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Background and aims Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain). Methods The multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up. Results Among 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p <0.001; for both comparisons). Conclusions This snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a “call-to-action” for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.

The disease outcome had been shown to improve with improving patient knowledge. The study had two objectives, firstly to assess the level of knowledge about cardiovascular diseases (CVDs) in the general population, and secondly, to provide written educational material regarding the risk factors, major symptoms, and the prevention of CVDs. MethodThe target population was the residents living in the Western region of Saudi Arabia, aged 18 years and above. All were invited to participate voluntarily. A pre-structured questionnaire was designed to collect data related to age, gender, marital status, education level, occupation, lifestyle habits, and a history of heart diseases, as well as cardiac symptoms, and risk factors. The educational material was provided after the questionnaire. ResultsThe majority of the participants were female (74.8%). The risk factors most frequently identified were lack of exercise, stress, and obesity. Chest pain was recognized as a major symptom (87.6%). Other symptoms included dyspnea, syncope, and excessive sweating. The level of knowledge regarding the risk factors for cardiovascular disease was poor. Only 18.5% were knowledgeable about the risk factors. The majority (60%) could identify the preventable factors, including smoking cessation (92.2%), a high level of cholesterol (88.6%), and hypertension (78.7%). The majority (83.7%) read the educational material and 99% reported that the lecture increased their knowledge about cardiovascular disease. ConclusionAlthough cardiovascular risk factors are common, there is a big gap in the knowledge in our population. Further, alarming symptoms that bring the patients to medical care are also deficient. A call for action at different levels is urgent. Simple educational material in a basic language and virtual education are useful and cheap tools that must be practiced wherever possible. Education is welcomed by the participants.

Introduction Several cardiovascular risk calculators are available online to measure the probability of developing cardiovascular disease (CVD) without defining the appropriate population. In the current study, four risk assessment instruments were investigated with Saudi Arabian patients with CVD to identify the instrument with the best predictability. The chosen instruments were the Framingham Risk Score (FRS), Systematic Coronary Risk Evaluation (SCORE), American College of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic Cardiovascular Disease Risk Estimator, and the United Kingdom score which is called QRISK ®. Methods Saudi patients, 40 years and older, with acute coronary syndrome, were recruited. Data related to age, gender, ethnicity, height, weight, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL), smoking status, diabetes mellitus, rheumatoid arthritis, chronic kidney disease, atrial fibrillation, heart attack in a first-degree relative, and use of antihypertensive treatment were recorded. Results Out of 129 patients, the ACC/AHA had higher predictability with low risk (26.3%) and high risk (66.7%) groups. The QRISK ® was highly applicable (95.3%); however, the SCORE was not considered applicable (22.5%). Conclusion The QRISK ® is easy to implement and applicable in a population-based study, but the ACC/AHA is superior in predicting individuals with a high risk of CVD.

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Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

Background The primary aim of this study was to evaluate the level of diagnostic overlap between daytime ambulatory blood pressure (BP) monitoring (DT-ABPM) and 24-hour ambulatory BP monitoring (24-h ABPM) in detecting masked hypertension (MH). Methods This is a prospective study that was performed in a sample of 196 soldiers aged between 21 and 50 years (without a history of hypertension) undergoing ABPM testing. The diagnosis of MH based on DT-ABPM defined as (office blood pressure (OBP) <140/90 and DT-ABPM ≥135/85) was compared with the 24-h ABPM defined as (OBP <140/90 mm Hg and 24-h ABPM ≥130/80 mm Hg). We critically analyzed the results to see the agreement between the two methods. Results The number of subjects classified as having MH based on both DT-ABPM and 24-h ABPM, only on 24-h ABPM, and only on DT-ABPM were 11 (5.6%), 29 (14.8%), and 18 (9.2%), respectively. The sensitivity, specificity, and positive and negative predictive values for DT-ABPM in detecting MH were: sensitivity = 100% (95% CI: 97.82%-100%), specificity = 62.07% (95% CI: 42.26%-79.31%), PPV = 93.82% (95% CI: 90.50%-96.03%), and NPV = 100%, respectively. The level of agreement between DT-ABPM and 24-h ABPM in diagnosing MH was 94.4% and discordance in 5.6% (11/196); (kappa=0.736, p < 0.001). Conclusion The sensitivity, specificity, positive and negative predictive values all showed agreement between the two BP methods to confirm the diagnoses of MH. DT-ABPM can be used as an alternative to the 24-h ABPM. DT-ABPM eliminates sleep disturbance attributable to ABPM and maximizes patient compliance with the ABPM test. A further larger trial is needed for more confirmation and to affect the guidelines for using daytime ABPM.

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication. We present a series of 10 patients who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization were necessary. Particularly with the COVID-19 restrictions in place, these cases highlight the need for physicians to be aware of the dramatic increase in the incidence of stuck prosthetic valves in patients on chronic warfarin therapy.