Mall Rates? Silent CV Risk Factors Abound in Dubai Shoppers

Shelley Wood

April 24, 2012

April 24, 2012 (Dubai, United Arab Emirates) — Physicians in Dubai have leveraged the Middle Eastern city's best-known asset to shine a light on what they say is a sweeping lack of awareness about cardiovascular risk factors and how to keep them in control.

Taking a novel approach to community outreach, Dr Suresh Nair Krishnan and colleagues (Dubai Heart Center, UAE) set up a free CV risk screening service in a busy mall in downtown Dubai, ultimately screening almost 1000 men and women over three separate days in 2010 and 2011.

"Dubai is synonymous with shopping," Krishnan told heartwire during last week's World Congress of Cardiology 2012. "If you want to see people, especially during the summer months, you won't find many people out on the roads or exercising outside. So the best place to find them is in the shopping malls, because that's where most people congregate."

In all, Krishnan screened 974 shoppers who were, on average, 40 years of age, 74% female, and of an ethnic mix reflecting Dubai's largely expat community (15% Arab, 51% South Asian, and 33% "other"). All subjects had weight, height, and waist circumference measured and blood pressures taken, along with tests for blood glucose and total serum cholesterol. Self-reported smokers also underwent carbon-monoxide testing; as Krishnan put it: "We wanted them to see for themselves--'this is the amount of carbon-monoxide that you are putting out--equal to a car's exhaust!' "

Dubai is synonymous with shopping.

A full 35% of shoppers who believed themselves to be healthy were found to have at least one CV risk factor. A further 29% reported a prior diagnosis of diabetes, hypertension, or hypercholesterolemia, and an additional 13% were overweight/obese or smokers. Strikingly, almost two-thirds of shoppers who reported a history of hypertension had inadequately controlled BP, while another 18% with no history of hypertension also had levels above 140/90 mm Hg.

A similar pattern was seen for cholesterol levels, with one-third of shoppers having undiagnosed hypercholesterolemia, while 38% of those with a prior diagnosis of high cholesterol had total serum cholesterol levels higher than 200 mg/dL. Less than 1% of shoppers reported a prior diagnosis of diabetes, yet 30% of shoppers had serum glucose levels >200 mg/dL.

"What was most important is that only 24% had no risk factors," study coauthor Dr Afzalhussein Yusufali (Dubai Hospital, UAE) told heartwire . "Now, that's a huge problem! That means 76% had a risk factor and of those, many did not know it."

Screen 'Em Where They Shop

Krishnan and colleagues are hoping to measure whether their screening clinics have had an impact on the 35% of subjects who had no prior knowledge that they had any risk factors. "We are following those patients and will ask them have you changed your diet, have you lost weight, have you seen a doctor, when was the last time you checked your BP? We hope to get those results and report them next year," Krishnan said.

Free cardiovascular-risk clinics are increasingly common around the globe, but they typically take place at healthcare facilities. Krishnan, Yusufani, and colleagues believe their mall-based initiative is unique and something that other cities could consider.

"A screening initiative should be specific to the region," Krishnan said. "And because Dubai has so many shopping malls, [this was an ideal location]. It was easy to get maximum representation and to raise awareness in our population."