Cardiovascular Disease in Saudi Arabia: Facts and the Way Forward

There is a need to understand the burden of cardiovascular diseases (CVDs) in Saudi Arabia (SA) and focus on cardiovascular (CV) risk factors and some proposed solutions. This could pave the way for strategic direction to mitigate CV risks and alleviate CVD burden, by developing policies and practical measures, in compliance to 2030 healthcare and economic vision for SA.

Key Takeaway

• Risk factors such as unidentified and untreated dyslipidemia, hypertension, diabetes, obesity, sedentary lifestyle, urbanization, and smoking contribute to the high prevalence of CVD in SA. Additionally, globalization, the rise of an aging population, as well as socioeconomic changes and stress, could also contribute to increasing CVD cases.
• Lifestyle modifications such as healthy diets, regular exercise and smoking cessation are among few modifiable risk factors to reduce the risk of CVD.
• Interventions to mitigate CVD should aim at primary prevention level focused on mitigating non-modifiable CV risk factors and preventing CVD onset, as well as on secondary prevention level early screening and diagnosis of CVD.
• Comprehensive awareness campaigns targeting the general population and healthcare professionals, promoting CVD risk factors knowledge, prevention, and early detection can lead to better health outcomes. Inclusion of a CVD prevention program in primary healthcare centers could step up CV health prevention across all SA provinces.
• Collaboration between government entities, healthcare providers, public health organizations, and community stakeholders is vital for a comprehensive approach to tackle CVD. Coordinated efforts can lead to effective policies, better healthcare delivery, and improved outcomes.
• Many interventional national registries have been established for CV care in various countries like USA, Italy, Sweden, Japan, UK based on their population data.
• Current practice in SA relies on latest US and European guidelines. Therefore, there is need for launching a continuous CV health registry for SA population which would help to identify unmet need, improve public health outcomes, and also lead to more specific Saudi-based guidelines.

Why This Matters

• CVD is one of the leading causes of morbidity and mortality across the globe.
• Although some risk factors for CVD are non-modifiable, other determinants such as obesity, hypertension, type 2 diabetes, and dyslipidemia could be mitigated by an array of measures to control CVD.
• This review highlights the current status of CV health and unmet needs in SA, along with focus on the CV risk factors and some proposed solutions.

Key Results

• In SA, 201,300 Saudi nationals were living with CVD in 2016 and accounting for over 45% of all deaths. This emphasizes the need to understand CV risk factors and possible solutions.
• Sedentary lifestyle leading to dyslipidemia, hypertension, diabetes, obesity among Saudi Arabians, especially in females and tobacco use have been contributing factors towards increased susceptibility for CVD.
• Economic burden of CVD in SA in year 2016 was estimated to be $3.5 billion ($1.9 billion in direct healthcare costs and $1.6 billion in indirect costs from loss of productivity). This number might triple to $9.8 billion in 2035.

Saudi initiatives to reduce modifiable and non-modifiable CV risk factors include:

Modifiable risk factors
Tobacco use	Guidelines to improve smoking cessation services, considering global evidence
Lifestyle modifications	Obesity Control & Prevention Strategy 2030
	RASHAKA Program for healthy lifestyle
	KSA National Strategy for Diet and Physical Activity
	City humanization and walkability
Hypertension Guideline	Updated guidelines on hypertension management
Dyslipidemia	2022 Saudi Guidelines for Dyslipidemia Management provide a comprehensive framework for dyslipidemia control and its CV consequences
Non-modifiable risk factors
Familial hyperlipidemia	Emphasis on early screening can turn this risk factor into a modifiable one with strict control of risk factors
	There is a need for developing a cardiogenomic database which could help in family mapping, future research, and developing new therapeutics.
Old age	Increase exercise and reduce calorie-intake
Premature early coronary artery disease and sudden cardiac death	Early detection and prompt management of CVD Early screening can turn familial hyperlipidemia, which is a non-modifiable risk factor into a modifiable one with strict control of associated risk factors Therefore, SA government has considered CVD as a public health priority and allocated one-off $3,000 per patient over 5 years for screening tests, healthcare costs, and lipid-lowering therapies

Pillars of healthcare systems in SA:

• Free healthcare at primary, secondary or tertiary levels
• Specialized diagnostic and therapeutic services
• Reforms have been started in the primary healthcare system so that primary healthcare centers throughout SA’s 13 regional health directorates could oversee and manage all other healthcare centers and services.
• Decentralization of healthcare services has improved this sector a lot.Access to specialized healthcare services in SA is not limited to physical appointments; “Seha” virtual hospital at the Ministry of Health (MOH) headquarters, with central cardiac imaging and CV information center for cardiac data review and complex cases discussion improved access to healthcare services, patients’ satisfaction along with productivity and efficiency.

Gaps still exist in healthcare system of SA:

• Some geographical areas of SA still have limited healthcare access.
• There is need to raise more awareness among patients for adherence at the level of primary care offices and about primary prevention and early diagnosis of CVDs.
• There are shortcomings in Saudi health information system such as lack of coordination among medical care levels and challenges in coordination between referral and referring centers. This emphasizes need for a systematic integration of a HIS across the country’s healthcare facilities.
• There is limited access to fitness centers; these warrants need for widely accessible and affordable community fitness centers.
• Manpower shortage emphasizes the need for more physicians, nurses, and nurse practitioners
• Need for leveraging care in primary care centers, for prevention and timely diagnosis of CV risk factors or CVDs and alleviation of CVD burden
• Keeping in consideration the rise in rate of obesity, tools for behavioral changes promoting healthy lifestyle should be widely promoted.

Measures/Recommendations that can be undertaken in SA:

Smoking	Smoking ban, including electronic cigarettes, and smokeless tobaccos
Diet	Rigorous control of salt content and consumption in diet
Physical activity	1) Mandatory physical program in schools 2) More community sport centers 3) Improving walkability in big cities
Screening Programs	Early detection and treatment of dyslipidemia, with a particular focus on lowdensity lipoprotein cholesterol
Health check-ups	Make regular health checks mandatory for all adults of all ages
Adequate resources	Provide primary care physicians all the resources they need (time, support, training, etc.) to focus on high quality prevention programs
Risk management	Enforce quality measures on CV risk management
Education and awareness	Health literacy committee at MOH to promote patient and community education, disease prevention, early symptoms reporting, treatment adherence Dedicated task force for CV health
National registries	Many interventional registries in various countries have evolved the field of cardiovascular care A continuous CV health registry specific to SA population is needed with multiple tracks focusing on risks, prevention, diagnoses, management, and outcomes of CVDs

MAT-SA-2400770/V1/DEC 2024