Risk Factors for Coronary Heart Disease Among Lebanese Women: A Case–Control Study

Fatima Ghaddar,1 Rouba K Zeidan,2– 5 Pascale Salameh,4,6– 8 Souzan Tatari,9 Guy Achkouty,10 Françoise Maupas-Schwalm11 1Doctoral School of Biology Health and Biotechnologies, Toulouse University, Toulouse, France; 2Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates; 3Faculty of Public Health II, Lebanese University, Mount-Lebanon, Lebanon; 4INSPECT-LB, National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon; 5CERIPH, Center for Research in Public Health, Faculty of Public Health, Lebanese University, Mount-Lebanon, Lebanon; 6Department of Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; 7Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; 8School of Medicine, Lebanese American University, Byblos, Lebanon; 9Cardiology department, Rafik Hariri University Hospital, Beirut, Lebanon; 10Cardiology Department, Mount Lebanon University Hospital, Mount-Lebanon, Lebanon; 11Faculty of Medicine, CHU Toulouse Rangueil, Toulouse, FranceCorrespondence: Fatima Ghaddar, Doctoral school of Biology Health and Biotechnologies, Toulouse University, Toulouse, France, Tel +32 470 53 71 52, Email fatmeghaddar90@gmail.comPurpose: Women are increasingly concerned by coronary heart disease (CHD), with peculiarities of their own, particularly concerning risk factors. The aim of the study was to assess the risk factors for CHD in Lebanese women over forty.Patients and Methods: A case–control study was carried out in 6 hospitals in Beirut and Mount-Lebanon, from December 2018 to December 2019 including 1500 patients (1200 controls and 300 cases). Women were stratified into pre- and post-menopausal groups. Personal and medical data were collected from hospital records and during an interview where validated questionnaires were used. Binary logistic regressions were performed to investigate potential predictors of CHD in the 2 groups.Results: In post-menopausal women, dyslipidemia (adjusted odds ratio [aOR], 3.018; 95% confidence interval, 2.102– 4.332), hypertension (aOR: 2.449, [1.386– 4.327]), a family history of CHD (aOR: 2.724, [1.949– 3.808]), cigarette smoking (aOR: 2.317, [1.574– 3.410]) and common non-rheumatic joint pain (aOR: 1.457, [1.053– 2.016]) were strongly associated with CHD. Conversely, living in Mount Lebanon seemed protective, compared to Beirut (aOR: 0.589, [0.406– 0.854]), as well as having a moderate monthly income (aOR: 0.450, [0.220– 0.923]), adhering to a Mediterranean diet (aOR: 0.965, [0.936– 0.994]), and practicing physical activity [PA] (aOR: 0.396, [0.206– 0.759] and 0.725, [0.529– 0.992], respectively for high and moderate vs low PA). In pre-menopausal women, dyslipidemia (aOR: 6.938, [1.835– 26.224]), hypertension (aOR: 6.195, [1.318– 29.119]), family histories of dyslipidemia (aOR: 6.143, [1.560– 24.191]) and CHD (aOR: 4.739, [1.336– 16.805]) reached statistical significance.Conclusion: The identification of factors associated with CHD in women, some of which are frequent and trivialized in post-menopause, underlines the need to put in place specific and dedicated CHD prevention strategies in women.Keywords: coronary disease, risk factors, aging, pre-menopausal women, post-menopausal women