Study offers rare insight into heart disease, diabetes risk in the Middle East, South Africa

By Marlene Leung.

A new study led by a St. Michael’s Hospital scientist provides a rare contemporary prevalence estimate of cardiovascular risk in people living with diabetes who reside in the Middle East and South Africa. Individuals from both of these regions continue to be under-represented in clinical trials thus limiting generalizability of the findings. 

The PACT-MEA study – led by Dr. Subodh Verma, a St. Michael’s clinician-scientist and Canada Research Chair in Cardiovascular Surgery, found that approximately 1 in 5 persons living with diabetes in these regions has heart disease. PACT-MEA also revealed that people in these regions who live with diabetes have a high prevalence of cardiovascular risk factors, including poor blood pressure control and high

“These are regions where rates of death and disability from diabetes remain quite high. Yet despite this understanding and the exponential growth of patients in these regions, there has been very little good quality data to understand overall cardiovascular risk,” said Verma. “This is what we aimed to do.”

The cross-sectional, observational study enrolled over 3,700 patients with type 2 diabetes from Bahrain, Egypt, Jordan, Kuwait, Qatar, the United Arab Emirates and South Africa. Researchers collected patient data during a doctor’s appointment using a standardized, electronic form.

Clinical research overwhelmingly take places in Western countries, and most participants are male. The PACT-MEA study, which includes a cohort that is 47 per cent female, fills a gap in knowledge about people from non-Western regions of the world.

The study found that overall 20.9 per cent of the participants had atherosclerotic cardiovascular disease, with significant variation between countries, ranging from 37 per cent in Bahrain to 19 per cent in Kuwait.

The study also found that 99 per cent of the cohort would be considered at high risk or very high risk for future cardiovascular events, based on the 2021 European Society of Cardiology guidelines.

To reduce cardiovascular risk, doctors recommend a combination of factors, including maintaining good blood sugar and blood pressure control, lowering cholesterol, access to the appropriate vascular protective medication, a body mass index (BMI) below 25 kg/m2 and frequent exercising, said Verma.

“Strikingly, zero per cent of the patients surveyed actually met all of these goals,” he said.

Verma hopes the study highlights the importance of having global representation in clinical research – something that is critical if research results and interventions are to have broad generalizability.

“I’m passionate about this study because it helped uncover a significant gap in our current understanding of the cardiovascular risk level in people living with diabetes in an area where there’s a growing tsunami of this chronic disease,” he said.

“It’s a call to action that if we are going to be global citizens and global researchers, more people from these regions need to be represented in clinical research.”