Despite War and Strife, Ischemic Heart Disease Leads Deaths in ‘Arab Spring’

Ischemic heart disease is the leading cause of death in the eastern Mediterranean region, a part of the world besieged by political and economic tumult, including the Arab uprisings, a new analysis shows.

From 1990 to 2013, the region comprised of 22 countries, including Afghanistan, Iran, Iraq, Palestine, and Syria, among others, saw a shift in the main causes of death from communicable to noncommunicable diseases. For example, the number of deaths from ischemic heart disease increased by more than 17% from 1990 to 2013, surpassing diarrheal diseases and lower respiratory infections as the leading cause of death.

“The eastern Mediterranean region is facing numerous health challenges as a result of previous wars, recent revolutions, the wars that followed, and ageing and population growth,” write Ali Mokdad (University of Washington, Seattle), and colleagues in their paper published online August 24, 2016, in the Lancet: Global Health. The group notes that life expectancy in the region increased by 6 years between 1990 and 2013, up from 65 to 71 years, but “the situation has resulted in deteriorating health conditions for many countries that are threatening these gains and will have an impact on the region and worldwide.”

After ischemic heart disease (90.3 deaths per 100,000 people), lower respiratory infections, preterm birth complications, diarrheal diseases, and congenital anomalies rounded out the top five leading causes of death. Cerebrovascular disease and diabetes were also among the leading causes. The number of deaths from diabetes increased from 12 per 100,000 people to 19 per 100,000 people between 1990 and 2013. For men, ischemic heart disease was the leading killer in 2013, while it was the number two cause of death in women (for whom lower respiratory infection was the leading cause death).

In terms of risk factors, high blood pressure, obesity, smoking, high fasting plasma glucose, and high dietary sodium were leading contributors to disability-adjusted life-years (DALYs), which is a measure of disease burden. Childhood undernutrition, unsafe water, suboptimal breastfeeding, and pollution also contributed to disability in the eastern Mediterranean.

Within the region, individuals living in Afghanistan had the lowest life expectancy—56 years for men and women—while Qatar had the highest (81.2 years for men and 83.1 years for women). Between 2010 and 2013, individuals in Yemen, Tunisia, and Egypt lost approximately 3 months of life expectancy, while the average life expectancy in Syria—a country beset with war since the 2011 prodemocracy uprising—declined by an average of 6 years over the same time period.

Overall, the regional DALYs decreased from 54,838 years per 100,000 people in 1990 to 34,217 years 100,000 people in 2013. Within the region, the prevalence of mental and substance disorders, which include depression, anxiety, and drug use, have also increased since 1990. The rise in these disorders has not been met with investments in prevention, except by Lebanon and Qatar, according to the researchers.

In an editorial, Riyadh Lafta, MD (Mustansiriya Medical School, Baghdad, Iraq) writes that the region is in a state of “epidemiological transition,” moving away from health problems related to sanitation and nutrition, such as infectious diseases, to health issues more commonly associated with developed countries. These include health problems such as ischemic heart disease, diabetes, obesity, and cancer, as well as road-traffic accidents and psychological illnesses.

“This transition has increased the burden of diseases on the community and exhausted the health system,” states Lafta.

The bottom line from the Global Burden of Disease Study analysis is that the eastern Mediterranean region is in the midst of a critical phase that could result in the deterioration in the health status of countries for many years. “We are facing common known and expected problems, but we should be more alert to emerging disasters that might result from the unfamiliar situation due to the continuous destruction of the infrastructures and the effect of the new sophisticated weaponry used in conflict,” writes Lafta.     

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