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Research ArticleOriginal Article
Open Access

The prevalence of cardiovascular disease in adults with type 2 diabetes mellitus in Saudi Arabia - CAPTURE study

Abdullah M. Alguwaihes, Amani Alhozali, Moataz M. Yahia, Tarek Abdel-Nabi, Mohamed Hassan Hatahet, Nader I. Albalkhi and Saud Al Sifri
Saudi Medical Journal January 2023, 44 (1) 57-66; DOI: https://doi.org/10.15537/smj.2023.44.1.20220402
Abdullah M. Alguwaihes
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD, MPH
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  • For correspondence: [email protected]
Amani Alhozali
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD, SSC-Med
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Moataz M. Yahia
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD, BCMAS
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Tarek Abdel-Nabi
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
BPharm, BCMAS
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Mohamed Hassan Hatahet
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD
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Nader I. Albalkhi
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD, MMed
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Saud Al Sifri
From the Department of Internal Medicine (Alguwaihes), King Saud University, from the Department of Internal Medicine (Alguwaihes), King Saud University Medical City, from the Department of Medical Affairs (Yahia, Abdel-Nabi), Novo Nordisk, from the Department of Internal Medicine (Albalkhi), Specialized Medical Centre Hospital, Riyadh, from the Department of Internal Medicine (Alhozali), King Abdulaziz University Hospital, Jeddah, from the Department of Internal Medicine (Hatahet), King Abdulaziz Hospital for National Guard, Al Ahsa, and from the Department of Internal Medicine (Al Sifri), Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia.
MD, FACE
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Article Figures & Data

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  • Figure 1
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    Figure 1

    - Cardiovascular disease and atherosclerotic cardiovascular disease prevalence in Saudi Arabia, stratified by care setting. Differences between care settings were not compared statistically.

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    Figure 2

    - Glucose-lowering agents with established cardiovascular benefit: use in Saudi Arabia. *Liraglutide, semaglutide, and dulaglutide. **Empagliflozin, canagliflozin, and dapagliflozin. CV: cardiovascular, GLP-1 RA: glucagon-like peptide-1 receptor agonist, SGLT2i: sodium-glucose co-transporter-2 inhibitor

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    Differences between care settings were not compared statistically. ASCVD: atherosclerotic cardiovascular disease, CVD: cardiovascular disease

Tables

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    Table 1

    - Characteristics of patients in the CAPTURE Saudi Arabia by care setting.

    CharacteristicsStudy population (N=883)Care setting
    Primary care (n=566)Secondary care (n=317)
    nDatanDatanData
    Female883404 (45.8)566219 (38.7)317185 (58.4)
    Age, years88358 [50-65]56660 [53-66]31754 [48-62]
    Diabetes duration, years88010.0 [5.0-17.0]56311.7 [5.1-20.0]3178.3 [4.5-12.8]
    HbA1c, %8768.0 [7.1-9.0]5597.8 [6.8-9.1]3178.4 [7.8-9.0]
    HbA1c, mmol/mol87664 [54-75]55962 [51-76]31768 [62-75]
    BMI, kg/m288129.1 [26.5-32.9]56430.2 [26.5-34.3]31727.9 [26.5-30.0]
    Systolic blood pressure, mmHg882132 [122-143]565134 [123-145]317130 [122-140]
    Diastolic blood pressure, mmHg88276 [69-80]56575 [69-80]31776 [69-82]
    Hypertension876486 (55.5)560382 (68.2)316104 (32.9)
    Familial hypercholesterolemia552112 (20.3)29490 (30.6)25822 (8.5)
    eGFR, mL/min/1.73 m2814497317
    >89318 (39.1)222 (44.7)96 (30.3)
    >59-89430 (52.8)223 (44.9)207 (65.3)
    >29-5960 (7.4)48 (9.7)12 (3.8)
    ≤296 (0.7)4 (0.8)2 (0.6)
    Albuminuria668474194
    Normal to mildly increased470 (70.4)340 (71.7)130 (67.0)
    Microalbuminuria157 (23.5)93 (19.6)64 (33.0)
    Macroalbuminuria41 (6.1)41 (8.6)-
    Retinopathy883566317
    Yes123 (13.9)106 (18.7)17 (5.4)
    Yes (referred by patient)11 (1.2)10 (1.8)1 (0.3)
    No749 (84.8)450 (79.5)299 (94.3)
    Nephropathy883566317
    Yes91 (10.3)85 (15.0)6 (1.9)
    Yes (referred by patient)24 (2.7)23 (4.1)1 (0.3)
    No768 (87.0)458 (80.9)310 (97.8)
    Neuropathy883566317
    Yes106 (12.0)88 (15.5)18 (5.7)
    Yes (referred by patient)24 (2.7)24 (4.2)-
    No753 (85.3)454 (80.2)299 (94.3)
    Smoking883566317
    Current smoker78 (8.8)63 (11.1)15 (4.7)
    Previous smoker91 (10.3)25 (4.4)66 (20.8)
    Never smoker714 (80.9)478 (84.5)236 (74.4)
    Physical activity, days/week*486284202
    0-1231 (47.5)185 (65.1)46 (22.8)
    2-3144 (29.6)48 (16.9)96 (47.5)
    4-576 (15.6)20 (7.0)56 (27.7)
    6-735 (7.2)31 (10.9)4 (2.0)

    Values are presented as numbers and precentages (%) or median interquartile range [IQR]. Differences between the care settings of primary and secondary were not compared statistically.

    BMI: body mass index, eGFR: estimated glomerular filtrate rate, HbA1c: glycated hemoglobin

    • ↵* Number of days in the last week with a minimum of 30 minutes of moderate activity.

  • SitesIEC/IRB names
    Alhada Armed Forces HospitalResearch & Ethics Committee of Armed Forces Hospital, Western Region
    King Saud University Medical City, King Saud UniversityKing Saud University Medical City IRB
    Specialized Medical Centre HospitalSpecialized Medical Center Hospital IRB
    King Abdulaziz University HospitalKing Abdulaziz University Hospital IRB
    King Abdulaziz Hospital for National GuardKing Abdullah International Medical Research Center
    Diabetes and Endocrinology Center-BuraidahKing Fahd Medical City IRB
    Dallah HospitalKing Saud University Medical City IRB

    IEC: Independent Ethics Committee, IRB: Institutional Review Board

    • Cardiovascular disease
      Atherosclerotic cardiovascular diseases
      SubtypesDiagnoses usedFurther optional details
      Cerebrovascular disease*Ischaemic strokeN/A
      Haemorrhagic stroke
      Stroke, unspecified
      Transient ischaemic attack
      Carotid artery disease*N/AN/A
      Coronary heart disease*Myocardial infarctionN/A
      Stable coronary artery diseaseAlso known as angina pectoris
      Other ischaemic heart diseaseN/A
      Past revascularisation procedureN/A
      Peripheral artery disease*Asymptomatic peripheral artery diseaseLow ankle-branchial index (<0.90) or pulse abolition
      ClaudicationN/A
      Limb ischaemiaN/A
      Non-traumatic amputationN/A
      Heart failureSymptomaticNYHA group II-IV or unknown, LVEF ≥50%, LVEF 40-49%, LVEF <40% or LVEF unknown
      AsymptomaticNYHA group I, LVEF ≥50%, LVEF 40-49%, LVEF <40%, or LVEF unknown
      Hospitalisation due to heart failureN/A
      Cardiac arrhythmiaAtrial fibrillation, atrial flutterN/A
      Supraventricular tachycardia
      Ventricular tachycardia
      Ventricular fibrillation
      Bradyarrhythmia, sinus node dysfunction
      Bradyarrhythmia, atrioventricular block
      Aortic diseaseAortic dissectionN/A
      Aortic aneurysm
      Thromboembolic aortic disease

      From original Table S1 from Mosenzon et al. Cardiovasc Diabetol 2021; doi: 10.1186/s12933-021-01344-0, under the Creative Commons Attribution License 4.0; Copyright © 2021, The Author(s).”

      • ↵* Cardiovascular disease was categorized as atherosclerotic cardiovascular disease, when a patient had one of these four diagnoses. LVEF: left ventricular ejection fraction, N/A: non-applicable, NYHA: New York Heart Association functional classification.

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    The prevalence of cardiovascular disease in adults with type 2 diabetes mellitus in Saudi Arabia - CAPTURE study
    Abdullah M. Alguwaihes, Amani Alhozali, Moataz M. Yahia, Tarek Abdel-Nabi, Mohamed Hassan Hatahet, Nader I. Albalkhi, Saud Al Sifri
    Saudi Medical Journal Jan 2023, 44 (1) 57-66; DOI: 10.15537/smj.2023.44.1.20220402

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    The prevalence of cardiovascular disease in adults with type 2 diabetes mellitus in Saudi Arabia - CAPTURE study
    Abdullah M. Alguwaihes, Amani Alhozali, Moataz M. Yahia, Tarek Abdel-Nabi, Mohamed Hassan Hatahet, Nader I. Albalkhi, Saud Al Sifri
    Saudi Medical Journal Jan 2023, 44 (1) 57-66; DOI: 10.15537/smj.2023.44.1.20220402
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      • Appendix 2 - Definition of atherosclerotic cardiovascular disease and cardiovascular disease subtypes in the CAPTURE study.
      • Appendix 3 - Prevalence of cardiovascular disease subtypes among CAPTURE study participants in Saudi Arabia by care setting.
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    Keywords

    • cardiovascular system
    • epidemiology
    • type 2 diabetes mellitus
    • Saudi Arabia

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