Review

Epidemiology of Cardiovascular Diseases in Morocco: A Systematic Review

Rida Elyamani, Abdelmajid Soulaymani, Hind Hami

Manuscript submitted October 19, 2020; resubmitted September 2, 2021; accepted September 24, 2021.

Keywords: cardiovascular disease, epidemiology, Morocco, heart, Africa

Abstract

OBJECTIVE: To provide a systematic review of studies on cardiovascular diseases (CVD) and their risk factors in the Moroccan population. METHODS: A systematic analysis was performed based on PRISMA guidelines by retrieving data bases (Medline, Embase, and other) using technical keywords in addition to manual research on official websites. Published studies in the English or French language, conducted in Morocco or concerning the Moroccan population within the last two decades, were identified. RESULTS: This is the first systematic review of CVD in Morocco. Data from 159 studies were retrieved and analyzed. Most studies were written in the English language (75.89%) and published between 2010 and 2019 (85.47%). The mortality rate caused by CVD in Morocco has reached 38%, with ischemic heart disease and stroke as the main events causing death (31.0% and 22.5% respectively). The risk factors present in the population studied were headed by tobacco smoking (45-50%), followed by physical inactivity (21.1%), elevated rate of hypertension (25.3%), and depression (5.47%). Impacted by a high rate of illiteracy and poverty and an unprepared health care system in Morocco, these numbers are expected to increase over the next decade. CONCLUSIONS: Based on these alarming incidences, investment in scientific research and epidemiological studies should be increased to determine the needs of the local population. The available evidence shows that the risk of cardiovascular disease and the associated mortality is very high in Morocco and will rise in the next years prospectively, which calls for urgent multi-sectorial approaches and treatment strategies.

1, Introduction

The global prevalence of diseases has increased drastically over the last three decades. Leading causes of disease and morbidity have shifted from communicable causes with infectious, maternal, and perinatal diseases to non-communicable diseases (NCD) and cardiovascular diseases (CVD) [1]. This epidemiological trend may be explained by the theory of epidemiological transition, whereby the general socioeconomic progress of a country will cause a health status shift from communicable diseases to NCD [2, 3].

In 2016, the World Health Organization (WHO) estimated a global mortality of 17.9 million deaths caused by CVD, representing 31% of total deaths. When all cases of heart disease were considered, ischemic heart disease (IHD) was seen as the leading cause of death, with an estimated 7.29 million people dying from acute myocardial infraction (95% CI: 6.8-7.81) and almost 110.55 million prevalent cases, followed by stroke and ischemic stroke, which caused the second and third largest number of cases of heart disorders to result in disability-adjusted life years (DALYS). It has been estimated that there were 5.39 million acute firstever ischemic stroke cases (95% CI: 5.02-5.73), 3.58 million cases of acute first-ever hemorrhagic and other forms of stroke (95% CI: 3.34-3.82), and 42.43 million prevalent cases of cerebrovascular diseases (95% CI: 42.07-42.77) overall in 2015. These phenomena are not equally distributed among countries. Instead, they depend on several factors such as culture, risk factor distribution, ethnicity (genetics), economy, and geographical location [4].

There is a relationship between CVD mortality and socioeconomic index (SEI) in societies. It increases sharply as SEI (SEI > 0.25) increases, shifting from women to men, and in high income countries (SEI > 0.75) it decreases again [5]. This is explained by technological progress and pharmacological advancements [6] associated with increasing awareness and improvement in health care access among populations of high-income countries. In contrast, there is a high mortality caused by CVD (80%) in low- and middle-income countries (LMIC) [7], but epidemiological investigations into CVD and the prevalence of its risk factors are few, particularly in rural or poor urban areas. It has been estimated that CVD data were unavailable in almost 89.8% of Sub-Saharan countries and in 48.1% of northern African countries compared to only 0.3% of high-income countries [5]. Therefore, the need for more studies in this research area is urgent, as is the need to devote resources to healthcare systems and interventional programs, which would allow scientists to evaluate the effectiveness of preventive programs and healthcare policy-makers to address new strategies depending on the needs of the local populations.

In this review, we provide a comprehensive systematic analysis of published studies in both the French and English language, and we included data collected in the Moroccan population over the last 20 years, in an effort to provide a reference work on the status of CVD in Morocco.

References