Literature review for a research Proposal assignment

The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1030-1034

1030

Received: 14/12/2017 DOI: 10.12816/0044357 Accepted: 24/12/2017

Evaluation of Knowledge about Risk Factors of Heart Disease in

Tabuk City between Adult Population Khalid Awd Albalawi, Saleh Hammad Alhawiti

Faculty of Medicine, University of Tabuk, Tabuk/ KSA Corresponding Author: Khalid Awd Albalawi, Email: [email protected], Telephone: (+966) 599566686

ABSTRACT

Background: According to World Health Organization (WHO), heart disease especially coronary heart

disease is the leading cause of death globally and one of the major health burdens worldwide. A report

released by the Media and Health Awareness Information Center at the Ministry of Health (MOH) in Saudi

Arabia, pointed out that, cardiovascular diseases (CVD), including heart attacks and strokes, are the cause of

42 percent of the Kingdom's non-communicable diseases deaths in 2010. Vascular injury accumulates in

adolescence, making it necessary for primary preventive measures to be taken from childhood. Therefore,

there is increasing emphasis on preventing atherosclerosis by modifying risk factors, such as healthy diet,

exercise and avoidance of smoking.

Methods: We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia.

The study was conducted during the period from May to September 2017. The participants were selected by

random sampling. Sampling was stratified for the different geographical areas of the city. The total sample

obtained was 460. All the pupils were approached to obtain the desired sample size. A self-administered

questionnaire about heart disease risk factors knowledge and awareness was filled by participants.

Results: the majority of participants showed right answers and were aware about some of the risk factors of

heart disease. The majority agreed to the following statements: (Being overweight increases a person's risk

for heart disease-96.7%), (Smoking is a risk factor for heart disease-92.4%), (High cholesterol is a risk factor

for developing heart disease-92.4%) and (High blood pressure is a risk factor for heart disease-86.5%).

Conclusion: more attention is needed on primary prevention programs that focus on diet, exercise and the

danger of heart disease and its risk factors should be emphasized.

Keywords: heart disease knowledge, risk factors, awareness, diet.

INTRODUCTION

Cardiovascular diseases (CVDs) are group

of disorders of heart and blood vessels. According

to WHO, heart disease especially coronary heart

disease is the leading cause of death globally and

one of the major health burdens worldwide (1)

.

For over 80 years, heart disease had been

the leading cause of mortality for both men and

women of all ages and all races in the United

States. Coronary heart disease (CHD) is the most

common type of heart disease, killing over 370,000

people annually in the United States (2)

.

A report released by the Media and Health

Awareness Information Center at the Ministry of

Health (MOH) in Saudi Arabia, pointed out that,

cardiovascular diseases, including heart attacks and

strokes, are the cause of 42 percent of the

Kingdom's non-communicable diseases deaths in

2010. The report also noted that the number of

patients with cardiac diseases in the primary health

centers mounts to 167499 people of both males and

females. The report underscored that the heart

attacks and strokes are usually acute events and are

mainly caused by a blockage that prevents blood

from flowing to the heart or brain. The most

common reason for this is a build-up of fatty

deposits on the inner walls of the blood vessels that

supply the heart or brain (3)

. WHO noted that CVD

has no geographic, socioeconomic or sex

boundaries. It is estimated that far from being

confined to the developed countries, cardiovascular

disease is the leading cause of death in developing

countries. 80% of CVD death is contributed by

countries with low and middle income. People in

low- and middle-income countries often do not

have the benefit of integrated primary health care

programmed for early detection and treatment of

people with risk factors compared to people in

high-income countries. People in low- and middle-

income countries who suffer from CVDs have less

access to effective and equitable health care

services which respond to their needs. As a result,

many people in low- and middle-income countries

are detected late in the course of the disease and

die younger from CVDs, often in their most

productive years (1)

. Some people are at greater risk

of cardiovascular disease than others. According to

the inter-heart and inter-stroke studies,

hypertension, diabetes, dyslipidemia, obesity,

smoking, physical activity, poor diet and alcohol

consumption are the most common risk factors for

myocardial infarction (heart attack) and strokes

worldwide (2,3)

.

Major Factors linked to an increased risk

of CVD are grouped into two categories, non-

modifiable and modifiable risk factors. Non-

modifiable risk factors are factors that are outside

Evaluation of Knowledge about Risk Factors…

1031

of a person's control and cannot be reduced or

altered. They are: family history, age and sex.

Modifiable risk factors can be reduced or

prevented by lifestyle behaviors or by medical

treatment. They are: cigarette smoking, excessive

alcohol consumption, raised blood cholesterol

levels, high blood pressure, high blood glucose,

physical inactivity, poor diet and overweight and

obesity (4)

. The discovery of oil and other natural

resources such as gas in the Gulf Cooperation

Council (GCC) countries including Saudi Arabia

led to rapid development and economic growth (4)

.

Along with the rapid socioeconomic growth in the

Gulf countries, there has been a change in lifestyle

such as an increased consumption of poor quality

foods and the adoption of a sedentary lifestyle (5)

and as a consequence the rates of CVD and

associated risk factors among the Gulf population

have also increased; the rates sometimes exceed

that of developed countries (5)

. There is a high

prevalence of cardiovascular risk factors in the

Saudi population (6)

.

It was estimated that 23.3 million people

will die by 2030, because of cardiovascular dis-

ease. high blood pressure, high cholesterol level,

high Blood glucose level, smoking, obesity and

physical inactivity are conventional risk factors (5)

.

Although cardiovascular disease occurs in

the middle age or later, risk factors (smoking,

dietary factors etc.) are determined to great extent

by behaviors learnt in childhood and continued to

adulthood (7)

. In the industrialized world, physical

activity continues to decline,while total caloric

intake increases. The resulting epidemic of

overweight and obesity may signal the start of the

age of inactivity and obesity. Rates of type 2

diabetes mellitus, hypertension and lipid

abnormalities are on the rise, trends that are

particularly evident in children. If these risk factor

trends continue, age adjusted CVD mortality rates

could increase in the coming years. Adherence to

healthy nutritional and lifestyle recommendations

can play an essential role in the prevention of

CVD (8)

. In order to encourage people to adopt a

cardio protective lifestyle; little is known about

knowledge of cardiovascular risk factors in general

population. Knowledge is an essential step in

developing a more cardio protective lifestyle (9)

.

Socioeconomic indicator “education” is a

strong predictor of cardiovascular risk factor

knowledge. Higher knowledge is associated with

higher education. Socioeconomic polarization

could partly explain the fact that a low

socioeconomic position has been associated with

higher morbidity and mortality of chronic

diseases (10)

.

METHODS

We have conducted a descriptive cross-

sectional study in Tabuk city population, Saudi

Arabia. The study was conducted during the period

from May to September 2017. The participants

were selected by random sampling. Sampling was

chosen from the different geographical areas of the

city. The study included both genders from twenty

years and above. The sample size was calculated

based on the formula (n= Z1-α 2 P(1-P)/d

2 ), where

n= sample size = 384 (11,12)

. Z= standard normal

variate = 1.96 (at 5% type I error, p= 0.05), P=

expected proportion = 50%, and d= precision error

= 5%. Additional 20 % was added to cover the

missing data. The total sample obtained was 460.

All the pupils were approached to obtain the

desired sample size. A self-administered

questionnaire, based on the risk factors of heart

disease, require information about heart disease

knowledge, filled by participants. A letter that

explains the objectives of the study and asks for

participants consent was sent with the

questionnaire. The questionnaire requires

information Knowledge of risk factors of heart

disease. The questionnaire responses were

analyzed using the Statistical Package for the

Social Science (SPSS Inc. Chicago, IL, USA)

version 23. Categorical variables were described

by frequencies and percentages. Descriptive

analysis involving Chi-square test was used to test

significance of association between categorical

variables. The level of significance was set at P<

0.05. The research was approved by the local

Research Committee of the Faculty of Medicine,

University of Tabuk.

RESULTS

Table 1 showesd general characteristics of the

participants. Participants were classified to four

categories according to age: from 20 to 29 years

old, from 30 to 39 years old, from 40 to 49 years

old, and 50 years old or above. Male and female

groups contributed to (45%) and (55%)

respectively. The majority of participants were

university graduates (90.2%), and about (9.8%)

were secondary education or bellow.

Table 2 showed percentage of correctly answered

questions. The majority of participants showed

right answers and were aware about some of the

risk factors of heart disease. The majority agreed to

the following statements: (Being overweight

increases a person's risk for heart disease-96.7%),

(Smoking is a risk factor for heart disease-92.4%),

(High cholesterol is a risk factor for developing

heart disease-92.4%), and ( High blood pressure is

a risk factor for heart disease-86.5%). At the same

time, 97.8% agreed to that as regular physical

Khalid Awd Albalawi and Saleh Hammad Alhawiti

1032

activity will lower a person's chance of getting

heart disease and 92.2% think that keeping blood

pressure under control will reduce a person's risk

for developing heart disease. 39.6% agreed to that

(a person always does not know when he/she has

heart disease), 36.7% agreed if they have a family

history of heart disease they are at risk for

developing heart disease, and 72.8% agreed to that

if a person increased in age, he is at increased risk

for developing heart disease. Half of participants

did not know that diabetes mellitus is a risk factor

for heart disease (50.4%), and about three quarters

disagreed to that if people have diabetes, they will

have high cholesterol.

Table 3 showed percentage of correctly answered

questions among gender groups. The two sexes

were nearly equal in knowledge and awareness of

heart disease. Males (58.9%) were more aware

than female (40.3%) in that diabetes mellitus as a

risk factor for heart disease.

Table 4 showed percentage of correctly answered

questions among education level of participants.

Participants with secondary education were more

aware than participants with bachelor and basic

education in that diabetes increases the risk for

heart disease and it will coexist with high

cholesterol.

Table 1: general characteristics n=460

Character

Age

From 20 to 29(n(%)) 182(39.6%)

From 30 to 39(n(%)) 137(29.8%)

From 40 to 49(n(%)) 126(27.4%)

50 years or above(n(%)) 15(3.3%)

Gender Male (n (%)) 207(45%)

Female (n (%)) 253(55%)

Education Primary and Intermediate (n (%)) 10(2.2%)

secondary (n (%)) 35(7.6%)

Bachelor (n (%)) 415(90.2%)

Income Below 5000 SR /month (n (%)) 112(24.3%)

5000-9999 SR /month (n (%)) 105(22.8%)

10000-19999 SR /month (n (%))

20000 or above SR /month (n (%))

233(50.7%)

10(2.2%)

Table 2: percentage of correctly answered questions

Question Right answer %

1.A person always knows when they have heart disease False 39.6%

2.If you have a family history of heart disease you are at risk for

developing heart disease

True 36.7%

3. The older a person is, the greater their risk of having heart

disease

True 72.8%

4. Smoking is a risk factor for heart disease True 92.4%

5. High blood pressure is a risk factor for heart disease. True 86.5%

6. Keeping blood pressure under control will reduce a person's risk

for developing heart disease

True 92.2%

7. High cholesterol is a risk factor for developing heart disease True 92.4%

8. Eating fatty foods does not affect blood cholesterol levels False 73.5%

9. If your "good" cholesterol (HDL) is high you are at risk for heart

disease

False 52.8%

10. If your "bad" cholesterol (LDL) is high you are at risk factor

for heart disease

True 88%

11. Being overweight increases a person's risk for heart disease. True 96.7%

12. Regular physical activity will lower a person's chance of

getting heart disease

True 97.8%

13. Diabetes Mellitus is a risk factor for developing heart disease True 49.6%

14. High blood sugar puts a strain on the heart True 61.3%

15. People with diabetes mellitus rarely have high cholesterol False 24.1%

Table 3: percentage of correctly answered questions among gender

Evaluation of Knowledge about Risk Factors…

1033

Gender

Question

Male

n=207

Female

n=253

P-value

1.A person always knows when they have heart disease 39.1% 39.9% .982

2.If you have a family history of heart disease you are at risk for

developing heart disease

37.2% 36.3% .737

3. The older a person is, the greater their risk of having heart disease 78.2% 68.3% .033

4. Smoking is a risk factor for heart disease 97.5% 88.1% .000

5. High blood pressure is a risk factor for heart disease. 85.5% 87.3% .834

6. Keeping blood pressure under control will reduce a person's risk

for developing heart disease

90.3% 93.6% .219

7. High cholesterol is a risk factor for developing heart disease 90.3% 94% .200

8. Eating fatty foods does not affect blood cholesterol levels 70.5% 75.8% .166

9. If your "good" cholesterol (HDL) is high you are at risk for heart

disease

49.2% 55.7% .251

10. If your "bad" cholesterol (LDL) is high you are at risk factor for

heart disease

83.1% 92.1% .004

11. Being overweight increases a person's risk for heart disease. 97.5% 96% .356

12. Regular physical activity will lower a person's chance of getting

heart disease

97.5% 98% .006

13. Diabetes mellitus is a risk factor for developing heart disease 58.9% 40.3% .001

14. High blood sugar puts a strain on the heart 53.1% 67.9% .003

15. People with diabetes mellitus rarely have high cholesterol 21.7% 26% .023

Table 4: percentage of correctly answered questions among education

Education

Question

Basic

n=10

Secondary

n=35

Bachelor

n=415

P-value

1.A person always knows when they have heart disease 0% 28.5% 41.4% .001

2.If you have a family history of heart disease you are at

risk for developing heart disease

50% 28.5% 37.1% .002

3. The older a person is, the greater their risk of having

heart disease

100% 28.5% 75.9% .001

4. Smoking is a risk factor for heart disease 50% 85.7% 93.9% .001

5. High blood pressure is a risk factor for heart disease. 50% 100% 86.2% .001

6. Keeping blood pressure under control will reduce a

person's risk for developing heart disease

50% 100% 92.5% .001

7. High cholesterol is a risk factor for developing heart

disease

50% 100% 92.7% .001

8. Eating fatty foods does not affect blood cholesterol

levels

0% 57.1% 76.6% .001

9. If your "good" cholesterol (HDL) is high you are at

risk for heart disease

50% 57.1% 52.5% .001

10. If your "bad" cholesterol (LDL) is high you are at

risk factor for heart disease

50% 85.7% 89.1% .001

11. Being overweight increases a person's risk for heart

disease.

100% 85.7% 97.5% .002

12. Regular physical activity will lower a person's

chance of getting heart disease

100% 100% 97.5% .981

13. Diabetes mellitus is a risk factor for developing heart

disease

50% 42.8% 50.1% .001

14. High blood sugar puts a strain on the heart 50% 100% 58.3% .001

15. People with diabetes mellitus rarely have high

cholesterol

0% 42.8% 23.1% .001

DISCUSSION

Khalid Awd Albalawi and Saleh Hammad Alhawiti

1034

According to WHO, heart disease

especially coronary heart disease is the leading

cause of death globally and one of the major

health burdens worldwide ( 1)

.

To the best of our knowledge, there is no

much data and insufficient studies done regarding

the knowledge and awareness of heart disease risk

factors among public. Half of participants did not

know that diabetes mellitus is a risk factor for

heart disease (50.4%), and about three quarters

disagreed to that if people have diabetes, they will

have high cholesterol. Similar findings reported in

another study and it showed that the participants

were unaware of comorbid conditions like

diabetes and hyperlipidemia (13)

.

In our study, the majority agreed to the

following risk factors for heart disease: being

overweight -96.7%, high cholesterol-92.4% and

high blood pressure -86.5%. Another study

reported overweight as considered a major risk

factor (100%) for heart disease by the participants

followed by high cholesterol level (98%) ,high

blood pressure level 94% and smoking 92% (14)

. In this study, 97.8% agreed to that as

regular physical activity will lower a person's

chance of getting heart disease and 92.2% though

that keeping blood pressure under control will

reduce a person's risk for developing heart

disease. similar findings reported, as regular

physical activity (90%) were considered as factors

that help lower chances of developing heart

disease, by the participants (14)

.

In this study, 72.8% agreed to that if a person

increased in age, he is at increased risk for

developing heart disease, while another study

reported few participants were unaware of older

age being a greater risk factor (10%). This study

showed that 36.7% of participants think if they

have a family history of heart disease they are at

risk for developing heart disease, while another

study showed similar results(32%) (14)

.

CONCLUSION More attention is needed in primary prevention

programs that focus on diet, exercise and the

danger of heart disease and should be emphasized.

Lifestyle changes such as modifying dietary habits

can benefit those who are at risk of developing

heart disease. Knowledge of risk factors of heart

disease is essential to prevent development of, and

identify heart disease. The study emphasizes on

the importance of educating the population about

the various risk factors of heart disease.

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http://www.who.int/mediacentre/factsheets/fs317/en/

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https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_02.pd

f. Kingdom of Saudi Arabia. Ministry of Health

Portal. Media center. Ministry News..

Cardiovascular diseases cause 42% of non-

communicable diseases deaths in the Kingdom.

October 30\ 2013.available on:

http://www.moh.gov.sa/en/ministry/mediacenter/news

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3- Heart Foundation of Australia (2010): Risk factors for heart disease online resources Available on:

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http://www.who.int/cardiovascular_diseases/en/cvd_a

tlas_04_childhood_youth.pdf?ua=1.

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10- https://www.surveymonkey.com/mp/sample-size- calculator

11- Kingdom of Saudi Arabia Census(2012): https://www.stats.gov.sa/sites/default/files/en-

census2010-dtl-result_2_1.pdf .

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cardiovascular risk factors in a teaching hospital.

International Journal of Pharma Research and Health

Sciences, 4 (3) :1166-1175.

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risk factors. Indian Journal of Pharmacy Practice, 7:

2-9.

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