Atherosclerotic Cardiovascular Diseases in Type 2 Diabetes in the Middle East and Africa: Insights from the PACT-MEA Study

Abstract Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among individuals with type 2 diabetes (T2D), particularly in regions with high diabetes prevalence, like the Middle East and Africa (MEA). However, contemporary data on ASCVD burden and management in these regions remain limited. The recent PACT-MEA study evaluated the prevalence of established ASCVD (eASCVD), cardiovascular risk profiles, and treatment practices in patients with T2D across seven countries. Several manuscripts and presentations on aspects of the study were published in several journals and conferences. This commentary consolidates a concise resume of the study. The PACT-MEA study is a multinational, cross-sectional, observational chart review and physician survey conducted across 55 centers in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and the United Arab Emirates. Data were collected from 3,726 adults with T2D and approximately 400 physicians. The weighted prevalence of eASCVD was 20.9%, with substantial variation by age and country. Nearly all participants have high or very high cardiovascular risk. Only 30 to 37% met individual treatment targets for HbA1c, blood pressure, and low-density lipoprotein cholesterol. Utilization of cardioprotective therapies was suboptimal. No participant achieved all guideline targets. The PACT-MEA and DISCOVER-MEA studies shared some objectives but differed in scope, design, and primary outcomes. The burden of ASCVD and associated risk among patients with T2D in the MEA region is alarmingly high, but comprehensive risk factor control is insufficient. The PACT-MEA study findings underscored an urgent need for targeted regional strategies to improve cardiovascular outcomes.