Obesity and ASCVD/ASCVD Risk in Patients with Type 2 Diabetes Across the Middle East and Africa

• Published in: Obesity (Silver Spring, Md.) Vol. 31; p. 90
• Main Authors: Yadav, Gourav, Assaad-Khalil, Samir, Alawadi, Fatheya, Almahmeed, Wael, Alamuddin, Naji, Alkandari, Hessa, Cinar, Tarhan, Haddad, Jihad, Husemoen, Lise Lotte, Lombard, Landman, Malik, Rayaz, Ngome, Mary, Sabbour, Hani, Salek, Sam, Verma, Subodh
• Format: Journal Article
• Language: English
• Published: Silver Spring Blackwell Publishing Ltd 01.11.2023
• Subjects: Body mass index; Diabetes; Metabolic syndrome; Obesity
• ISSN: 1930-7381; 1930-739X

Background: Obesity is a key risk factor for established atherosclerotic cardiovascular disease (eASCVD) or ASCVD risk in patients with type 2 diabetes (T2D). We report the prevalence of obesity and eASCVD/ASCVD risk from the PACT-MEA study, stratified by obesity status, obesity class, and metabolic syndrome. Methods: A cross-sectional, observational, study, PACT-MEA collected medical chart data during a routine clinic visit from patients with T2D across 55 sites in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and United Arab Emirates. Prevalence (95% CI) of eASCVD and high/very high (latter includes eASCVD) risk was estimated. ASCVD risk was defined by the 2021 European Society of Cardiology (ESC) Guidelines. Overall prevalence estimates were weighted according to each country's diabetes population. Results: Of the 3726 patients enrolled, median age was 57.7; 53% were male. Median body mass index (BMI) was 30.1 kg/m2 (interquartile range [IQR] 26.7-34.8). Twenty-nine percent had class 1 obesity (BMI ≥30-34 kg/m2), 15% had class 2 (BMI ≥35-39 kg/m2), and 9% had class 3 (BMI ≥40 kg/m2). Across obesity classes, prevalence was similar for eASCVD (range: 18.1% to 22.3%), high ASCVD risk (range: 68.7% to 73.8%), and very high ASCVD risk (range: 26.2% to 31.3%). Using a definition of metabolic syndrome as per a joint position paper by nine professional societies published in 2022, which uses abdominal obesity or BMI measures, 47% of our study sample (n = 3225 with all available measures) who had eASCVD also had metabolic syndrome; of those at high and very high risk, 48% and 47% had metabolic syndrome, respectively. More patients with obesity than those without were on insulin (43% vs 32%), glucagon-like peptide-1 receptor agonists (18% vs 8%), renin-angiotensin system inhibitors (54% vs 46%), calcium channel blockers (26% vs 21%), or diuretics (26% vs 16%). One-third of patients with (35%) and without obesity (34%) were receiving high-intensity statins; intensity did not vary by obesity class. Conclusions: Half of the patients with T2D in our real-world study had obesity. Both patients with and without obesity had a high prevalence of eASCVD and high/very high risk. Overall, these data suggest the need for better management of cardiovascular risk factors like obesity, in patients with T2D in the regions, including optimal use of cardio-protective intervention.