Premature coronary artery disease in the Middle East: a systematic review and meta-analysis of risk factor profiles

Review title: Premature coronary artery disease in the Middle East: a systematic review and meta-analysis of risk factor profiles Type and method of review: Meta analysis Stage of review at time of this submission: Review ongoing — the protocol has been finalised and the peer-reviewed search prepared; formal screening not yet started. Review question: In Patients with premature coronary artery disease in Middle Eastern countries, what is the effect of Traditional cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidaemia, obesity and family history) compared with Patients with non-premature coronary artery disease, where reported on Pooled prevalence of each cardiovascular risk factor among patients with premature coronary artery disease? Searches: The following sources will be searched: Europe PMC (PubMed, MEDLINE & preprints), PubMed / MEDLINE, Embase, Scopus, Google Scholar. Additional records may be imported from other databases. No date or language restrictions are applied unless otherwise stated. The search strategy underwent peer review (PRESS) before execution. Condition or domain being studied: Patients with premature coronary artery disease in Middle Eastern countries Participants / population: Patients with premature coronary artery disease in Middle Eastern countries Intervention(s), exposure(s): Traditional cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidaemia, obesity and family history) Comparator(s) / control: Patients with non-premature coronary artery disease, where reported Types of study to be included: Inclusion criteria: Patients with premature coronary artery disease in Middle Eastern countries (e.g. men under 55 and women under 65 years, or as defined by the study); Coronary artery disease confirmed by angiography or a diagnosis of acute coronary syndrome or myocardial infarction; Reports the prevalence of at least one traditional cardiovascular risk factor; Cross-sectional, registry-based or cohort studies; Full-text article published in English. Exclusion criteria: No separately reported age-defined premature coronary artery disease group; Populations outside Middle Eastern countries without separately reported data; Reviews, editorials, letters, case reports or conference abstracts; Overlapping samples (the largest or most recent report is kept) Main outcome(s): Pooled prevalence of each cardiovascular risk factor among patients with premature coronary artery disease Data extraction (selection and coding): Two reviewers will independently screen titles/abstracts and full texts, blinded to each other’s decisions, and extract data in duplicate using a standardised, piloted form. Disagreements will be resolved by discussion or a third reviewer. Risk of bias (quality) assessment: The risk of bias of each included study will be assessed independently by two reviewers using a study-design-appropriate tool. Disagreements will be resolved by consensus. Risk of bias in the review itself will be appraised with ROBIS. Strategy for data synthesis: Results will be synthesised narratively. Where studies are sufficiently homogeneous, effect estimates will be pooled in a meta-analysis using a fixed- or random-effects model as indicated by heterogeneity (I²). The certainty of the evidence will be rated using GRADE.