STUDY FINDS WEALTHY FACE BIGGER HEART RISK
▶ Results challenge accepted view of bigger income, better health
A groundbreaking study in the UAE has found that greater wealth puts people at greater risk of coronary artery disease.
The findings contrast with many developed parts of the world, where poorer people are more likely to develop the dangerous condition.
A test group of patients who each earned more than US$5,300, or almost Dh19,500 a month, were significantly more likely to have coronary artery disease than those earning less than $1,300.
But they do tie in with what is often happening in developing countries, where increasing wealth creates a lifestyle that lead to greater rates of coronary artery disease.
One of the study’s authors, Dr Alawi Alsheikh-Ali, dean of the college of medicine at the Mohammed bin Rashid University of Medicine and Health Sciences in Dubai, said higher rates of diabetes, obesity and a sedentary lifestyle among wealthier people accounted for the study’s findings.
“The message from this growing literature is that socio-economic development is typically accompanied by increased risk of chronic diseases such as heart disease, which is probably driven by lifestyle risk factors,” Dr Alsheikh-Ali said.
Published in The Open Cardiovascular Medicine Journal, the research looked at more than 1,068 patients undergoing a coronary angiography, a procedure in which dye is injected into the heart’s blood vessels to look for narrowing, at five hospitals in the UAE and Saudi Arabia.
When the data on the patients was analysed for the disease, which is characterised by a narrowing of a major blood vessel in the heart, it was found that people who were unemployed were at greater risk than those in work.
It also found that people with greater incomes had higher rates of the disease, and a related condition called multi-vessel disease, than people who earned less.
Among the researchers involved was Dr Salem Al Kaabi of the cardiology department at Zayed Military Hospital, Abu Dhabi.
Another of the study’s authors, Dr Amin Daoulah, of King Faisal Specialist Hospital and Research Centre in Jeddah, said that the well-accepted socio-economic relationship to coronary artery disease, in which poor people were most susceptible and risks fell as income increased, “might not be applicable to all regions of the world”.
“We suggest that the interpretation of socio-economic status should take into account the differences in risk factors among different ethnicities and cultural differences in individual lifestyles from the same socio-economic status,” Dr Daoulah said.
Another finding was that people in rural areas were more at risk of heart problems than those in urban areas, something the researchers suggested may be because they have less access to medical care such as screening services.
Prof Julia Critchley, a scientist not associated with the study who has researched efforts to combat heart disease and diabetes in the Arab world, suggested the low levels of education among many patients in the study may explain the finding that wealthier people were at higher risk.
When people have a low level of education, greater wealth may lead them to adopt unhealthier lifestyles, an outcome not typically seen among better-educated groups.
“Income may be protective against obesity only when someone is highly educated,” said Prof Critchley, a professor of epidemiology at St George’s, University of London.
A 2012 study of women in Egypt found that among the lesser educated, greater wealth was associated with a higher risk of obesity, a trend not seen among more highly educated women.
“With education, people use their income to make positive choices,” Prof Critchley said. “That’s not necessarily the case for people who are illiterate; they may not be making health-improving choices.
“Large-scale studies investigating socio-economic effects in detail have generally only been carried out in high-income countries. Larger studies with different measures of socio-economic status that can be assessed individually and in combination would be very useful to better understand the way they interact, and help to design culturally specific responses.”
The recent study was written by 16 researchers in the UAE, Saudi Arabia and the United States. In many developed nations, death rates from cardiovascular disease have fallen over the past decades and there are initiatives in the Gulf aimed at a similar result.
Dr Alsheikh-Ali highlighted the recently launched Gulf Population Risks and Epidemiology of Vascular Events and Treatment study, which aims to quantify how much conventional risk factors are causing heart attacks in young adults and hopes to identify more.
“The study aims to identify barriers to adherence to treatment after discharge with a heart attack, including socio-economic barriers,” he said.
Researchers found that factors such as lifestyle and ethnicity also had a bearing on the results of their studies