Association between education and major adverse cardiac events among patients with acute coronary syndrome in the Arabian Gulf

Ibrahim Al-Zakwani, Ruth M Mabry, Mohammad Zubaid, Alawi A. Alsheikh-Ali, Wael Almahmeed, Abdullah Shehab, Wafa Rashed

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7 Citations (Scopus)


Introduction The objective of this study was to evaluate the association between education and major adverse cardiac events in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods Data were analysed from 3874 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013. Education was defined as any type of formal training from primary school and above. MACE included stroke/transient ischaemic attack (TIA), myocardial infarction (MI), all-cause mortality and readmissions for cardiac reasons. Results The overall mean age was 60±13 years and 67% (n=2579) were men. A total of 53% (n=2039) of the patients had some form of school education. Adjusting for demographic and clinical characteristics as well as socioeconomic measures (insurance type and employment), at 12-month follow-up, educated patients were significantly less likely to have had MACE (adjusted OR (aOR): 0.55; 95% CI 0.44 to 0.68; p<0.001) than those with no formal education. The lower rate of events was also consistent across all MACE components: stroke/TIA (aOR: 0.56; 95% CI 0.33 to 0.94; p=0.030), MI (aOR: 0.58; 95% CI 0.38 to 0.86; p=0.008), all-cause mortality (aOR: 0.58; 95% CI 0.39 to 0.87; p=0.009) and readmissions for cardiac reasons (aOR: 0.61; 95% CI 0.48 to 0.77; p<0.001). MACE outcomes were consistent across men and women and across countries. Conclusions Education was associated with lower MACE events in patients with ACS in the Arabian Gulf. Interventions promoting healthy lifestyles and management of clinical risk factors for patients with low health literacy are urgently required.

Original languageEnglish
Article numbere001278
JournalBMJ Global Health
Issue number1
Publication statusPublished - Jan 1 2019


  • acute coronary syndrome
  • arabs
  • education
  • middle east
  • mortality
  • myocardial infarction
  • patient readmission
  • stroke
  • transient ischemic attack

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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