Inclusion Criteria:
* Qataris
* Long-term residents (≥10 years of residence in Qatar) who are not planning to leave Qatar voluntarily within the next 5 years.
* Age ≥40 years.
* English or Arabic speaker.
* Presence of either atherosclerotic cardiovascular disease (ASCVD) or very high cardiovascular risk.
1. ASCVD:
ASCVD is defined as either clinical ASCVD or unequivocally documented ASCVD on imaging, based on the European Society of Cardiology (ESC) guidelines for the management of cardiovascular disease in patients with diabetes.
i.Clinical ASCVD: History or presence of any of the following atherosclerotic events or revascularization in major arterial territories:
1. Coronary Artery Disease (CAD)
* Myocardial infarction (ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction (NSTEMI))
* Stable or unstable angina with angiographic stenosis ≥50%
* History of coronary revascularization (Percutaneous coronary intervention (PCI) or Coronary artery bypass graft surgery (CABG))
2. Cerebrovascular Disease
•Ischemic stroke or transient ischemic attack (TIA)
* Symptomatic carotid artery stenosis ≥50% or prior carotid intervention
3. Peripheral Arterial Disease (PAD) •Intermittent claudication with objective evidence of arterial obstruction
•Prior peripheral revascularization, limb amputation due to ischemia, or Ankle-brachial index ABI \<0.9
4. Aortic Atherosclerotic Disease •Aortic aneurysm (abdominal or thoracic) of atherosclerotic origin ii.Unequivocally Documented ASCVD on Imaging:
a. Coronary artery calcium (CAC) score \>100 Agatston units or \>75th percentile for age and sex b. Coronary CT angiography or invasive angiography showing ≥50% stenosis in ≥1 major epicardial artery c. Carotid ultrasound or angiography showing plaque or ≥50% stenosis d. Lower-limb CT/MR/Doppler angiography showing atherosclerotic plaque or stenosis ≥50%
2. Very High Cardiovascular Risk i. In non-diabetic patients (ESC 2021 CVD Prevention Guidelines): •10-year fatal/non-fatal CVD risk ≥7.5% using SCORE2 (ages 40-49),≥10% using SCORE2 (ages 50-69), or ≥15% using SCORE2-OP (age≥70 years)
•Severe chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73m²; or eGFR 30-44 mL/min/1.73 m² and UACR \>30 mg/g.
ii.In diabetic patients (ESC 2023 Diabetes \& CVD Guidelines):
•10-year fatal/non-fatal CVD risk ≥20% using SCORE2-Diabetes (ages 40-69),or ≥15% using SCORE2-OP (age ≥70),since SCORE2-Diabetes is not validated beyond age 69. Severe target organ damage:
•Severe target organ damage:
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1. eGFR \<45 mL/min/1.73m² (regardless of albuminuria)
2. eGFR 45-59 mL/min/1.73m² with microalbuminuria (UACR 30-300 mg/g)
3. Proteinuria (UACR \>300 mg/g)
4. Microvascular disease in at least three sites (e.g., microalbuminuria, retinopathy, neuropathy).
3.Microvascular disease in at least three sites (e.g., microalbuminuria, retinopathy, neuropathy)
Exclusion Criteria:
* Type 1 diabetes or monogenic diabetes (e.g., MODY).
* Pregnancy (self-reported).
* Active cancer, under medical or radiation therapy or terminal, or cancer in remission \< 1 year.
* Chronic immune or chronic infectious diseases.
* End stage renal disease (ESRD) (estimated glomerular filtration rate \<15 mL/min/1.73m²).
* Prisoners.
* Inability or unwillingness to provide informed consent, including language barriers.
* Mental incapacity.
