years	1.04 (1.02–1.05)	*	1.04 (1.02–1.06)	*	1.05 (1.02–1.08)	*
Male	2.32 (1.49–3.61)	*	2.23 (1.20–4.15)	**	4.69 (2.49–8.83)	*
Rural vs urban	–		–		–
Work status
Working	1		1		–
Not working	1.10 (0.67–1.81)		1.38 (0.71–2.69)		–
Retired	2.30 (1.37–3.85)	***	2.81 (1.45–5.45)	***	–
Lower than secondary level	–		–		–
Income/person of the household lower than the first quartile of the sample	1.75 (1.21–2.54)	***	1.73 (0.07–2.78)	**	2.21 (1.26–3.90)	***
Cigarette smoking
Non-cigarette smoker			1		–
0.1–14.9 cigarette-pack-years			1.08 (0.55–2.14)		–
15–29.9 cigarette-pack-years			1.09 (0.45–2.63)		–
≥30 cigarette-pack-years			2.02 (1.19–3.44)	***	–
BDS-22			–		–
LMDS			–		–
WC			1.04 (1.02–1.05)	*	–
BMI			–		–
Hypertension					2.64 (1.36–5.11)	***
Diabetes					2.19 (1.18–4.05)	**
Hypercholesterolemia					5.20 (2.97–9.07)	*
Hypertriglyceridemia					–
Family history of premature CVD					2.36 (1.18–4.71)	**

Notes:

a Regression Model 1 included sociodemographic factors: age, sex, region type, marital status, work status, education level, income for each person of the household.

b Regression Model 2 included variables entered in Model 1, plus lifestyle factors: cigarette-pack-years, BDS-22, LMDS, WC, BMI.

c Regression Model 3 included variables entered in Model 2, plus biological factors: hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, family history of premature CVD.

* ≤0.001,

** ≤0.05,

*** ≤0.01.

Abbreviations: CHD, coronary heart disease; aOR, adjusted odds ratio; CI, confidence interval; BDS-22, Beirut Distress Scale; LMDS, Lebanese Mediterranean Diet Score; WC, waist circumference; BMI, body mass index; CVD, cardiovascular disease.