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J Community Med Public Health, an open access journal
ISSN: 2577-2228
1 Volume 4; Issue 01
Journal of Community Medicine & Public Health
Research Article
AlYafei A, et al. J Community Med Public Health 4: 173.
Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients
with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014
DOI: 10.29011/2577-2228.100073
Anees AlYafei1*
, Sherif Omar Osman2
, Nagah Selim2
, Noora Alkubaisi3
, Rajvir Singh4
1
Wellness Program, Preventive Medicine, Primary Health Care Corporation, Doha, Qatar
2
Family and Community Medicine, Community Medicine Training Program, Doha, Qatar
3
Clinical Affairs, Primary Health Care Corporation, Doha, Qatar
4
Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
*
Corresponding author: Anees AlYafei, Wellness Program, Preventive Medicine, Primary Health Care Corporation, Doha, Qa-
tar
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among
Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4:
173. DOI: 10.29011/2577-2228.100073
Received Date: 27 February, 2020; Accepted Date: 04 March, 2020; Published Date: 09 March, 2020
Abstract
Background: Patients with Type 2 diabetes mellitus experience a substantial risk of cardiovascular disease owing to modifiable
risk factors.
Objective: To estimate the prevalence of cardiovascular disease risk factors among Qatari patients with Type 2 diabetes mellitus
attending primary health care centres 2014.
Method: Cross sectional design was used. Total of 532 Qatari diabetic patients attending primary healthcare were enrolled. Data
was collected using interview administered questionnaire, anthropometric & blood pressure measurement and medical records.
Cardiovascular risk was assessed by using General Framingham Risk Prediction Score (GFRP).
Results: GFRP score categorized (12.2%) of participants as low risk and (57.6%) as in high and very high risk for cardiovas-
cular disease in 10-years. Lifestyle-related risk factors were dominant among participants. The majority of patients did not
consume recommended daily fruit and vegetables (94.2%) and (91.2%) respectively. Additionally, they did not practice recom-
mended frequency of physical activity and were currently smoking in (71.4%) and (4.1%) respectively. Metabolic factors were
second common risk factors. The combined overweight and obesity were leading metabolic factors as calculated in (94%) of
them. More than two thirds showed uncontrolled diabetes status and (27.6%) were within undesirable range for HDL. The third
common cardiovascular disease risk factors were medical and family history. Three quarters of them found to have hyperlipi-
daemia and (72.7%) were with history of hypertension. The family history of premature cardiovascular disease occurrence in
father and/or brother was reported in (16.9% and 13%) of participants respectively.
Conclusion: Reduction of cardiovascular disease burden necessitate further focus on preventive interventions especially the
lifestyle related risk factors.
Keywords: Cardiovascular disease; Lifestyle-related risk
factors; Metabolic factors; Prevalence; Qatar; Type 2 diabetes
mellitus
Abbreviations:BMI:BodyMassIndex;CVD:Cardiovascular
Disease; GFRP: General Framingham Risk Prediction; HbA1C:
Glycated Hemoglobin A1; HDL: High Density Lipoproteins; IRB:
Institutional Research Board; LDL: Low Density Lipoproteins;
NCD: Non-Communicable Disease; PHC: Primary Health Care;
PHCC: Primary Health Care Corporation; SD: Standard Deviation;
SPSS®: Statistical Package of Social Science; Type 2 DM: Type 2
Diabetes Mellitus; WHO: World Health Organization
Introduction
Patients with Type 2 Diabetes Mellitus (DM) are always at
advanced risk of Cardiovascular Disease (CVD), where coronary
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
2 Volume 4; Issue 01
J Community Med Public Health, an open access journal
ISSN: 2577-2228
heart disease is the leading mortality cause among them owing to
the fast growth of multiple modifiable and metabolic cardiac risk
factors worldwide [1]. Both CVD and Type 2 DM are significant
causes of premature death as well as long-term disability. They
contribute substantially to the escalating costs of health care
globally, overwhelming health budgets everywhere.
The cardiovascular disease, mainly coronary heart disease
and stroke, is the number one cause of mortality worldwide. The
WHO reported 17.3 million deaths in 2008 due to CVD. This
represented 30% of all global mortality. It is expected to increase
up to 23.3 million deaths by the year 2030 and to remain the
single leading cause of death globally unless effective preventive
interventions are implemented [2].
The State of Qatar has undergone significant social and
economic changes over the last two decades, resulting in rapid
urbanization with a consequent increase in the burden of Non-
Communicable Disease (NCD). Although the total mortality rate
related to CVD was reduced by almost 46.5% from 36.7 in (2003)
to 17.1 deaths in (2010) per 100,000 populations, nevertheless
CVD still the leading mortality cause in Qatar as also confirmed
by many references [3-5].
According to the National STEPWise survey of chronic
disease risk factors conducted in 2012, about (66%) of Qatari adult
populations live with three or more modifiable risk factors related
to CVD. Besides, the prevalence of type 2 DM is about (17%),
which is one of the highest prevalence globally [6].
The multiplicative interactions between different risk
factors of CVD in type 2 diabetic patients were well-described
[7]. Comprehensive understanding of these modifiable risk factors
is crucial to direct integrated efforts, plans, and services toward
earlier prevention at the level of primary health care. Such early
identification of these risk factors will successively reduce the
CVD burden in the long term. However, the knowledge about the
common NCD well documented in Qatar, but little is knowledge
about the CVD risk factors prevalence among patients with type
2 DM.
Aim and Objective
Recognition of common risk factors of CVD among Qatari
patients with Type 2 DM at the Primary Health Care (PHC)
level, eventually helps in the development of evidence-based
recommendations that assist health care workers in all care level
in early identification of such risk factors and deciding for primary
prevention of CVD. The efficient management of these risk factors
subsequently will reduce the total burden of CVD and contributing
to improving the quality of life to Qatari patients with type 2 DM in
the long term. The study objective was to estimate the prevalence
of risk factors related to CVD among Qatari patients with Type 2
diabetes attending PHC centres during 2014.
Method
Study Settings and Design
The study was conducted as a cross sectional study and
patients were recruited from NCD clinics as well as general
walk-in clinics at PHC centres during 2014. There were 21 PHC
centres under Primary Health Care Corporation (PHCC) which is a
governmental leading primary care provider cross all the country.
Where, each health centre has its own well identified geographic
and population catchment area.
Study Population
Qatari type 2 DM patients attended the selected PHC centres
during July to November 2014 and meeting the eligibility criteria.
Inclusion criteria were; male & female Qatari patients with type 2
DM. Exclusion criteria were; patients refused to participate.
Sample Size and Sampling Technique
Sample size was calculated by: n=Z2
×P(1-P)/e2
[8]. Where,
n=required sample size, Z=the probability value associated with
confidence level which equals to 1.96, P=the prevalence of CVD
among patients with type 2 DM, which is 0.26 based on a study
carried out in Oman in (2010) at PHC level [9], e=desired margin of
error was set to be 0.05, The significance level was set at ˂0.05 and
confidence level of 95%. Calculation came out to be 532patients
after inflated by 20% for compensation of non-response and design
effect of 1.5, the study period continued till the calculated sample
was completed.
Simple cluster technique with proportionate allocation of
the calculated sample size was used. Simple random sampling
was conducted to select six health centres out of the 21. A cluster
sampling technique was done in which PHC centres have been
considered as clusters or primary sampling units. Within each
selected health centre, all eligible patients were included in the
study. The estimated sample size was distributed proportionately
among the six randomly selected health centres according to the
size of registered patients with type 2 DM within each of these
centres.
Research Instruments
The following instruments used in the study; 1. Arabic
version interview administered questionnaire, 2. Blood Pressure
(BP) measurements, 3. Body Mass Index (BMI) measurement &
calculation. 4. Data extraction sheet to record metabolic variables
of interest from the electronic medical records of each eligible
patient. 5. The General Framingham Risk Profile (GFRP) score for
primary care was used to assess 10-years total CVD risk.
The Arabic version interview administered questionnaire
developed by principle investigator and involving three sections;
1. Socio-demographic characteristics of; age, gender, education
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
3 Volume 4; Issue 01
J Community Med Public Health, an open access journal
ISSN: 2577-2228
level, marital status and occupation. 2. Personal medical history
of; duration of diabetes, presence of hypertension and history of
taking antihypertensive medications. 3. Life-style assessment on;
dietary history about fruits and vegetable consumption, consuming
snacks, outside prepared meals, soft drinks consumption, fatty food
intake, physical activity about both activity at work & physical
activity at leisure time during a regular week and tobacco use.
Validityofthequestionnairewasensuredthroughbothcontent
and face validity. Where, questions were developed by through
literature review and consultation of experts in fields of preventive
medicine, epidemiology, diabetology and cardiovascular disease.
Besidesthequestionnaire,dataextractionsheetusedtorecord
B.P, BMI, recent HbA1C %, serum High Density Lipoprotein
(HDL) and Low-Density Lipoprotein (LDL) levels for each patient
from the electronic medical records.
Cardiovascular risk was calculated by using the electronic
GFRP score, which is an Excel®
sheet-based calculator. The
researcher entered the following risk factors for all eligible patients;
sex, age in years, systolic blood pressure in (mmHg), either on
antihypertensive or not, smoking or non-smoking, and BMI. The
calculator gave the probability as a percentage automatically and
patients categorized into four categories based on the management
recommendations:
Low risk (<10%): patients in this category were at low risk,
•	
and low risk does not mean “no” risk.
Moderate risk (10% to <20%): patients in this category were
•	
at moderate risk of fatal or nonfatal cardiovascular events.
High risk (20% to <30%): patients in this category were at
•	
high risk of fatal or nonfatal cardiovascular events and risked
lowering medications recommended.
Very high risk (≥30%): patients in this category were at a very
•	
high risk of fatal or nonfatal cardiovascular events and risked
lowering medications recommended.
Research Approach
After obtaining Institutional Review Board (IRB) approvals.
Arabic speaking nurses assigned to assist in data collection.
The researcher explained to assigned nurses aim of the study,
data collection process and answered their enquiries. Inside the
selected health centres; eligible patients were invited to participate
voluntarily, after detailed explanation of study`s aim, future
benefits and process of data collection. All eligible patients were
kindly asked to sign informed consent which was approved by the
IRB committee. The researcher and/or assigned nurses interviewed
patients prior to their visit to their treating physician in a vital signs
assessment room, where also blood pressure and anthropometric
measurements were measured. Standardized methods for
measurements were used as recommended by PHCC guidelines.
Electronic medical records were accessed to record HbA1C% and
lipid profile for every patient. All accomplished questionnaires
were reviewed to ensure completeness and consistency.
Data Management
The researcher entered all collected data from completed
questionnaires and extracted spread sheet into an Excel®
sheet daily
and later all data was exported to a “Statistical Package of Social
Science” version 20.0 (SPSS®
) software database for analysis [10].
Different questions included in the interview questionnaires were
coded and entered on regular basis.
Descriptive statistics: frequency tables, proportions, figures
such bar, mean and standard deviation were used as appropriate.
Results
Five hundred thirty-two Qatari patients with type 2 DM met
the eligibility criteria were recruited voluntarily during the study
period.
Background Characteristics of the Study Participants
The most common age group was (50- 59) years with
(40.6%), with mean age of (56.06 ± 8.16 Standard Deviation (SD)).
Almost two thirds of them were females (66.7%). Elementary
school was the most frequent educational level encountered among
the patients (34.0%). The vast majority of patients were married
(86.5%) and being a housewife was found to be in more than half
of total sample (54.0%) as shown in the Table 1.
Variable Frequency (%)
Age
40 - 49 128 (24.0)
50 - 59 216 (40.6)
60 - 69 158 (29.7)
≥ 70 30 (5.7)
Gender
Male 177 (33.3)
Female 355 (66.7)
Educational Level
Illiterate 169 (31.8)
Elementary School 181 (34.0)
Secondary school 85 (16.0)
University and above 97 (18.2)
Marital Status
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
4 Volume 4; Issue 01
J Community Med Public Health, an open access journal
ISSN: 2577-2228
Single 17 (3.2)
Married 460 (86.5)
Divorced or Widowed 55 (10.3)
Occupation
Housewife 287 (54.0)
Retired 121 (22.7)
Professional / Clerk / Admin 117 (22.0)
Others 7 (1.3)
Table 1: Distribution of Background Characteristics of Qatari
Patients with Type 2 DM, Primary Health Care Centers, 2014. (N
= 532).
By using (GFRP) score, the 10-years CVD risk prediction
was low (<10%) in (12.2%) of the participants, moderate (10%
to <20%) in (30.2%), high (20% to <30%) in about one fourth of
them, while (33.5%) were at very high risk.
Life-Style related Risk Factors
Lifestyle-related risk factors were dominant among the
studied patients. The majority of patients did not consume the
recommended daily 5 servings of fruit and vegetable (94.2%) and
(91.2%) of patients respectively, as well as, consuming snacks,
outside prepared meals, soft drinks and fatty food consumption
more than two times per week, in (42.7%), (38.9%), (29.9%) and
(25.2%) of patients respectively.
While the mean number of fruits and vegetables servings
was (0.8 and 1.4) respectively Additionally, they did not practice
the recommended frequency of physical activity at leisure time
(71.4%). Furthermore, current smoking habit was only reported in
(4.1%) of the studied patients as illustrated in Figure 1.
Figure 1: Prevalence of cardiovascular lifestyle related risk factors
among Qatari patients with type 2 DM, Primary Health Care Centers,
2014. (N=532).
Metabolic Characteristics of the Study Participants
Metabolic risk factors were the second most common CVD
risk factors seen among patients of this study. By using World
Health Organization (WHO) definition of BMI, only (6%) of
patients were found to be within the normal range, one fourth were
in the overweight and as high as (69%) of patients were obese [3].
The combined overweight and obesity were the leading metabolic
risk factors as it was calculated in (94%) of the studies patients.
Type 2 DM glycemic control is determined by HbA1C (%) level
which measures it over the past three months. Target was to keep
the HbA1C level ≤ 7.0% as per PHC guidelines [11]. More than
two thirds (65%) of the participants were uncontrolled (HbA1C
level >7.0%). Total serum cholesterol was measured and classified
as desirable, borderline and high according to PHCC clinical
guidelines. Around (82.0%) of the participants were within the
normal range. Moreover, more than a quarter of them (27.6%)
were within the undesirable range for HDL, as seen in Figure 2.
Figure 2: Prevalence of metabolic risk factors for cardiovascular
disease among Qatari patients with type 2 DM, Primary Health
Care Centers, 2014. (N=532).
Analysis of the lipid profile showed that (27.6%) of the
participants were in undesirable range for HDL, while only (3.9%)
had high LDL and (3.8%) with high total serum cholesterol, as
seen in Figure 2. Participants were divided into 5 groups based on
5 years duration of type 2 DM occurrence. Almost (29%) of the
participants had type 2 DM between 5 years and less than 10 years.
Around (98.7%) of them used antihypertensive medications.
The third most common CVD risk factors among the
Qatari patients with type 2 diabetes were the medical & family
history. Three quarters (74.4%) of the studied patients were found
to have hyperlipidaemia in their confirmed history, and (72.7%)
are with confirmed history of hypertension. The family history of
the premature CVD occurrence in the father and/or the brother
was reported in (16.9% and 13%) of the studied diabetic patients
respectively. Furthermore, history of premature death in the father
and/or the brother due to CVD was found in (11.8%) of the sample,
as illustrated in Figure 3.
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
5 Volume 4; Issue 01
J Community Med Public Health, an open access journal
ISSN: 2577-2228
Figure 3: Prevalence of family and medical history related risk
factors for cardiovascular disease among Qatari patients with type
2 DM, Primary Health Care Centers, 2014. (N=532).
Discussion
The leading CVD risk factors were lifestyle-related factors
followed by the metabolic as well as the medical and family history
related risk factors.
This study showed that (59.6%) of the participated patients
used to have a daily fruits intake in a typical week with mean
days number of (4.88±2.34 SD), but (94.2%) of them reported
the consumption of less than 5-servings of fruits a day, with mean
number of servings (1.81±1.14SD) per day. Furthermore; despite
that (84.5%) of the patients reported eating vegetables daily with
mean of (5.77±1.85SD) days, but (91.2%) of them used to consume
less than the recommended 5-servings a day, with mean number of
the servings (1.92±1.33SD).
These results were much better than those seen in the
STEPwise survey conducted among the Qatari general population
during(2012),outofwhich(16.7%)weretype2diabetic.Itreported
that the majority of the Qatari population (91.1%) consume less
than the 5-servings for fruits and/or vegetables on average per day
[6]. The survey calculated the mean number of days for fruits and
vegetables consumed as (3.4 and 5.5) days respectively. While the
mean number of fruits and vegetables servings was (0.8 and 1.4)
respectively. Such narrow difference in figures compared to the
current study might be due to the influence of dietary counseling
and/or recall bias.
Physical inactivity is a well-known risk factor for CVD
development in the general population as well as in patients with
type 2 DM. The current study showed that (71.4%) of participants
were not practicing physical activity for at least 30 minutes once
a day weekly. This was much better than results addressed by
a study conducted by Qatar-Bio bank (2015), where a survey
was done questioning the Qatari general population and non-
Qatari individuals residents for 15years and more, where (81%)
of participants were not practicing the minimum recommended
frequency of weekly physical activity [12]. This is even better than
published findings reported by Al-Kaabi and colleagues in a cross-
sectional study done in the UAE during (2006) among patients
with type 2 DM. Only (3%) of participants reported the minimum
recommended frequency of physical activity [13].
Although the current study showed, better proportion of
patients practicing the recommended physical activity, but it was
still far less than what is expected in high-risk population. This
could be explained by the limited effect of counselling conducted
to such patients.
The present study showed that current tobacco use among
Qatari patients with type 2 DM is unexpectedly low (4.1%)
compared to the general population (16.4%) as reported in the
national STEPwise survey done in Qatar (2012). This prevalence
is considered also low if it is compared to several other studies
conducted among diabetic patients, like in Canada during (2012)
where more than two thirds (36%) of the studied sample were
currently tobacco users [14], or a study from Pakistan where
current tobacco smokers were (27%) during (2014) [15]. The
possible justification for the current study low tobacco usage may
be affiliated to that more than two thirds of the study participants
are older female adults where smoking in general is uncommon,
plus the possible denial by patients always will be blamed if they
continue a bad habit after being counselled against.
Metabolic CVD risk factors were the second most common
factors among studied patients. Overweight and obesity were
prevalent CVD risk factors among the studied Qatari patients
with type 2 DM. The present study showed that (25% and 69%)
of the studied patients were overweight and obese respectively.
This was higher than the numbers obtained from the general
population, were overweight prevalence was (28.7%) and obesity
(41.4%) during (2012) [6]. The present study findings were also
higher than that found in Yemen, where a bigger proportion of the
diabetic patients were with normal weight (45.5%), (43.5%) were
overweight and (11%) were obese [16]. The higher prevalence of
overweight and obesity in this study could be related to the higher
proportion of them were older female adults and the majority were
housewives or retired with considerably low physical activity and
living a sedentary life.
The majority of the studied patients (65%) were within
uncontrolledleveloftheHbA1C(>7.0%)withameanof(8.01±1.70
SD). This was consistent with many other studies carried out to
assess the glycemic control among patients with type 2 DM. In
UAE (68%) of the studied patients in (2006) were uncontrolled
based on HbA1C assessment [13]. Similarly, some other studies
showed relatively higher proportion (71%) of patients with high
HbA1C level as in a study done by Sabanaygam in Singapore
[17].
Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
6 Volume 4; Issue 01
J Community Med Public Health, an open access journal
ISSN: 2577-2228
On contrary; some studies indicated less proportion of
diabetic patients within the uncontrolled limit of the HbA1C as by
Leiter in Canada (2012) were only (50.4%) of the studied patients
were uncontrolled with mean of (7.4±1.3 SD) [15]. The differences
in HbA1C level may vary from one community to another mostly
due to proper counselling, compliance to the diet and medications,
as well as other lifestyle modification role.
The current study revealed low prevalence (3.8%) of high
serum cholesterol level among the participated Qatari patients
with type 2 DM, with mean level (4.48±0.91 SD) compared to the
prevalence of (28.8%) among patients with type 2 DM in a study
conducted in Saudi Arabia during (2009) by Al-Rowais [18]. Such
apparentdifferencecouldbeattributedtoeffectivepharmacological
influence of the lipid lowering medications which was taken by
almost all of the current study patients (97.5%).
Moreover, low prevalence of undesirable HDL and LDL
blood levels in the current study could be explained by effective
pharmacological effect of the lipid lowering medications. Where;
undesirable level of the HDLblood level (<1.0 mmol/l) was around
one fourth (27.6%) among patients in this study, while the high
LDL level (≥4.1mmol/l) was seen in (3.9%) of patients.
These results were lower than those found in a cross-sectional
study carried out in Jordan during (2008) among patients with type
2 DM, where (60.2%) were with undesirable HDL blood level and
(52.7%) of participants with high LDL blood level [19].
The third most common CVD risk factors among the studied
Qatari patients with type 2 DM were medical and family history.
Hypertension is a well-recognized associated risk factors in patients
with type 2 DM. The prevalence of the systolic hypertension (≥140
mmHg) in this study was (21.4%) which was lower than a study
conducted in Canada by Leiter at the PHC level during (2012),
which showed more than one third of the patients (36%) were
suffering systolic hypertensive [15]. Although, the mean of the
systolic blood pressure in the two studies were close (127±13.44
SD) and (128±14 SD) respectively. This prevalence was also low
in comparison with the Omani diabetic patients with systolic
hypertension (40%) and the mean (130.5±12.7 SD) study done by
Al-Lawati [9].
Such differences in the prevalence of systolic hypertension
not only could be explained by more proportion of elderly
patients in the above-mentioned studies compared to the current
study, but also to the proportion of patients on anti-hypertensive
medications. In the current study the majority (98.7%) of patients
were on anti-hypertensive medications, which was higher than
that in the study done by Leiter and his colleagues yielding a
prevalence of (83%), and also a prevalence of (40%) in the study
of AL-Lawatia. The explanation here could be also referred to
the extent of management compliance and/or anti-hypertensive
pharmacological effectiveness.
Study limitations were; inability to demonstrate the
temporality between the type 2 DM and different related risk factors
due to study design as cross sectional. Insufficient references of
such descriptive study for risk factors prevalence in Arabian Gulf
population, which share similar risk factor profile.
Conclusions
The most common CVD risk factors among Qatari patients
with type 2 DM were seen to be in the following sequence; the
lifestyle related risk factors, followed by the metabolic ones and
finally risk factors in relation to the medical and family history.
Such results must stimulate further focused effort toward secondary
prevention on patients with type 2 DM in more comprehensive and
multi-disciplinary team management.
Conflict of Interest
Authors have no financial interest, arrangement or affiliation
with anyone in relation to this research that could be perceived as
a real or apparent conflict of interest in the context of the subject
of this study.
Acknowledgement
We are grateful to those professionals who took the time and
effort to participate in the study from PHCC. I would also like to
convey thanks to the patients who participated in this study by
giving me their time and information.
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Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes
Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073
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Prevalence of cvd risk factors among qatari patients with type 2 diabetes mellitus

  • 1. J Community Med Public Health, an open access journal ISSN: 2577-2228 1 Volume 4; Issue 01 Journal of Community Medicine & Public Health Research Article AlYafei A, et al. J Community Med Public Health 4: 173. Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014 DOI: 10.29011/2577-2228.100073 Anees AlYafei1* , Sherif Omar Osman2 , Nagah Selim2 , Noora Alkubaisi3 , Rajvir Singh4 1 Wellness Program, Preventive Medicine, Primary Health Care Corporation, Doha, Qatar 2 Family and Community Medicine, Community Medicine Training Program, Doha, Qatar 3 Clinical Affairs, Primary Health Care Corporation, Doha, Qatar 4 Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar * Corresponding author: Anees AlYafei, Wellness Program, Preventive Medicine, Primary Health Care Corporation, Doha, Qa- tar Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 Received Date: 27 February, 2020; Accepted Date: 04 March, 2020; Published Date: 09 March, 2020 Abstract Background: Patients with Type 2 diabetes mellitus experience a substantial risk of cardiovascular disease owing to modifiable risk factors. Objective: To estimate the prevalence of cardiovascular disease risk factors among Qatari patients with Type 2 diabetes mellitus attending primary health care centres 2014. Method: Cross sectional design was used. Total of 532 Qatari diabetic patients attending primary healthcare were enrolled. Data was collected using interview administered questionnaire, anthropometric & blood pressure measurement and medical records. Cardiovascular risk was assessed by using General Framingham Risk Prediction Score (GFRP). Results: GFRP score categorized (12.2%) of participants as low risk and (57.6%) as in high and very high risk for cardiovas- cular disease in 10-years. Lifestyle-related risk factors were dominant among participants. The majority of patients did not consume recommended daily fruit and vegetables (94.2%) and (91.2%) respectively. Additionally, they did not practice recom- mended frequency of physical activity and were currently smoking in (71.4%) and (4.1%) respectively. Metabolic factors were second common risk factors. The combined overweight and obesity were leading metabolic factors as calculated in (94%) of them. More than two thirds showed uncontrolled diabetes status and (27.6%) were within undesirable range for HDL. The third common cardiovascular disease risk factors were medical and family history. Three quarters of them found to have hyperlipi- daemia and (72.7%) were with history of hypertension. The family history of premature cardiovascular disease occurrence in father and/or brother was reported in (16.9% and 13%) of participants respectively. Conclusion: Reduction of cardiovascular disease burden necessitate further focus on preventive interventions especially the lifestyle related risk factors. Keywords: Cardiovascular disease; Lifestyle-related risk factors; Metabolic factors; Prevalence; Qatar; Type 2 diabetes mellitus Abbreviations:BMI:BodyMassIndex;CVD:Cardiovascular Disease; GFRP: General Framingham Risk Prediction; HbA1C: Glycated Hemoglobin A1; HDL: High Density Lipoproteins; IRB: Institutional Research Board; LDL: Low Density Lipoproteins; NCD: Non-Communicable Disease; PHC: Primary Health Care; PHCC: Primary Health Care Corporation; SD: Standard Deviation; SPSS®: Statistical Package of Social Science; Type 2 DM: Type 2 Diabetes Mellitus; WHO: World Health Organization Introduction Patients with Type 2 Diabetes Mellitus (DM) are always at advanced risk of Cardiovascular Disease (CVD), where coronary
  • 2. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 2 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 heart disease is the leading mortality cause among them owing to the fast growth of multiple modifiable and metabolic cardiac risk factors worldwide [1]. Both CVD and Type 2 DM are significant causes of premature death as well as long-term disability. They contribute substantially to the escalating costs of health care globally, overwhelming health budgets everywhere. The cardiovascular disease, mainly coronary heart disease and stroke, is the number one cause of mortality worldwide. The WHO reported 17.3 million deaths in 2008 due to CVD. This represented 30% of all global mortality. It is expected to increase up to 23.3 million deaths by the year 2030 and to remain the single leading cause of death globally unless effective preventive interventions are implemented [2]. The State of Qatar has undergone significant social and economic changes over the last two decades, resulting in rapid urbanization with a consequent increase in the burden of Non- Communicable Disease (NCD). Although the total mortality rate related to CVD was reduced by almost 46.5% from 36.7 in (2003) to 17.1 deaths in (2010) per 100,000 populations, nevertheless CVD still the leading mortality cause in Qatar as also confirmed by many references [3-5]. According to the National STEPWise survey of chronic disease risk factors conducted in 2012, about (66%) of Qatari adult populations live with three or more modifiable risk factors related to CVD. Besides, the prevalence of type 2 DM is about (17%), which is one of the highest prevalence globally [6]. The multiplicative interactions between different risk factors of CVD in type 2 diabetic patients were well-described [7]. Comprehensive understanding of these modifiable risk factors is crucial to direct integrated efforts, plans, and services toward earlier prevention at the level of primary health care. Such early identification of these risk factors will successively reduce the CVD burden in the long term. However, the knowledge about the common NCD well documented in Qatar, but little is knowledge about the CVD risk factors prevalence among patients with type 2 DM. Aim and Objective Recognition of common risk factors of CVD among Qatari patients with Type 2 DM at the Primary Health Care (PHC) level, eventually helps in the development of evidence-based recommendations that assist health care workers in all care level in early identification of such risk factors and deciding for primary prevention of CVD. The efficient management of these risk factors subsequently will reduce the total burden of CVD and contributing to improving the quality of life to Qatari patients with type 2 DM in the long term. The study objective was to estimate the prevalence of risk factors related to CVD among Qatari patients with Type 2 diabetes attending PHC centres during 2014. Method Study Settings and Design The study was conducted as a cross sectional study and patients were recruited from NCD clinics as well as general walk-in clinics at PHC centres during 2014. There were 21 PHC centres under Primary Health Care Corporation (PHCC) which is a governmental leading primary care provider cross all the country. Where, each health centre has its own well identified geographic and population catchment area. Study Population Qatari type 2 DM patients attended the selected PHC centres during July to November 2014 and meeting the eligibility criteria. Inclusion criteria were; male & female Qatari patients with type 2 DM. Exclusion criteria were; patients refused to participate. Sample Size and Sampling Technique Sample size was calculated by: n=Z2 ×P(1-P)/e2 [8]. Where, n=required sample size, Z=the probability value associated with confidence level which equals to 1.96, P=the prevalence of CVD among patients with type 2 DM, which is 0.26 based on a study carried out in Oman in (2010) at PHC level [9], e=desired margin of error was set to be 0.05, The significance level was set at ˂0.05 and confidence level of 95%. Calculation came out to be 532patients after inflated by 20% for compensation of non-response and design effect of 1.5, the study period continued till the calculated sample was completed. Simple cluster technique with proportionate allocation of the calculated sample size was used. Simple random sampling was conducted to select six health centres out of the 21. A cluster sampling technique was done in which PHC centres have been considered as clusters or primary sampling units. Within each selected health centre, all eligible patients were included in the study. The estimated sample size was distributed proportionately among the six randomly selected health centres according to the size of registered patients with type 2 DM within each of these centres. Research Instruments The following instruments used in the study; 1. Arabic version interview administered questionnaire, 2. Blood Pressure (BP) measurements, 3. Body Mass Index (BMI) measurement & calculation. 4. Data extraction sheet to record metabolic variables of interest from the electronic medical records of each eligible patient. 5. The General Framingham Risk Profile (GFRP) score for primary care was used to assess 10-years total CVD risk. The Arabic version interview administered questionnaire developed by principle investigator and involving three sections; 1. Socio-demographic characteristics of; age, gender, education
  • 3. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 3 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 level, marital status and occupation. 2. Personal medical history of; duration of diabetes, presence of hypertension and history of taking antihypertensive medications. 3. Life-style assessment on; dietary history about fruits and vegetable consumption, consuming snacks, outside prepared meals, soft drinks consumption, fatty food intake, physical activity about both activity at work & physical activity at leisure time during a regular week and tobacco use. Validityofthequestionnairewasensuredthroughbothcontent and face validity. Where, questions were developed by through literature review and consultation of experts in fields of preventive medicine, epidemiology, diabetology and cardiovascular disease. Besidesthequestionnaire,dataextractionsheetusedtorecord B.P, BMI, recent HbA1C %, serum High Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) levels for each patient from the electronic medical records. Cardiovascular risk was calculated by using the electronic GFRP score, which is an Excel® sheet-based calculator. The researcher entered the following risk factors for all eligible patients; sex, age in years, systolic blood pressure in (mmHg), either on antihypertensive or not, smoking or non-smoking, and BMI. The calculator gave the probability as a percentage automatically and patients categorized into four categories based on the management recommendations: Low risk (<10%): patients in this category were at low risk, • and low risk does not mean “no” risk. Moderate risk (10% to <20%): patients in this category were • at moderate risk of fatal or nonfatal cardiovascular events. High risk (20% to <30%): patients in this category were at • high risk of fatal or nonfatal cardiovascular events and risked lowering medications recommended. Very high risk (≥30%): patients in this category were at a very • high risk of fatal or nonfatal cardiovascular events and risked lowering medications recommended. Research Approach After obtaining Institutional Review Board (IRB) approvals. Arabic speaking nurses assigned to assist in data collection. The researcher explained to assigned nurses aim of the study, data collection process and answered their enquiries. Inside the selected health centres; eligible patients were invited to participate voluntarily, after detailed explanation of study`s aim, future benefits and process of data collection. All eligible patients were kindly asked to sign informed consent which was approved by the IRB committee. The researcher and/or assigned nurses interviewed patients prior to their visit to their treating physician in a vital signs assessment room, where also blood pressure and anthropometric measurements were measured. Standardized methods for measurements were used as recommended by PHCC guidelines. Electronic medical records were accessed to record HbA1C% and lipid profile for every patient. All accomplished questionnaires were reviewed to ensure completeness and consistency. Data Management The researcher entered all collected data from completed questionnaires and extracted spread sheet into an Excel® sheet daily and later all data was exported to a “Statistical Package of Social Science” version 20.0 (SPSS® ) software database for analysis [10]. Different questions included in the interview questionnaires were coded and entered on regular basis. Descriptive statistics: frequency tables, proportions, figures such bar, mean and standard deviation were used as appropriate. Results Five hundred thirty-two Qatari patients with type 2 DM met the eligibility criteria were recruited voluntarily during the study period. Background Characteristics of the Study Participants The most common age group was (50- 59) years with (40.6%), with mean age of (56.06 ± 8.16 Standard Deviation (SD)). Almost two thirds of them were females (66.7%). Elementary school was the most frequent educational level encountered among the patients (34.0%). The vast majority of patients were married (86.5%) and being a housewife was found to be in more than half of total sample (54.0%) as shown in the Table 1. Variable Frequency (%) Age 40 - 49 128 (24.0) 50 - 59 216 (40.6) 60 - 69 158 (29.7) ≥ 70 30 (5.7) Gender Male 177 (33.3) Female 355 (66.7) Educational Level Illiterate 169 (31.8) Elementary School 181 (34.0) Secondary school 85 (16.0) University and above 97 (18.2) Marital Status
  • 4. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 4 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 Single 17 (3.2) Married 460 (86.5) Divorced or Widowed 55 (10.3) Occupation Housewife 287 (54.0) Retired 121 (22.7) Professional / Clerk / Admin 117 (22.0) Others 7 (1.3) Table 1: Distribution of Background Characteristics of Qatari Patients with Type 2 DM, Primary Health Care Centers, 2014. (N = 532). By using (GFRP) score, the 10-years CVD risk prediction was low (<10%) in (12.2%) of the participants, moderate (10% to <20%) in (30.2%), high (20% to <30%) in about one fourth of them, while (33.5%) were at very high risk. Life-Style related Risk Factors Lifestyle-related risk factors were dominant among the studied patients. The majority of patients did not consume the recommended daily 5 servings of fruit and vegetable (94.2%) and (91.2%) of patients respectively, as well as, consuming snacks, outside prepared meals, soft drinks and fatty food consumption more than two times per week, in (42.7%), (38.9%), (29.9%) and (25.2%) of patients respectively. While the mean number of fruits and vegetables servings was (0.8 and 1.4) respectively Additionally, they did not practice the recommended frequency of physical activity at leisure time (71.4%). Furthermore, current smoking habit was only reported in (4.1%) of the studied patients as illustrated in Figure 1. Figure 1: Prevalence of cardiovascular lifestyle related risk factors among Qatari patients with type 2 DM, Primary Health Care Centers, 2014. (N=532). Metabolic Characteristics of the Study Participants Metabolic risk factors were the second most common CVD risk factors seen among patients of this study. By using World Health Organization (WHO) definition of BMI, only (6%) of patients were found to be within the normal range, one fourth were in the overweight and as high as (69%) of patients were obese [3]. The combined overweight and obesity were the leading metabolic risk factors as it was calculated in (94%) of the studies patients. Type 2 DM glycemic control is determined by HbA1C (%) level which measures it over the past three months. Target was to keep the HbA1C level ≤ 7.0% as per PHC guidelines [11]. More than two thirds (65%) of the participants were uncontrolled (HbA1C level >7.0%). Total serum cholesterol was measured and classified as desirable, borderline and high according to PHCC clinical guidelines. Around (82.0%) of the participants were within the normal range. Moreover, more than a quarter of them (27.6%) were within the undesirable range for HDL, as seen in Figure 2. Figure 2: Prevalence of metabolic risk factors for cardiovascular disease among Qatari patients with type 2 DM, Primary Health Care Centers, 2014. (N=532). Analysis of the lipid profile showed that (27.6%) of the participants were in undesirable range for HDL, while only (3.9%) had high LDL and (3.8%) with high total serum cholesterol, as seen in Figure 2. Participants were divided into 5 groups based on 5 years duration of type 2 DM occurrence. Almost (29%) of the participants had type 2 DM between 5 years and less than 10 years. Around (98.7%) of them used antihypertensive medications. The third most common CVD risk factors among the Qatari patients with type 2 diabetes were the medical & family history. Three quarters (74.4%) of the studied patients were found to have hyperlipidaemia in their confirmed history, and (72.7%) are with confirmed history of hypertension. The family history of the premature CVD occurrence in the father and/or the brother was reported in (16.9% and 13%) of the studied diabetic patients respectively. Furthermore, history of premature death in the father and/or the brother due to CVD was found in (11.8%) of the sample, as illustrated in Figure 3.
  • 5. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 5 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 Figure 3: Prevalence of family and medical history related risk factors for cardiovascular disease among Qatari patients with type 2 DM, Primary Health Care Centers, 2014. (N=532). Discussion The leading CVD risk factors were lifestyle-related factors followed by the metabolic as well as the medical and family history related risk factors. This study showed that (59.6%) of the participated patients used to have a daily fruits intake in a typical week with mean days number of (4.88±2.34 SD), but (94.2%) of them reported the consumption of less than 5-servings of fruits a day, with mean number of servings (1.81±1.14SD) per day. Furthermore; despite that (84.5%) of the patients reported eating vegetables daily with mean of (5.77±1.85SD) days, but (91.2%) of them used to consume less than the recommended 5-servings a day, with mean number of the servings (1.92±1.33SD). These results were much better than those seen in the STEPwise survey conducted among the Qatari general population during(2012),outofwhich(16.7%)weretype2diabetic.Itreported that the majority of the Qatari population (91.1%) consume less than the 5-servings for fruits and/or vegetables on average per day [6]. The survey calculated the mean number of days for fruits and vegetables consumed as (3.4 and 5.5) days respectively. While the mean number of fruits and vegetables servings was (0.8 and 1.4) respectively. Such narrow difference in figures compared to the current study might be due to the influence of dietary counseling and/or recall bias. Physical inactivity is a well-known risk factor for CVD development in the general population as well as in patients with type 2 DM. The current study showed that (71.4%) of participants were not practicing physical activity for at least 30 minutes once a day weekly. This was much better than results addressed by a study conducted by Qatar-Bio bank (2015), where a survey was done questioning the Qatari general population and non- Qatari individuals residents for 15years and more, where (81%) of participants were not practicing the minimum recommended frequency of weekly physical activity [12]. This is even better than published findings reported by Al-Kaabi and colleagues in a cross- sectional study done in the UAE during (2006) among patients with type 2 DM. Only (3%) of participants reported the minimum recommended frequency of physical activity [13]. Although the current study showed, better proportion of patients practicing the recommended physical activity, but it was still far less than what is expected in high-risk population. This could be explained by the limited effect of counselling conducted to such patients. The present study showed that current tobacco use among Qatari patients with type 2 DM is unexpectedly low (4.1%) compared to the general population (16.4%) as reported in the national STEPwise survey done in Qatar (2012). This prevalence is considered also low if it is compared to several other studies conducted among diabetic patients, like in Canada during (2012) where more than two thirds (36%) of the studied sample were currently tobacco users [14], or a study from Pakistan where current tobacco smokers were (27%) during (2014) [15]. The possible justification for the current study low tobacco usage may be affiliated to that more than two thirds of the study participants are older female adults where smoking in general is uncommon, plus the possible denial by patients always will be blamed if they continue a bad habit after being counselled against. Metabolic CVD risk factors were the second most common factors among studied patients. Overweight and obesity were prevalent CVD risk factors among the studied Qatari patients with type 2 DM. The present study showed that (25% and 69%) of the studied patients were overweight and obese respectively. This was higher than the numbers obtained from the general population, were overweight prevalence was (28.7%) and obesity (41.4%) during (2012) [6]. The present study findings were also higher than that found in Yemen, where a bigger proportion of the diabetic patients were with normal weight (45.5%), (43.5%) were overweight and (11%) were obese [16]. The higher prevalence of overweight and obesity in this study could be related to the higher proportion of them were older female adults and the majority were housewives or retired with considerably low physical activity and living a sedentary life. The majority of the studied patients (65%) were within uncontrolledleveloftheHbA1C(>7.0%)withameanof(8.01±1.70 SD). This was consistent with many other studies carried out to assess the glycemic control among patients with type 2 DM. In UAE (68%) of the studied patients in (2006) were uncontrolled based on HbA1C assessment [13]. Similarly, some other studies showed relatively higher proportion (71%) of patients with high HbA1C level as in a study done by Sabanaygam in Singapore [17].
  • 6. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 6 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 On contrary; some studies indicated less proportion of diabetic patients within the uncontrolled limit of the HbA1C as by Leiter in Canada (2012) were only (50.4%) of the studied patients were uncontrolled with mean of (7.4±1.3 SD) [15]. The differences in HbA1C level may vary from one community to another mostly due to proper counselling, compliance to the diet and medications, as well as other lifestyle modification role. The current study revealed low prevalence (3.8%) of high serum cholesterol level among the participated Qatari patients with type 2 DM, with mean level (4.48±0.91 SD) compared to the prevalence of (28.8%) among patients with type 2 DM in a study conducted in Saudi Arabia during (2009) by Al-Rowais [18]. Such apparentdifferencecouldbeattributedtoeffectivepharmacological influence of the lipid lowering medications which was taken by almost all of the current study patients (97.5%). Moreover, low prevalence of undesirable HDL and LDL blood levels in the current study could be explained by effective pharmacological effect of the lipid lowering medications. Where; undesirable level of the HDLblood level (<1.0 mmol/l) was around one fourth (27.6%) among patients in this study, while the high LDL level (≥4.1mmol/l) was seen in (3.9%) of patients. These results were lower than those found in a cross-sectional study carried out in Jordan during (2008) among patients with type 2 DM, where (60.2%) were with undesirable HDL blood level and (52.7%) of participants with high LDL blood level [19]. The third most common CVD risk factors among the studied Qatari patients with type 2 DM were medical and family history. Hypertension is a well-recognized associated risk factors in patients with type 2 DM. The prevalence of the systolic hypertension (≥140 mmHg) in this study was (21.4%) which was lower than a study conducted in Canada by Leiter at the PHC level during (2012), which showed more than one third of the patients (36%) were suffering systolic hypertensive [15]. Although, the mean of the systolic blood pressure in the two studies were close (127±13.44 SD) and (128±14 SD) respectively. This prevalence was also low in comparison with the Omani diabetic patients with systolic hypertension (40%) and the mean (130.5±12.7 SD) study done by Al-Lawati [9]. Such differences in the prevalence of systolic hypertension not only could be explained by more proportion of elderly patients in the above-mentioned studies compared to the current study, but also to the proportion of patients on anti-hypertensive medications. In the current study the majority (98.7%) of patients were on anti-hypertensive medications, which was higher than that in the study done by Leiter and his colleagues yielding a prevalence of (83%), and also a prevalence of (40%) in the study of AL-Lawatia. The explanation here could be also referred to the extent of management compliance and/or anti-hypertensive pharmacological effectiveness. Study limitations were; inability to demonstrate the temporality between the type 2 DM and different related risk factors due to study design as cross sectional. Insufficient references of such descriptive study for risk factors prevalence in Arabian Gulf population, which share similar risk factor profile. Conclusions The most common CVD risk factors among Qatari patients with type 2 DM were seen to be in the following sequence; the lifestyle related risk factors, followed by the metabolic ones and finally risk factors in relation to the medical and family history. Such results must stimulate further focused effort toward secondary prevention on patients with type 2 DM in more comprehensive and multi-disciplinary team management. Conflict of Interest Authors have no financial interest, arrangement or affiliation with anyone in relation to this research that could be perceived as a real or apparent conflict of interest in the context of the subject of this study. Acknowledgement We are grateful to those professionals who took the time and effort to participate in the study from PHCC. I would also like to convey thanks to the patients who participated in this study by giving me their time and information. References World Health Organization (2013) Cardiovascular diseases fact sheet. 1. Geneva: WHO Press. World Health Organization (2010) Global status report on noncommu- 2. nicable diseases 2010. Geneva: WHO Press. Supreme Council of Health (2010) Qatar health trends 2001-2010. 3. Doha, Qatar. Supreme Council of Health (2013) Qatar Health Report 2013. Doha, 4. Qatar. World Health Organization (2014) Global health estimates 2014 sum- 5. mary tables: Estimated deaths by cause, sex and WHO Member State 2012. Geneva. Supreme Council of Health (2012) Non-communicable disease depart- 6. ment of public health. Qatar STEPS Survey 2012 Fact sheet. Doha, Qatar. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams GS, Bloom LR, et al. 7. (2011) The Global Economic Burden of Noncommunicable Diseases. A report by the World Economic Forum and Harvard School of Public Health. 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  • 7. Citation: AlYafei A, Osman SO, Selim N, Alkubaisi N, Singh R (2020) Prevalence of Cardiovascular Disease Risk Factors among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centres, 2014. J Community Med Public Health 4: 173. DOI: 10.29011/2577-2228.100073 7 Volume 4; Issue 01 J Community Med Public Health, an open access journal ISSN: 2577-2228 Al-Lawati JA, Barakat MN, Al-Lawati NA, Al-Maskari MY, Elsayed MK, 9. et al. (2013) Cardiovascular risk assessment in diabetes mellitus: comparison of the general Framingham risk profile versus the World Health Organization/International Society of Hypertension risk predic- tion charts in Arabs--clinical implications. Angiology 64: 336-342. (2011) IBM-SPSS 10. © . Version 20. Chicago IL: USA. Primary Health Care Corporation (2011) PHC physician guidelines for 11. non-communicable diseases. Doha: Qatar. Qatar Biobank (2015) Qatar Biobank Report 2015. Doha: Qatar Foun- 12. dation. 32 pages. Al-Kaabi J, Al-Maskari F, Saadi H, Afandi B, Parkar H, et al. (2009) 13. Physical activity and reported barriers to activity among type 2 diabetic patients in the United Arab Emirates. Rev Diabet Stud 6: 271-278. Leiter LA, Berard L, Bowering CK, Cheng AY, Dawson KG, et al. (2013) 14. Type 2 diabetes mellitus management in Canada: is it improving? Can J Diabetes 37: 82-89. Khalid N, Ahmad KE, Saleem S, Tahir A , Mahmood H, et al. (2014) 15. Prevalence and Associated Factors of Cigarette Smoking among Type 2 Diabetes Patients in Pakistan. IJCRIMPH 6: 73-88. Al-Sharafi BA, Gunaid AA (2014) Prevalence of obesity in patients 16. with type 2 diabetes mellitus in yemen. Int J Endocrinol Metab 12: e13633. Sabanayagam C, Shankar A, Saw SM, Tai ES, Lim SC, et al. (2009) 17. Prevalence of diabetes mellitus, glycemic control, and associated fac- tors in a Malay population in Singapore. Asia Pac J Public Health 21: 385-398. Al-Rowais NA (2014) Glycemic control in diabetic patients in King Kha- 18. lid University Hospital (KKUH) - Riyadh - Saudi Arabia. Saudi Pharm J 22: 203-206. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K (2010) Factors as- 19. sociated with poor glycemic control among patients with type 2 diabe- tes. J Diabetes Complications 24: 84-89.