Cardiovascular disease research in the Arab world: a scoping review from seven Arab countries (2000–2018)

Highlights

• There has been an increase in volume of cardiovascular research output in Arab Region but in journals of low impact factor.

• Studies are mostly observational, conducted in medical or laboratory settings, with a lack of implementation research.

• Cardiovascular disease research in the Arab region remains limited and largely underutilised by policy makers.

Abstract

Objectives

The objective of this study is to map cardiovascular disease (CVD) research productivity in Arab countries and identify gaps and opportunities that would inform future research agenda.

Study design

This is a scoping review.

Methods

A review of research output between January 2000 and December 2018 in seven Arab countries, selected to represent various economies and epidemiological transitions, was conducted. Data on quantity and quality, study design, setting and focus were extracted and analysed for trends by time and place.

Results

Over the study period, a total of 794 articles were published, with an average of 7.3 publications per million population. While time trends showed a 6-fold increase in the number of publications over the study period, a decreasing trend in mean journal impact factor was noted (from 2.3 in 2000 to 1.5 in 2018). Most studies (71%) were observational, 56% were conducted in medical facilities (hospitals or clinics) and most of the experimental studies (10%) were based in laboratory settings. Behavioural risk factors were addressed in 52% of the studies, and there was a dearth of studies examining associations with diet, physical inactivity or family history.

Conclusions

Findings from this review indicate gaps in robust methods and pertinent themes in CVD research in the Arab region. Greater attention should be paid to high-quality evidence and implementation research. Also, there is a need for a more targeted CVD research agenda that is responsive to local and regional health burden and needs.

Introduction

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. In 2015, 17.7 million people died from these diseases, mainly coronary heart disease and stroke, with more than 70% occurring in low- and middle-income countries (LMICs).¹ In 2015, the proportionate mortality rate for CVDs in the Eastern Mediterranean region was 34.1%.² Most CVD deaths are premature and preventable by targeting behavioural risk factors, including physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.¹ Epidemiological data have shown an increasing trend in the burden of CVD risk factors in LMICs.³

Health research is a tool to improve population health and should be based on health burden and local needs.4, 5 Although evidence is accumulating on the rising burden of non-communicable disease (NCD) in general and CVDs in particular in LMICs, CVD research is not given enough attention from research agencies or funding organisations. This might be due to the simplistic dichotomy between developed and developing nations and between non-communicable and communicable diseases and the perceived belief that NCDs are mainly diseases of the affluent populations.⁶ While much effort has been invested in improvement of health service delivery in NCDs, less effort has been directed to improving NCD health research. The World Health Organization notes that ‘there is no health without research’ and emphasises the importance of strategic, evidence-informed approaches to health research, particularly for LMICs.⁷ Investment in research should go in parallel with investment in health to be able to provide high-quality evidence for health interventions.⁴ In the Arab region, health research is in its infancy and remains largely underutilised, with little evidence that knowledge produced is translated into programmes and policies. Research expenditure in the Arab region does not exceed 0.3% of its average gross domestic product (GDP).⁸ Several United Nation reports and academic reviews note the low research funding and productivity in the Arab countries (if not the lowest)⁹ and point to the scarcity of evidence when it comes to implementation.¹⁰

From another global perspective, and in a series published in The Lancet reflecting on ‘research value and research waste’, Chalmers et al. highlight the high expenditure spent on health and biomedical research, which does not necessarily address the core health needs of users of research.¹¹ They also note that funders have primary responsibility for reducing waste by demanding that proposals be justified by systematic reviews of existing evidence and by so-called ‘research-on-research'.¹¹ Drawing out data from a large scoping review ‘Mapping of NCD Research in selected Arab Countries’ in the Arab region,¹² we take a closer look at CVD research output, assess strengths and gaps in methods used and themes addressed and examine whether the knowledge produced reflects disease burden and meets population needs. Findings from this study have implications on funding allocation and CVD research agenda in the region.