Hypercholesterolemia and its associated risk factors—Kingdom of Saudi Arabia, 2013

doi:10.1016/j.annepidem.2014.08.001

Annals of Epidemiology

Volume 24, Issue 11, November 2014, Pages 801-808

https://doi.org/10.1016/j.annepidem.2014.08.001 Get rights and content

Abstract

Purpose

To assess the prevalence of hypercholesterolemia and its associated factors in the Kingdom of Saudi Arabia.

Methods

A national multistage representative sample of Saudis aged 15 years or older was surveyed through face-to-face interviews. Data on sociodemographics, risk factors, and health information were collected, and blood sample analysis was performed. Data were analyzed using SAS 9.3 to account for the sample weights and complex survey design.

Results

Between April and June 2013, a total of 10,735 participants completed the survey. Overall, 8.5% of Saudis had hypercholesterolemia. Another 19.6% had borderline hypercholesterolemia. Among hypercholesterolemic Saudis, 65.1% were undiagnosed, 2.3% were treated uncontrolled, 28.3% were treated controlled, and 4.3% were untreated. The risk of being hypercholesterolemic increased with age and among individuals who reported consuming margarine, obese individuals, and those who have been previously diagnosed with hypertension or diabetes.

Conclusions

More than a million Saudis have hypercholesterolemia, and 700,000 of them are unaware of their condition which can be controlled through early detection campaigns and lifestyle change and medication. An urgent awareness and screening campaign is needed in Kingdom of Saudi Arabia to prevent and avoid disease progression toward more serious stages.

Introduction

Cholesterol is essential for the body, specifically for hormone synthesis, fat digestion, and formation of cell membranes [1]. However, large amounts of cholesterol in the bloodstream lead to myocardial infarction, stroke, ischemic injury, and organ failure [2]. Hypercholesterolemia can be prevented, and measures such as dietary changes and clinical follow-up must be taken for high-risk individuals to reduce adverse events [3], [4], [5], [6], [7].

The Global Burden of Disease 2010 study estimated that high cholesterol is a leading risk factor for death from cardiovascular diseases in the Kingdom of Saudi Arabia (KSA). It accounted for about 5.14% of total deaths, 3.96% of years of life lost, and 1.99% of disability-adjusted life years. From 1990 to 2010, the burden of hypercholesterolemia remained very high in KSA as it ranked eighth among the risk factors for total deaths [8].

Previous studies reported on prevalence of hypercholesterolemia in KSA. In the early 80s, prevalence of hypercholesterolemia was 7% for males and 8% for females and increased with age and body mass index (BMI) [9], [10]. Since the late 90s, data on hypercholesterolemia are limited [11]. However, prevalence of hypercholesterolemia was reported as 18.6% for males and 19.7% for females in 2005 [12].

To assess the current status of hypercholesterolemia in KSA, we analyzed the 2013 Saudi Health Interview Survey (SHIS) to describe the magnitude of hypercholesterolemia in KSA by different sociodemographic groups and risk factors.

Section snippets

Materials and methods

SHIS is a national multistage survey of individuals aged 15 years or older. Households were randomly selected from a national sampling frame maintained and updated by the Census Bureau. KSA was divided into 13 regions. Each region was divided into subregions and blocks. All regions were included, and a probability proportional to size was used to randomly select subregions and blocks. Households were randomly selected from each block. A roster of household members was collected, and an adult

Results

Between April and June 2013, a total of 10,735 participants completed the SHIS—response rate of 89.4%—and were invited to the local health clinics. The remaining 1265 participants completed part of the household enumeration, or all of it, but the selected adult did not complete the survey. A total of 5590 individuals went to the local clinics and provided blood samples for analyses—a response rate of 52.1%. The characteristics of respondents who completed the questionnaire and the laboratory

Discussion

To our knowledge, this is the first national study to report on cholesterol levels in KSA. We found high rates of undiagnosed cholesterol and borderline levels in a country where chronic diseases are the major health burden. Our findings call for awareness campaigns to educate the public about the danger of high cholesterol levels and the importance of early diagnosis. Indeed, because Saudis have free medical care, receive free medication when needed, and our data show high control levels of

Conclusions

Our findings call for urgent measures by the Saudi Ministry of Health to reduce the burden of hypercholesterolemia in KSA. Targeted blood cholesterol screening campaigns are required to detect individuals with hypercholesterolemia and refer them for medical follow-up. Moreover, the early detection campaigns should offer those with borderline hypercholesterolemia means to control their cholesterol levels through behavioral changes or medication if they have other risk factors. In addition, these

Acknowledgment

This study was financially supported by a grant from the Ministry of Health (MOH) of the Kingdom of Saudi Arabia. The authors would like to acknowledge Adrienne Chew at the Institute for Health Metrics and Evaluation, Seattle, WA for editing this paper.

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: Conflicts of interest: The salaries of the authors from the Institute for Health Metrics and Evaluation were fully or partially paid through a grant from the Ministry of Health (MOH) of the Kingdom of Saudi Arabia. The MOH managed the data collection for this study.

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Original articleHypercholesterolemia and its associated risk factors—Kingdom of Saudi Arabia, 2013

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Acknowledgment

Int J Cardiol

Int J Cardiol

Prev Med

J Saudi Heart Assoc

Lancet

Nutrition

Vander's Human physiology: the mechanisms of body function

Cholesterol and atherosclerosis: a contemporary perspective

Ann Acad Med Singapore

[Diet therapy of hypercholesterolemia. From theory to practice]

Ann Cardiol Angéiol

A life course approach to diet, nutrition and the prevention of chronic diseases

Public Health Nutr

Original article
Hypercholesterolemia and its associated risk factors—Kingdom of Saudi Arabia, 2013