Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2017; 9(4): 371-377
Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.371
Inter-ethnic marriages and severity of coronary artery disease: A multicenter study of Arabian Gulf States
Amin Daoulah, Salem Al-kaabi, Amir Lotfi, Mushabab Al-Murayeh, S Ali Nasseri, Waleed Ahmed, Salah N Al-Otaibi, Mohamed N Alama, Osama E Elkhateeb, Amy J Plotkin, Majed M Malak, Khalid Alshali, Mohamed Hamzi, Saleh Al Khunein, Mohammed Abufayyah, Alawi A Alsheikh-Ali
Amin Daoulah, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Kingdom of Saudi Arabia
Salem Al-kaabi, Cardiology Department, Zayed Military Hospital, Abu Dhabi 3740, United Arab Emirates
Amir Lotfi, Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, United States
Mushabab Al-Murayeh, Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt 61961, Kingdom of Saudi Arabia
S Ali Nasseri, Politecnico di Torino, 10126 Torino, Italy
Waleed Ahmed, Mohamed Hamzi, Mohammed Abufayyah, Internal Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Kingdom of Saudi Arabia
Salah N Al-Otaibi, Cardiac Anesthesiology, King Faisal Specialist Hospital AND Research Center, Riyadh 11211, Kingdom of Saudi Arabia
Mohamed N Alama, Cardiology Department, King Abdul Aziz University Hospital, Jeddah 21589, Kingdom of Saudi Arabia
Osama E Elkhateeb, Cardiology Department, King Abdullah Medical City in Holy Capital, Makkah 24241, Kingdom of Saud Arabia
Amy J Plotkin, Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, United States
Majed M Malak, Khalid Alshali, Internal Medicine Department, King Abdul Aziz University Hospital, Jeddah 21589, Kingdom of Saudi Arabia
Saleh Al Khunein, Anesthesia Department, Prince Sultan Military Medical City, Riyadh 11159, Kingdom of Saudi Arabia
Alawi A Alsheikh-Ali, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
Alawi A Alsheikh-Ali, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi 51900, United Arab Emirates
Author contributions: Daoulah A participated in study design; acquisition, interpretation of the data, and drafted the initial manuscript; Alsheikh-Ali AA participated in analysis and interpretation of the data; all other authors participated equally in data collection, and reviewing the article critically for important intellectual content.
Institutional review board statement: The study was approved by King Faisal Specialist Hospital and Research Center Institutional Review Board, and reviewed for waiver by the institutional review board of each of the participating hospitals.
Informed consent statement: Consent to participate in this study was not required due to the design of our study and no follow up. However, an invitation letter was given to all participants who affirmed verbal consent prior to their enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amin Daoulah, MD, FRCPC, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah 21499, Kingdom of Saudi Arabia. amindaoulah@yahoo.com
Telephone: +966-505-795656 Fax: +966-266-77777-65822
Received: January 6, 2017
Peer-review started: January 10, 2017
First decision: February 17, 2017
Revised: February 28, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: April 26, 2017
Abstract
AIM

To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease (CAD) in men undergoing angiography.

METHODS

We conducted a prospective multicenter, multi-ethnic, cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates, in which we used logistic regression analysis with and without adjustment for baseline differences.

RESULTS

Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1st, 2013 to March 30th, 2014. Ethnicities of spouses were available only for male patients. Of those enrolled, 687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52 (95%CI: 0.33, 0.81)] or multi-vessel disease (MVD) [adjusted odds ratio 0.57 (95%CI: 0.37, 0.86)]. The adjusted association with left main disease showed a similar trend, but was not statistically significant [adjusted odds ratio 0.74 (95%CI: 0.41, 1.32)]. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives (P interaction > 0.05 for both).

CONCLUSION

Among married men undergoing coronary angiography, inter-ethnic, as compared to intra-ethnic, marriage is associated with lower odds of significant CAD and MVD.

Keywords: Arabian Gulf, Inter-ethnic marriage, Coronary artery disease, Cardiac epidemiology, Coronary angiography

Core tip: One thousand and sixty-eight enrolled patients underwent coronary angiography for clinical indications. Ethnicities of spouses were available for only male patients. Of the 771 males, 687 were married. Seventy percent of them were in intra-ethnic marriages and 30% in inter-ethnic marriages. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant coronary artery disease (CAD) or multi-vessel disease (MVD). The adjusted association with left main disease showed a similar trend, but was not statistically significant. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives.