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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 29-33

Knowledge about cardio-vascular disease and its risk factors among college-going students in peri-urban Bengaluru, South India


1 Undergarduate Student, St. John's Medical College, Bengaluru, Karnataka, India
2 Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
3 Government Tribal Speciality Hospital, Wayanad, Kerala, India
4 Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India

Date of Submission21-Jul-2020
Date of Decision14-Dec-2020
Date of Acceptance02-Jan-2021
Date of Web Publication21-Apr-2021

Correspondence Address:
Dr. Farah Naaz Fathima
Department of Community Health, St. John's Medical College, Sarjapur Road, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_47_20

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  Abstract 


Background: Knowledge on cardiovascular disease (CVD), its risk factors and preventive measures including lifestyle and behavior changes among youth is an important primary prevention measure to control CVDs.
Objective: To assess the knowledge about CVD and its risk factors among college-going youth near Bengaluru city, Karnataka
Methods: A cross-sectional study was conducted among college-going youth pursuing various undergraduate degree courses in a peri-urban area near Bangalore, South India. A face-validated, pre-tested, and self-administered questionnaire which captured sociodemographic details along with fifty questions to assess knowledge of CVD and its risk factors was administered.
Results: A total of 693 college students participated in the study, of whom 342 (49.4%) were male. The mean age of the participants was 19.06 ± 1.62 years. Overall mean knowledge score regarding CVD and its risk factors was 20.69 ± 6.75 (out of 50). Knowledge scores were significantly higher among those residing in a hostel (P = 0.043) and among those in the 2nd and 3rd year of the course (P < 0.001).
Conclusions: College-going youth were found to have poor knowledge about CVD and its risk factors. We were able to identify erroneous beliefs and myths regarding CVD and its risk factors. It is necessary to create awareness among the youth by including CVD and its risk factors as a part of the regular college curriculum.

Keywords: Cardiovascular disease, college, knowledge, youth


How to cite this article:
Thomas J, Johnson AR, Mathew SS, Tomy C, Fathima FN. Knowledge about cardio-vascular disease and its risk factors among college-going students in peri-urban Bengaluru, South India. Int J Non-Commun Dis 2021;6:29-33

How to cite this URL:
Thomas J, Johnson AR, Mathew SS, Tomy C, Fathima FN. Knowledge about cardio-vascular disease and its risk factors among college-going students in peri-urban Bengaluru, South India. Int J Non-Commun Dis [serial online] 2021 [cited 2021 May 10];6:29-33. Available from: https://www.ijncd.org/text.asp?2021/6/1/29/314209




  Introduction Top


Cardiovascular diseases (CVD) are the leading cause of death globally estimated to be 17.9 million deaths in 2016, accounting to 31% of deaths in the world, of which 85% are due to myocardial infarction and stroke.[1] The number of deaths due to CVD in 2030 is projected to be 23.6 million.[2] Three fourth of the deaths due to CVD globally happens in middle-income and low-income countries.[1] Of 17 million premature deaths (deaths under 70 years of age) due to non-communicable diseases globally, 82% are in low- and middle-income countries of which 37% are due to CVD.[1] In India, CVD-specific death rate of 272/100,000 population annually is higher than the global burden of 235/100,000 population.[3] Deaths due to CVD in India, tend to occur at a younger age as compared to the global scenario.[4] Although cardiovascular events are less common in individuals under 30 years, the presence of risk factors such as hypertension, smoking, diabetes, high serum levels of LDL cholesterol, obesity, and diabetes mellitus in this age group are used as predictors of future cardiovascular events.[5]

According to the United Nations, youth is a group of population belonging to the age group between 15 and 24 years so, to decrease the incidence of CVD it is important to tackle the risk factors present in this population group. Changes in risk factors in this age group include lifestyle and behavior changes which are important to reducing the burden of CVD.[6],[7] Studies conducted in South India suggests that South Indians have a higher predisposition to develop hypertriglyceridemia and metabolic syndromes due to their genetic constitution and dietary habits leading to CVD.[8],[9] Knowledge of a disease and its risk factors is an important step toward the prevention of the disease.

With this background, our study was conducted with the aim of assessing the knowledge about CVD and its risk factors among college-going youth near Bangalore city, in the South of India.


  Methods Top


This was a cross-sectional study done in a general degree college located in a peri-urban area (fringe areas of Bangalore city characterized by a mix of rural and urban area),[10] around 25 km from Bangalore city. Around 800 students enrolled in the college were pursuing their undergraduate degree in various streams such as Arts (BA), Commerce (B Com), Computer Applications (BCA), Business Administration (BBA), and Business Management (BBM). Institutional Ethics Committee approval was obtained prior to the commencement of the study, as well as permission from the college authorities. All students enrolled in undergraduate courses at the college were included in the study.

The sample size was estimated with reference to a study done by Reiner et al.[11] who reported that 41.7% of entry-level medical students had no knowledge on CVD prevention. With a relative precision of 10% and 95% confidence limits, the minimum sample size required for our study was estimated to be 537. However, on request of the college authorities to include all the enrolled students, universal sampling technique was employed, and all the students present on the day of data collection were included in the study. Those who were absent on the day of visit by the researchers were excluded from the study.

Written informed consent was obtained from all the study participants, before administering a face-validated, pre-tested, and self-administered questionnaire which captured sociodemographic details along with fifty questions to assess knowledge of CVD and its risk factors. The fifty questions were divided into the following domains: (1) Knowledge of CVD, (2) Knowledge of disease risk factors for CVD, (3) Knowledge of Lifestyle risk factors for CVD, and (4) Myths regarding CVD and its risk factors. The correct answer for each of these questions carried a score of 1 and incorrect answers or unanswered questions carried a score of 0. Therefore, a maximum total knowledge score of 50 was possible.

Data were entered into Microsoft Excel and analyzed using SPSS version 16 (SPSS Inc. Chicago, USA). The sociodemographic data and knowledge scores were described using frequencies, mean, and standard deviation. T-test and ANOVA were used for testing association between knowledge scores and various socio-demographic data. P < 0.05 was considered statistically significant.


  Results Top


A total of 693 college students participated in the study, of whom 342 (49.4%) were male and 599 (86.4%) were day scholars. The mean age of the participants was 19.06 ± 1.62 years. Overall mean knowledge score regarding CVD and its risk factors was found to be 20.69 ± 6.75 (range = 0–39). Mean knowledge score was 20.50 ± 6.83 for male students and 20.87 ± 6.67 for female students. This difference was not statistically significant. Day scholars had a mean score of 20.44 ± 6.65, which was significantly lower as compared to the students residing in hostel who had a mean score of 22.10 ± 7.43 (P = 0.043). The students in the 1st year of the various degree courses had a mean score of 19.14 ± 6.43, which was significantly lower than that of the 2nd and 3rd year students. (P < 0.001). The mean knowledge score among the study participants and its association with the sociodemographic characteristics is depicted in [Table 1].
Table 1: Difference in mean knowledge score among various demographic variables (n=693)

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While majority of the students were aware that CVD is a problem not only in developed countries but also developing countries such as India (87.2%), and that CVD cannot spread from one person to another person (85.1%), only 59% were aware that chest pain and sweating are symptoms of having a heart attack, and less than half were aware that men and women experience the same symptoms of a heart attack. The proportion of study participants with correct knowledge for CVD for each question is depicted in [Table 2].
Table 2: Knowledge of cardiovascular disease among the study subjects (n=693)

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Regarding knowledge of disease-risk factors for CVD, only one-third of the students were aware that diseases such as diabetes and high blood pressure are risk factors for CVD, or that diabetics can have a heart attack without having any symptoms. While only 38.8% knew that a person may have high blood pressure and still appear completely normal and 12.4% were aware of the concept of good and bad cholesterol, only a quarter of the students were aware that normal blood pressure is 120/80 mm Hg or below. The proportion of study participants with correct knowledge for physiological risk factors for CVD for each question is depicted in [Table 3].
Table 3: Knowledge of physiological risk factors for cardiovascular disease among the study subjects (n=693)

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Regarding knowledge of lifestyle risk factors for CVD, majority of the students were aware of dietary risk factors for CVD and need for physical activity to prevent CVD, however, one-third of the students were unaware that smoking increases blood pressure or secondhand smoke is linked to CVD or that increasing dietary fiber is an easy way to lower blood cholesterol. Nearly half the students were unaware that exercise for the heart (aerobic exercise) involves increased breathing and increased heart rate for a sustained period of time. The proportion of study participants with correct knowledge for lifestyle-related risk factors for CVD for each question is depicted in [Table 4].
Table 4: Knowledge of lifestyle risk factors for cardiovascular disease among the study subjects (n=693)

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One in every five students believed in myths such as CVD is a problem only in cities not in rural areas or CVD can be completely cured or that CVD occurs due to bacteria, viruses' fungi, or parasites. One in every three students believed the myth that people who take medications regularly need not follow lifestyle modifications, that smokeless tobacco (chewing tobacco and snuff) is harmless or that trans fats are healthier for the heart than other kinds of fats. Nearly two-thirds believed that regular household work is sufficient exercise to prevent CVD. [Table 5] depicts the myths regarding CVD and its risk factors among the study participants.
Table 5: Myths regarding cardiovascular disease and its risk factors perceived by the study subjects (n=693)

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  Discussion Top


Our study showed that the knowledge of CVD among college students was poor, with day scholars and 1st year degree students having significantly lower knowledge levels.

Some erroneous beliefs were that diabetic and hypertensive medication could be stopped once blood pressure and blood sugars were under control and antihypertensives were not lifelong medications, and also that diabetes and hypertension could be cured. We were able to identify myths that smoking could lower blood pressure and that regular housework was sufficient exercise. This public health implication of these findings is that erroneous beliefs if not corrected, could perpetuate health-seeking behaviors and self-care practices that could lead to increased CVD-related complications and would increase the burden of CVD and its complications.

In a study done by Gurdogan et al. among nursing, physiotherapy and rehabilitation, nutrition and dietician students, using CARRF-KL scale to study the knowledge out of a total score of 28, the mean score of their 1st year students were found to be 17.32 ± 2.47.[12] This study found that students who had a family history of CVD had a higher knowledge score than students who did not. A study done by Reiner et al. among medical students in Croatia showed that 41.7% of their entry-level medical students had no knowledge about European guidelines about the prevention of CVD.[11] Our study showed that the knowledge of various risk factors for CVD was lower than that found by Fakültesi et al. in a similar study.[12] The lower knowledge levels could be attributed to the fact that our study included students from all streams (arts, science, and commerce), whereas the study by Fakültesi et al. included participants from allied health specialties where students are likely to be exposed to some basics on heart diseases as a part of the curriculum.

Less than three quarter (71.8%) of the participants in a study by Shaikh et al.[13] who were entry year students in a medical university, agreed that smoking is a risk factor for hypertension whereas 32.95% of our participants were of the belief that smoking lowers blood pressure. This difference points toward the prevalence of erroneous beliefs among the Indian students due to peer acceptance of smoking habits and the lack of basic understanding about tobacco and its effects on the human body.

In a study done by Potvin et al.[14] among Canadian residents aged 18–74, 60% mentioned that fat in food is a risk factor for CVD whereas in our study, 85.7% of the individual's agreed that fat and oily food is not good for the heart. More than two-thirds (78.9%) of our study population perceived that lack of exercise is a risk factor for CVD compared to 41% in Potvin et al. study. This difference may be due to the increased advertisements in mass media which influence public opinion.

The significant increase in the average knowledge scores among hostel residents in comparison to their peers is because they are more likely to interact with their peers in hostel and would learn more about CVD, importance of exercise, dietary habits, and modifications during their general communication in hostels and become more health conscious. The increase in knowledge score among 2nd and 3rd year students in comparison to 1st year students is more likely to be attributed to increased exposure to the peer discussions about health and health-related aspects during their leisure talks in campus.

Our study throws light on the level of knowledge on CVD and its risk factors among youth population in South India as well as the common myths and misconceptions on this topic. Addressing this knowledge gap will help in promoting changes in lifestyle and will in turn reduce the future burden of CVD in the population. In addition, understanding the myths and misconceptions is crucial, as these need to be addressed in program planning and implementation. Regular college curriculum could include information on the importance of diet, exercise, healthy lifestyle, and adherence to medication, as well as recognition of metabolic syndrome as the Indian population, is at higher risk for metabolic syndrome due to our genetic predisposition.[8] Screening should be done for diabetes, hypertension, and dyslipidemia among the youth so as to detect risk factors early, thereby reducing the incidence of mortality and morbidity associated with CVD. Further research is needed on which interventions would be successful to improve CVD knowledge levels and bring about behavioral changes among the youth.

Strengths and limitations

The strength of this study is that it elicited in-depth quality information regarding a relatively undocumented research area with a large sample size. The limitation of our study was that it was done in one college in peri-urban Bengaluru, so may not be reflective of college-going youth in general. The study instrument was face-validated, but not a standardized one, therefore there is direction for future research for standardizing this tool.


  Conclusions Top


Based on the result obtained by our study we could conclude that the overall knowledge about CVD and its risk factors among the youth was found to be poor, with a mean score of 20.69 ± 6.75 out of a total score of 50. Knowledge scores were significantly higher among those residing in a hostel and among those in the 2nd and 3rd year of the course. We were able to identify various erroneous beliefs and myths regarding CVD and its risk factors, which could have implications such as poor health-seeking and delayed preventive measures. It is necessary to create awareness among the youth by including CVD and its risk factors as a part of the regular college curriculum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Cardiovascular Diseases- Key Facts. Geneva: World Health Organization; c2017. Available from: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). [Last accessed on 2019 Dec 06].  Back to cited text no. 1
    
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Heart and Stroke Statistics 2018-At-a-Glance. Dallas, TX: American Heart Association, American Stroke Association; c2018. Available from: https://healthmetrics.heart.org/wp-content/uploads/2018/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-2018.pdf. [Last accessed on 2019 Dec 06].  Back to cited text no. 2
    
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Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation 2016;133:1605-20.  Back to cited text no. 3
    
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Chauhan S, Aeri BT. Prevalence of cardiovascular disease in India and its economic impact – A review. Int J Sci Res Publ 2013;3:1-5.  Back to cited text no. 4
    
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Berry JD, Lloyd-Jones DM, Garside DB, Greenland P. Framingham risk score and prediction of coronary heart disease death in young men. Am Heart J 2007;154:80-6.  Back to cited text no. 5
    
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By Youth, with Youth, for Youth. Paris: UNESCO; c2019. Available from: https://en.unesco.org/youth. [Last accessed on 2019 Dec 19].  Back to cited text no. 6
    
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Deshpande K, Patel S, Bhujade R, Deepak P. Lifestyle and obesity among college students in Ujjain, India. Nat J Community Med 2013;4:291-3.  Back to cited text no. 7
    
8.
Vimaleswaran KS, Radha V, Mohan V. Thr54 allele carriers of the Ala54Thr variant of FABP2 gene have associations with metabolic syndrome and hypertriglyceridemia in urban South Indians. Metabolism 2006;55:1222-6.  Back to cited text no. 8
    
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Sowmya N, Lakshmipriya N, Arumugam K, Venkatachalam S, Vijayalakshmi P, Ruchi V, et al. Comparison of dietary profile of a rural south Indian population with the current dietary recommendations for prevention of non-communicable diseases (CURES 147). Indian J Med Res 2016;144:112-9.  Back to cited text no. 9
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India's Peri-Urban Regions: The Need for Policy and the Challenges of Governance; 2019. Available from: https://www.orfonline.org/series/urbanisation-and-its-discontents/. [Last accessed on 2020 Dec 21].  Back to cited text no. 10
    
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Reiner Ž, Sonicki Z, Tedeschi-Reiner E. The perception and knowledge of cardiovascular risk factors among medical students. Croat Med J 2012;53:278-84.  Back to cited text no. 11
    
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Gurdogan EP, Kurt S, Unsar S. The knowledge about cardiovascular risk factors among students in a faculty of health sciences. Eurasian J Fam Med 2014;3:79-84.  Back to cited text no. 12
    
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Shaikh RB, Mathew E, Sreedharan J, Muttappallymyalil J, Al Sharbatti S, Basha SA. Knowledge regarding risk factors of hypertension among entry year students of a medical university. Family Community Med 2011;18:124-9.  Back to cited text no. 13
    
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Potvin L, Richard L, Edwards AC. Knowledge of cardiovascular disease risk factors among the Canadian population: Relationships with indicators of socioeconomic status. CMAJ 2000;162 Supp l: S5-11.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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