KNOWLEDGE, AWARENESS, AND PRACTICE OF RISK FACTORS OF

CORONARY ARTERY DISEASE AMONG YOUNG ADULTS IN

BARANGAY 54-A, BANKEROHAN, DAVAO CITY

IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE BACHELOR OF SCIENCE
IN MEDICAL TECHNOLOGY

Arnao, Patrick A.

Dimaraw, Rashmera A.

Jose, Lindy Mae A.

Pagayao, Zahanee Y.

Papa, Mary Mhel P.

TABLE OF CONTENTS

Chapter 1: Introduction
 3.1: Review of Related Literature
 3.2: Statement of the Problem
 3.3: Theoretical/Conceptual Framework
 3.4: Hypothesis
 3.5: Definition of Terms
 3.6: Significance of the Study

Chapter 2: Methodology
 4.1: Research Design
 4.2: Research Instruments
 4.3: Participants
 4.4: Measures
 4.5: Data Gathering Procedure
 4.6: Data Analysis
 Chapter I

INTRODUCTION

Coronary heart disease is the leading cause of death in the United States among men and

women. It is also a major cause of physical disability, particularly in the rapidly growing elderly

population (Sultan, 2008). According to WHO, recent evidence indicates that South Asian

individuals with a lower socioeconomic status (SES) are developing a higher disease burden of

CAD than higher income individuals. Only about one-fourth of those who have CAD are aware of

their disease and are seeking medical care.

Risk factors for Coronary artery disease (CAD) are now well recognized and modification

of these factors can prevent heart attacks and prolong life. Primary prevention refers to risk

reduction in patients without evidence of CAD. High cholesterol, cigarette smoking, hypertension,

positive family history, age and diabetes mellitus are the major risk factors of CAD. Age, male sex

and family history are the non-modifiable risk factors. Smoking, hypertension, Diabetes mellitus,

sedentary lifestyle, obesity and high cholesterol diet are the modifiable risk factors. High risk of

cardiovascular disease has been reported in south Asian population regardless of whether they live

overseas or in the native country (Almas, 2008).

Further, according to Leonard (2014), the knowledge of heart disease risk factors is

essential to make informed decision that will result in reduction in overall cardiovascular risk of

an individual. In the Health Belief Model (HBM), a person must feel susceptible to a disease in

order to motivate a change in behavior. Adequate knowledge and perception of risk are therefore

important in stimulating behavioral change towards a better health. The prevention of subsequent
coronary events and the maintenance of physical functioning in such patients are major challenges

in preventive care.

Knowledge about CVD and its modifiable risk factors is a vital pre-requisite to change the

individuals’ health attitudes, behaviors and lifestyle practices. Knowledge improvement to the

recognition of heart attack and stroke symptoms will lead to earlier presentation to medical care

that may result in better patients’ outcomes. Good knowledge about CVD risk factors among

individuals will aid them to be proactive in decreasing their risk since the majority of the risk

factors are modifiable (Awad, 2014).

Moreover, risk of CVD will decrease by adherence to dietary and lifestyle

recommendations, which results in lower risk factor levels. Thus, young adults must change their

behavior in order to reverse the trend of increasing risk factor levels. Health behavior models

propose that knowledge of the negative health consequences of a behavior is a necessary condition

for behavior change, because without knowledge there is no motivation to change. Because other

factors may prevent translation of knowledge into motivation and action, risk factor knowledge is

not sufficient to promote behavior change. If knowledge of risk is necessary for motivation and

action, greater risk factor knowledge should be associated with healthier risk factor development

over time (Greenland, 2006).

The estimation of the baseline knowledge about CAD among the population has significant

public health application as it helps in developing targeted educational programs. Knowledge of

CAD, its symptoms and risk factors have been studied worldwide in various populations. (Nafisi,

2014). Greater knowledge of CAD risk factors helps individuals to correctly assess their personal

risk, motivates them to increase prevention-seeking behaviors and has been associated with

increased action to lower risks. Estimating knowledge of traditional CAD risk factors among a
population is therefore crucial in the prevention and treatment of this condition and continues to

serve as the baseline for most screening programs. Inherent psycho-cognitive factors such as the

perceived risk of a disease or the importance of behavioral change as well as barriers to the

adoption of preventative behaviors or CAD screening may contribute to lack of knowledge

(Tamimi, 2016).

The study however would determine the knowledge, awareness and practice of individuals

or residents of Barangay 54-A, Bankerohan, Davao City on the risk factors of Coronary Artery

Disease particularly in the young adults.

 Review of Related Literature

Prevention of Coronary Artery Disease is important part of human health wellbeing,

Knowledge on how to understand risk factors on coronary artery disease is empirical. this is true

even for the young adult.

I. Related Theories

CAD is caused by atherosclerosis of the coronary arteries that leads to a restriction of blood

flow to the heart.1 Depending on the degree of stenosis (narrowing) and plaque characteristics,

patients may experience stable angina (angina pectoris) or remain asymptomatic until a plaque

ruptures and thrombosis occurs, causing ACS.

Because the underlying atherosclerosis causal to CAD is a systemic disease, patients with CAD

often have ischemic vascular disease affecting two or more vascular beds (known as polyvascular

disease).

It is estimated that approximately 20% of the population will be ≥65 years old by 2030, and

cardiovascular disease will be responsible for 40% of deaths. With an ageing population, the health

burden of ischemic heart disease is expected to increase over the next few decades.11

Because of longer life expectancy, the economic burden of CAD is expected to increase. The cost

of CAD-related healthcare in the US population aged 35–84 years is projected to increase to $177.5

billion in 2040 compared with $126.2 billion in 2010 (Greenland, 2010).

 CAD happens when the arteries that supply blood to heart muscle become hardened and

narrowed. This is due to the build-up of cholesterol and other material, called plaque, on their inner

walls. This build-up is called atherosclerosis. As it grows, less blood can flow through the arteries.

As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain

(angina) or a heart attack. Most heart attacks happen when a clot suddenly cuts off the hearts' blood

supply, causing permanent heart damage (Oman, 2008).

The Modifiable Risk Factors

High blood cholesterol

As high blood cholesterol, itself does not cause symptoms, many people may not be aware

that their cholesterol level is high. Therefore, it is important to check your cholesterol level

regularly. If the level is high, it should be lowered to reduce your susceptibility to coronary heart

disease. The desirable level of cholesterol depends on your pre-existing risk for coronary heart

disease.

High blood pressure / hypertension

"Hypertension is one of the major risk factors for coronary heart disease and

cerebrovascular disease, such as stroke," say doctors from National Health Center Singapore, a

member of the SingHealth group. Hypertension usually occurs without any symptoms.

Hypertension, left untreated over the long term, can lead to damage of the heart and blood vessels

leading to stroke or heart attack. When your blood pressure is eextremely high, headaches,

dizziness or alterations in vision may be experienced. Marginally elevated blood pressure may

normalize when you lose weight, exercise more and reduce salt intake. If these measures are not
successful, then drug treatment may be needed. Once medication has started, it is essential to

continue with the treatment, complemented by a healthy lifestyle. Treatment of hypertension for

most people is lifelong. You should have your blood pressure checked at least once a year. It is

recommended that adults over 40 years should have their blood pressure checked annually, and

their blood cholesterol checked once every three years; more frequently if results are abnormal or

if there are other risk factors.

Diabetes and abnormal blood glucose (sugar) levels

Diabetes mellitus is a chronic illness. It is often associated with other cardiovascular risk

factors, such as high blood pressure, increased total cholesterol and triglyceride levels, decreased

HDL-cholesterol levels (“good” cholesterol) and obesity. The basic treatment strategy is to

maintain good control over the amount of glucose in your blood. Maintaining a healthy weight, a

balanced diet and a regular exercise routine can prevent the onset of diabetes mellitus. People with

diabetes are 2 to 4 times more likely to develop coronary artery disease and stroke.

Menopause

Many women before menopause seem to be partly protected from coronary heart disease,

heart attack and stroke by natural estrogen. A woman’s estrogen level is highest during her

childbearing years and declines during menopause. If menopause is caused by surgery to remove

the uterus and ovaries, the risk rises sharply. As a woman ages, the loss of natural oestrogen may

contribute to a higher risk of heart disease and stroke. If menopause occurs naturally, the risk rises

gradually. However, routine hormone replacement for women who have undergone natural

menopause does not prevent heart disease.

Obesity and overweight

People with excess body fat – especially around the waist – are more prone to developing

heart disease and stroke even if they have no other risk factors. Excess weight increases the strain

on the heart, raises blood pressure, blood cholesterol and triglyceride levels, and lowers HDL. It

is also associated with the development of diabetes mellitus. Family history and environment play

a part in determining obesity. Physical inactivity and a high fat diet also contribute to obesity. As

body fat increases when more food calories than required are consumed over a long period of time,

weight control (fat loss) is possible by decreasing food intake together with increasing physical

activity. If you burn more calories because of increased physical activity, a gradual decrease in

body weight will take place. Diet alone can also cause weight loss, which leads to a decrease in

blood pressure, blood glucose and blood cholesterol levels.

Physical inactivity

An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate physical

activity helps prevent heart and blood vessel disease if done over a period of time. Regular exercise

may also lead to an improvement in other cardiovascular risk factors, such as weight loss, lower

blood pressure, decreased stress and improved cholesterol levels. Exercise is beneficial especially

since the risks involved are minimal. Exercise programmes should start at a slow pace initially to

avoid injury to muscles and ligaments. People with known coronary artery disease or those above

40 years of age who have been inactive should seek medical advice before starting a regular

exercise programme.
Smoking

Smokers account for 40 per cent of deaths caused by heart disease in patients younger than

65 years. Smoking also leads to heart attack, stroke, high blood pressure, blood vessel disease,

cancer and lung disease. Smoking causes a decrease in HDL-cholesterol. Smokers have 2 to 3

times the risk of non-smokers for sudden cardiac death.

Stress

Your blood pressure goes up momentarily when you get angry, excited, frightened or when

you are under stress.

II. Related Study

It has been well-established that the presence of cardiovascular disease (CVD) risk factors

in young adulthood is associated with increased mortality risk. In the past 40 years, the prevalence

of hypertension, hypercholesterolemia, and cigarette smoking have decreased in the US population

as a whole. Recently, however, the prevalence of several CVD risk factors has increased among

subsets of young adults. From 1988–1991 to 1999–2000, the prevalence of hypertension in the

National Health and Nutrition Examination Survey (NHANES) increased from 5.1 percent to 7.2

percent among adults aged 18–39 years, and total cholesterol levels increased 0.09 mmol/liter in

men aged 29–34 years. From 1990 to 2000, smoking prevalence increased slightly among adults

aged 18–24 years (from 24.5 percent to 26.8 percent). Finally, the prevalence of obesity among

adults aged 20–39 years increased significantly from NHANES 1988–1991 to NHANES 1999–

2000 in both men (from 14.9 percent to 23.7 percent) and women (from 20.6 percent to 28.4

percent).
 Risk of CVD can be decreased by adherence to dietary and lifestyle recommendations,

which results in lower risk factor levels. Thus, young adults must change their behavior in order

to reverse the trend of increasing risk factor levels. Health behavior models propose that

knowledge of the negative health consequences of a behavior is a necessary condition for behavior

change, because without knowledge there is no motivation to change. Because other factors may

prevent translation of knowledge into motivation and action, risk factor knowledge is not sufficient

to promote behavior change. If knowledge of risk is necessary for motivation and action, greater

risk factor knowledge should be associated with healthier risk factor development over time.

We examined the level and determinants of knowledge of CVD risk factors and the relation

between knowledge and 10-year changes in CVD risk burden in a large population sample of

young adult Whites and Blacks with a wide range of educational backgrounds. To date, only one

observational study has examined the relation between individual knowledge and CVD risk factor

development, and those investigators found no relation. However, that study was limited in two

ways: 1) the follow-up period was only 12 weeks long and 2) the sample consisted of mostly

White, relatively high socioeconomic status young adults. Thus, the results of the current study

have potential public health importance. If lack of knowledge is related to long-term development

of CVD risk factors, increasing knowledge may help decrease the pace of risk factor development.

MATERIALS AND METHODS

Study population

The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a

multicentre, longitudinal study of the evolution of CVD risk factors in Black and White adults
aged 18–30 years. CARDIA participants were recruited in 1985–1986 from four US cities:

Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California (30).

The CARDIA sample of 5,115 participants at baseline was designed to include approximately

equal numbers of participants by race (Black/White), sex, age (18–24 years/25–30 years), and

education (high school or less/more than high school). In the current study, we used data from two

follow-up examinations: the year 5 examination (1990–1991), the year the participants' knowledge

of CVD risk factors was assessed, and the year 15 examination (2000–2001), for calculation of

10-year changes in risk factors.

Exclusions

Of the 4,352 participants seen at the year 5 examination, those with missing data on the

knowledge question, systolic blood pressure, total cholesterol, body mass index, smoking, or

education (n = 159) were excluded from the cross-sectional analysis; this resulted in a sample size

of 4,193. Of those 4,193 persons, 3,351 participants were also examined at year 15. After

exclusions for missing data at year 15 (n = 80), the longitudinal sample consisted of 3,271

participants.

Knowledge assessment

At the year 5 examination (1990–1991), participants were asked, “What do you think are

the most important causes of heart attack and stroke?” The interviewer was instructed to probe for

up to five responses by saying, “Can you think of anything else?” The interviewer marked the

category corresponding to the participant's response from a list of possible responses, including:

eating too much/too many calories/general dietary response, smoking, overweight, cholesterol in
the blood, cholesterol in the diet, lack of exercise, stress, heredity, high blood pressure, eating too

much meat, eating too much fat, eating too much sugar, not eating enough vegetables/fiber, being

too thin, exercising too much, lack of knowledge of the causes of CVD, and not seeing a doctor.

If the participant mentioned a cause that was not included on the list, this was coded as “other”;

those responses were not analysed in the current study. Risk factor knowledge scores were

calculated for each participant based on the number of established modifiable CVD risk factors

and lifestyle factors mentioned. Participants received one point for mentioning each of the

following five established CVD risk factors: high blood pressure, blood cholesterol, smoking,

overweight, and lack of exercise; and one point for mentioning at least one of the following specific

dietary causes: eating too much fat/cholesterol, salt, or meat and not eating enough

vegetables/fiber. Because participants could provide up to five responses, knowledge scores

ranged from 0 to 5.

Risk factor measurements

Participants were asked to fast for 12 hours prior to each examination and to avoid smoking

or physical activity for at least 2 hours prior to the examination. Lipid levels were measured by the

CARDIA central laboratory according to CARDIA procedures. Cigarette smoking status, age,

race, education, diabetes history, and medication use were based upon participant self-report.

Blood pressure was measured three times using a random-zero device, and the average of the last

two measurements was used. Height and weight were measured while participants stood wearing

light clothing and no shoes. Body mass index was calculated as the ratio of weight (kg) to standing

height (m) squared (kg/m2). Physical activity at years 5 and 15 was included as a behavioral risk
factor. Physical activity was assessed using the CARDIA physical activity history questionnaire

and was coded as “exercise units”.

Participants were assigned a risk score, ranging from 0 to 5, reflecting their CVD risk factor

burden at year 5. Participants were assigned one point for each of the following risk factors:

diabetes, body mass index ≥25 (33), current cigarette smoking, systolic blood pressure ≥120

mm/Hg or diastolic blood pressure ≥80 mm/Hg or use of antihypertensive medication, and serum

cholesterol level ≥200 mg/dl or use of cholesterol-lowering medication. Because the participants

were young adults, they were considered to have a given risk factor if the status of that factor was

nonoptimal.

Ten-year change in CVD risk factor status was defined as the difference between year 5

and year 15 levels of the following risk factors: body mass index, low density lipoprotein

cholesterol, high density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic

blood pressure, cigarette smoking, and physical activity. For cholesterol, blood pressure, and body

mass index, change was calculated by subtracting the year 5 level from the year 15 level.

Prevalences of smoking cessation were calculated among persons who were current smokers at

year 5. A participant was defined as quitting smoking if he/she was a current smoker at the year 5

examination and a former smoker at the year 15 examination.

Statistical analysis

We present year 5 risk factor levels across sex/race groups, stratified by education (≤12

years vs. >12 years). T tests and chi-squared analyses were used to measure differences in race,

stratified by sex and education.

We calculated the proportion of each sex/race/education group mentioning each recorded cause.

Chi-squared tests were used to measure racial differences in the likelihood of mentioning each

cause, stratified by sex and education. The following causes were mentioned by less than 5 percent

of participants and were not analysed further: being too thin, exercising too much, lack of

knowledge of the causes of CVD, and not seeing a doctor. We also calculated the percentage of

persons in each sex/education/race group mentioning each number of CVD risk factors, in order

to collapse the knowledge score variable into levels with roughly equal numbers of participants.

In addition, we calculated the mean knowledge scores for the sex/race/education subgroups.

We assessed cross-sectional relations between demographic and physiologic variables and

risk factor knowledge. To assess the predictors of knowledge scores, participants were divided into

three approximately equal-sized groups: The lowest knowledge group had a knowledge score of 0

or 1, the medium knowledge group had a knowledge score of 2, and the highest knowledge group

had a knowledge score of 3 or higher. We used polytomous logistic regression to determine

predictors of being in the medium and highest knowledge groups relative to the lowest knowledge

group, which served as the reference group. The model included demographic variables and

participant risk scores. Participants with medium risk (one or two risk factors) and high risk (three

or more risk factors) were compared with participants with low risk (zero risk factors), who served

as the reference group.

We also used logistic regression models to test the relation between having a risk factor

and mentioning that risk factor. Separate logistic regression models were used to test the relation

between elevated total cholesterol level and mentioning cholesterol as a risk factor, body mass

index ≥25 and mentioning overweight, current cigarette smoking and mentioning smoking,
elevated blood pressure and mentioning high blood pressure, and low physical activity and

mentioning lack of exercise. For this analysis, participants in the lowest quartile of the physical

activity score were coded as having low physical activity. Covariates in these models included sex,

race, education (coded as ≤12 years vs. >12 years), age, and risk factors (coded as dummy

variables). Risk factors included nonoptimal cholesterol level, nonoptimal blood pressure level,

being overweight, current cigarette smoking, and low physical activity.

Longitudinal relations between risk factor knowledge and risk factor changes were

assessed in two ways, corresponding to two different measures of knowledge. First, general linear

regression was used to test for a trend in which greater levels of overall CVD risk factor knowledge

were associated with risk factor changes between years 5 and 15. For this analysis, the knowledge

score (the number of CVD risk factors mentioned by the participant) was the independent variable

and the dependent variable was the difference in risk factor levels between years 5 and 15.

Covariates included in these analyses were age at the year 15 examination, race, sex, education at

the year 15 examination, and year 5 level of the dependent-variable risk factor. Separate analyses

were performed for each risk factor. The second set of analyses used a measure of specific

knowledge, which was a dichotomous variable representing whether the person mentioned the

specific CVD risk factor related to the dependent variable (whether mention of smoking as a CVD

risk factor was related to quitting smoking, whether mention of overweight as a CVD risk factor

was related to change in body mass index, etc.). Multivariate regression analyses, adjusting for

education, sex, race, and baseline (year 5) level of the dependent variable, were used to examine

the relation between specific knowledge and changes in risk factors.

 In 1990–1991 (year 5), across sex and education level, Blacks were younger than Whites

and were more likely to have nonoptimal blood pressure levels. Among women at both education

levels, the prevalence of overweight was higher among Blacks than among Whites, and levels of

physical activity were lower. Among less educated men, Whites had a higher prevalence of

nonoptimal total cholesterol levels than Blacks. Among men in the high education group, Blacks

had a higher prevalence of overweight and smoking than Whites.

Cardiovascular disease is the commonest cause of mortality worldwide. Many risk factors

predate the development of cardiovascular diseases. Adequate knowledge of risk factors for

cardiovascular diseases is the first step towards effective preventive strategies to combat the

cardiovascular diseases burden in any population. This study aims to determine the knowledge of

workers in a Nigerian University on risk factors for cardiovascular diseases.

Materials and Methods:

A cross-sectional survey of 206 academic and non-academic staff of Ladoke Akintola

University of Technology, Ogbomoso, Nigeria using the Heart Disease Fact Questionnaire

(HDFQ). Demographic data were taken. The lipid profile and random blood sugar were taken.

Statistical analysis was done using SPSS 17.0.

Results:

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%).

The mean HDFQ score was 48.6%. Only 41 (19.9%) of participants were assessed to have good

knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64

(31.2%) had fair knowledge of heart disease risk factors. There was no significant difference
between prevalence of CV risk factors between those with good or fair or low level of knowledge.

Most participants did not have a good level of knowledge about risk factors, prevention, treatment

and association with diabetes as it relates to heart diseases.

Knowledge of heart disease risk factors is low among University workers in Nigeria.

Effective education on heart disease risk factors and appropriate preventive strategies are indeed

important to reduce cardiovascular disease burden in Nigerian University communities.

Materials and Methods

This was part of another study on the prevalence of cardiovascular risk factors among

University workers in Ladoke Akintola University of Technology, Ogbomoso, Nigeria. It was a

cross-sectional descriptive study, The Heart Disease Fact Questionnaire (HDFQ) was used.

Two-hundred and six adult staff including academic and non-academic staff of the Ladoke

Akintola University of Technology, Ogbomoso, Nigeria were randomly selected from all faculties

and units of the University. Apart from the other part of the study which has been described

elsewhere, the HDFQ Questionnaire was administered to each participant. The HDFQ

Questionnaire is a 25-item measure of heart disease knowledge. It evaluates for knowledge of risk

factors for heart disease, the link between diabetes and heart disease and how to reduce the risk for

heart disease. Respondents were asked to mark one of the options including ‘True’, ‘false’ or ‘I

don’t know’. Scores are calculated in percentages by summing the total number of correct answers

with a higher score indication a higher knowledge. Participants with score of <50% were classified

as low level of knowledge while those whose score were between 50 and 69% were classified as

moderate level of knowledge and those with HDFQ score>70% as good level of knowledge.

Questions that <70% of the respondents answered correctly was deemed unsatisfactory. The
HDFQ Questionnaire has been used in other population with reliable test-retest reliability, internal

consistency and satisfactory discriminant validity.

The demographic parameters were taken using a pretested data sheet. Information obtained

includes age, gender, highest level of education, systolic and diastolic blood pressure, weight,

height, waist circumference and marital status. Laboratory parameters taken include random blood

sugar, lipid profile (including triglycerides, total cholesterol, high density lipoprotein cholesterol

and low density lipoprotein- cholesterol) were taken.

Statistical analysis was performed with the aid of the Statistical Package for Social

Sciences SPSS 17.0 (Chicago Ill). Data were summarised using means and standard deviation for

quantitative variables and frequencies and percentages for qualitative variables. Relationship

between continuous variables was tested using the Analysis of Variance while the Pearson Chi-

Square test was used to test for relationship between qualitative/nominal variables. P < 0.05 was

taken as statistically significant. Ethical approval was obtained from the Institutional Ethical

Research Board.

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%)

and 110 female participants (53.6%). The mean body mass index was 28.4 ± 6.0 kg/m2. The mean

systolic and diastolic blood pressures were 135.8 ± 23.0 mmHg and 83.6 ± 13.4 mmHg

respectively. The mean waist circumference was 92.8 ± 11.8 cm. Seventy-nine (38.3%) of the

participants had body mass index >30 kg/m2.

Demographic characteristics of study participants

The HDFQ scores were used to determine the level of knowledge of heart disease. Those

with HDFQ score >70% were assessed to have good knowledge, those with score between 50 and
69% were said to have moderate knowledge and those with score <50% as low level of knowledge.

About half of all the participants had low level of knowledge 49.0% compared to 31.1% with

moderate level of knowledge and 19.9% with good level of knowledge. There was also no

significant difference between those with different level of knowledge as it is associated with

prevalence of hypertension, family history of hypertension and obesity. There was no significantly

difference between age and level of knowledge among study participants. Among the questions

which showed the greatest consistency with the highest rate of agreement include knowing that

smoking is a risk factor for heart disease ad that treating elevated blood pressure can lead to

reduction the risk of developing heart disease. These were the only two questions where

participants scored >70% and the participants showed a good level of knowledge as it relates to

risk factor for heart disease. Frequency of answers given to different questions in the heart disease

frequency questionnaire by the participants

The participants showed a moderate level of knowledge as it regards three facts: Firstly,

that a person who stops smoking will lower their risk of developing heart disease. Secondly, that

high blood pressure is a risk factor for heart disease and thirdly that high blood cholesterol is a risk

factor for heart disease. Other questions which showed moderate consistency in the level of

knowledge include being overweight increases the chance of someone developing heart disease,

diabetes is a risk factor for heart disease and the fact that subject with diabetes can reduce their

risk of heart disease if they control their blood pressure, cholesterol, weight and blood sugar.

Among those facts with consistent low level of knowledge in the participants include the fact that

diabetes has low HDL, the people with heart disease always knows about it and the fact that eating

fatty foods affect blood cholesterol level.

The major outcome of this study revealed that majority of the participants in this study had
poor knowledge of heart disease risk factors even though they work in the University community.

Only about a fifth had a very good level of knowledge of heart disease risk factors among the study

participants. There was no relationship among age, gender or education level and the level of

knowledge of heart disease risk factor as estimated with the HDFQ score. We also found no

significant difference between those with high level of knowledge in the mean value of total

cholesterol, systolic and diastolic blood pressure, triglycerides, low density lipoprotein and body

mass index. Other researchers have shown that age and gender were associated with level of

knowledge.

Although, this is one of the first set of evidences for low knowledge of heart disease risk

factors using the HDFQ Questionnaire, other studies have shown an inappropriately low level of

knowledge of coronary heart disease using other instruments among University staff.

Similarly, Wagner et al. showed that knowledge of heart disease risk factors was low even among

Spanish speakers with diabetes in a survey of diabetic subjects from Puerto Rico. The mean level

of knowledge is even lower among other similar population.

This study also showed that HDFQ scores were not in any way related to some

demographic factors such as age, gender or presence of cardiovascular diseases. The pattern of

cardiovascular disease was also not significantly related to the pattern of cardiovascular risk factors

among the participants in this study. Much curiously is the fact that the level of education did not

significantly associated with the level of knowledge of cardiovascular risk factors as many people

with higher degrees including academic staff had limited knowledge about risk factors for heart

diseases in this study. This is contrary to the study by Wagner who showed that those with a high-

school certificate were much likely to have a higher HDFQ score than those without a high-school

certificate. In that study also, those with a bank account were also much likely to a have a higher
HDFQ score than those without a bank account and this is likely to be related to their level of

education and socio-economic status. We did not assess the highest income in this study but it can

be assumed that all participants were not likely to be less than in the middle class considering the

many opportunities for distinctive salary scale, emolument and allowances and other opportunities

available to University workers.

This study revealed some major findings: Questions 1-8 in the HDFQ are related to the

knowledge about cardiovascular risk factors such as smoking, hypertension, family history of heart

disease, overweight, etc. Surprisingly, only in the relationship between smoking and heart disease

was the level of knowledge adjudged to be good. The participant knowledge about the relationship

between hypertension and heart disease was at best moderate although most people know that

treating high blood pressure could result in reduction in chance to develop heart disease. The

participants’ level of knowledge as it concerns its association with cholesterol fractions was

abysmally low. This is despite the fact that the first risk factor to be associated with heart disease

was cholesterol in the Framingham study. Similarly, the average level of knowledge as it relate to

preventive strategies in questions 13-15 were also at best moderate. Only 48.5% of the participants

agreed that walking and gardening are considered exercise that will help lower a person's chance

of developing heart disease although 68.4% agreed that regular physical activity will lower a

person's chance of getting heart disease. The last aspect of the HDFQ identified the level of

knowledge on diabetes as it relates to heart disease. The level of knowledge is also averagely low

as only about half agreed that diabetes is a risk factor for heart disease. A worse outcome was

obtained when testing for knowledge of association between diabetes and cholesterol profile as it

relates to heart disease. The outcome of this study shows a much lower level of knowledge as it

concern level of knowledge of heart disease when compared to a similar report among African-
Americans although they were a bit younger in that study.

There appear to be a general poor level of knowledge on the main risk factors, prevention,

relationship of cholesterol, diabetes and heart disease among Nigerian University workers in

LAUTECH, Ogbomoso, Nigeria. Despite the surging trend in cardiovascular disease worldwide

and in developing nations like Nigeria and having reported that in this environment, the

commonest reason for medical admission to Teaching Hospital are cardiovascular disease, there

is still poor level of knowledge of heart disease among University workers. An outreach

programme including training on the risk factors for heart diseases, preventive strategies, treatment

and association with cholesterol and diabetes is, therefore, very essential.

Africans including African-Americans have been shown to have higher rates of

cardiovascular disease. They should therefore be targeted for interventions to prevent or reduce

the burden of cardiovascular diseases. Therefore, increasing the level of knowledge of heart

disease risk factors, prevention and treatment remain a major way to reduce the burden of

cardiovascular diseases among Africans.

This outcome of this study is a call for action among University administrators in Nigeria.

In order to achieve a healthy workforce and reduce incapacitation, University workers must be

exposed adequately to increased cardiovascular awareness as they may be at increased risk due to

low level of knowledge and awareness of heart disease risk factors among them. This poor level

of knowledge is inexorably a harbinger of poor preventive modalities for cardiovascular disease

among them.

Appropriate health education to increase awareness about heart disease risk factors remains

the fulcrum of preventing increased cardiovascular risk among Nigerian University workers.

University administrators should, therefore, design and implement massive, cost-effective long
term health education for University workers to prevent cardiovascular morbidity and mortality

among them in the nearest future. Low and middle- income countries including the South Asian

countries of India and Pakistan contribute significantly to the global burden of cardiovascular

diseases accounting for 75% of all deaths and 86.3% of all loss of disability adjusted life years

Risk factors for Coronary artery disease (CAD) are now well recognized and modification

of these factors can CAD. High cholesterol, cigarette smoking, hypertension, positive family

history, age and diabetes mellitus are the major risk history are the non-modifiable risk factors.

Smoking, hypertension, Diabetes mellitus, sedentary lifestyle, obesity and high cholesterol diet are

the modifiable risk factors. High risk of cardiovascular disease has been reported in south Asian

population regardless of whether they live overs

Knowledge about risk factors is an important prerequisite for an individual to implement

behavioral changes towards CAD prevention. In a country like ours, where resources are limited

and so are the facilities to combat effectively against diseases, preventive measures and lifestyle

modification appears to be the only essential weapon. The prevention of subsequent coronary

events and the maintenance of is scant on the level of knowledge about been poor about risk factors

of CAD in lower middle class in urban population in style is in many respects not governed by the

intellect but the result of education, lifelong habits and possibly also genetically determined study

was conducted to elucidate knowledge of CAD risk factors, coronary intervention in Adult non-

medical students of Karachi East. The mean knowledge score about CAD risk factors were also

calculated.
Statement of the Problems

This study will focus on the evaluation of people’s knowledge, awareness and practice on

the risk factors of coronary artery disease of the residents of barangay 54-A, Bankerohan, Davao

City. Specifically, it will aim to answer the following research questions:

1. What is the level of knowledge on the risk factors of coronary artery disease of the

residents of Barangay 54- A, Bankerohan, Davao city?

2. What is the level of awareness on the risk factors of coronary artery disease of the

residents of Barangay 54- A, Bankerohan, Davao city?

3. What is the level of practice on the risk factors of coronary artery disease of the

residents of Barangay 54- A, Bankerohan, Davao city?

4. How does affect the behavior of the residents of Barangay 54-A, Bankerohan, Davao

City on the risk factors on coronary artery disease?

5. What policy or health measures will benefit the residents on the risk factors of the

coronary artery disease?

Theoretical Framework

The study is anchored under the principles of Coronary Artery Risk Development in Young

Adult (CARDIA) as espoused by Elizabeth Lynch, Kiang Liu, Catarina Kiefe, Philip Greenland

(American Journal Epidemiology, volume 164.2006).

As illustrated in the diagram below, there are two boxes which contend the independent

variable in the first box and the dependent variable in the second box. The first box represents the
risk of the coronary artery disease while the second box represents the knowledge, awareness and

practice.

Conceptual Framework

Independent Variable Dependent Variable

Level of:
 Knowledge
Risk of Coronary Artery
Disease (CAD)  Awareness

 Practice

The risk of a person to have Coronary Artery Disease (CAD) is dependent on his/her

knowledge, awareness and practice. Meaning, if there is a high level of knowledge, awareness and

practice, there is low risk for CAD, and if there is a low level of knowledge, awareness and

practice, there is a high risk for CAD.

Hypothesis

In order to formulate a hypothesis, we used null hypothesis. Cristobal (2017) defined null

hypothesis as the kind that is always expressed as a negative statement. We will create a statement

and after doing the experiment we either accept it or reject it. We have two statements and these

are:

Ho: there is no significant relationship between the risk of having Coronary Artery Disease

and the level of knowledge, awareness, and practice.

 Ha: there is a significant relationship between the risk of having Coronary Artery Disease

and the level of knowledge, awareness, and practice.

Definition of Terms

Coronary Artery Disease (CAD): a common term for the build-up of plaque in the heart's arteries

that could lead to heart attack. Operationally, this term is used find out the its prevalent and

effect to young adult ranging from 18 to 35 years old.

Knowledge: operationally, knowledge is used in this study to determine their level understanding

of the CAD

Awareness: the state or condition of being aware; having knowledge; consciousness. It is used in

this study to find out the level of awareness of the respondents on the CAD.

Practice: to do something habitually or as a practice. It is used in this study determine the

respondents’ usual lifestyle and behaviour as far as CAD is concern.

Significance of the Study

The purpose of this study will provide information about the levels of knowledge,

awareness & the risk factor of Coronary Artery Diseases (CAD). The beneficiaries are the

following:

Society. Society will learn the risk factors leading to Coronary Artery Disease.

Students. This study will give them information about Coronary Artery Disease and its risk factors.

Future Researchers. This study can be their reference in their future research.
 CHAPTER II

METHODOLOGY

In this section, the researchers will discuss when, where, and how the study is to be done.

The research design, research subjects, research instruments, data gathering procedure and the

data analysis tool of data will also be presented.

Research Design

In this study, the researchers utilize the correlation research design. In general, a

correlational study is a quantitative method of research in which you have 2 or more quantitative

variables from the same group of participants, & you are trying to determine if there is a

relationship (or co-variation) between the 2 variables (that is, a similarity in pattern of scores

between the two variables, not a difference between their means) (Waters J, 2017).

Research Instruments

The researchers’ data will be coming through a survey. For this reason, this Research will

use survey questionnaires as research instrument. Survey research is a commonly used method of

collecting information about a population of interest.

In our study, we use these survey questionnaires as a means to gather data from a specific

sample, which are young adults with the age bracket of 18 to 35 years old. The survey

questionnaires contain questions related to the risk factors of Coronary Heart Disease (CAD) as

well as the lifestyles of each sample. (Refer to page for the actual contents of the questionnaire.)
Settings

The researchers will conduct their study in Bankerohan (Barangay 5-A), Davao City. The

researchers chose this setting for the reason that the educational system in the said place is not

that well established. Many of the locals’ livelihoods and lifestyle require strenuous activities,

such as fishermen and porters (kargador), may pose as several risk factors for CAD.

Participants

The participants in this study are the locals in Barangay 5-A aged between 18 to 35 years

old. The locals will be answering the survey questionnaires and will be assured of their

confidentiality. However, they are required to state their email address and cellular phone

number, if they have any.

Variables and Measures

 Age: Between 18 to 35 years old; defined as yong adults

 Marital Status: Single, Married, Widowed, Separated

 Educational Attainment: None, Primary, Secondary, College, Post College

 Lifestyle: Smoker, Alcoholic,

Procedure

As mentioned before, this study is of correlational research design and will be utilizing

survey questionnaires to obtain the desirable data essential to the research.

The researchers will gather at least 100 respondents or participants from Barangay 5-A.

These respondents would answer and fill up the survey questionnaires as per instruction.
Afterwards, the researchers will evaluate the gathered data according to the variables and measures

presented such as age, gender, lifestyle, educational attainment, and marital status, as well as the

risk factors each participant face in their livelihood. The respondents' level of knowledge,

awareness, and practice would also be questioned.

With these steps done, the researchers should be able the correlate the variables, measures,

and risk factors with the level of awareness, knowledge, and practice about CAD in young adults

in Barangay 5-A.

Data Analysis

The data will be collected through the use of research survey questionnaires that contains

the variables and measures necessary for the evaluation of the said data.

Limitations of the Study

 The study is limited in terms of the number of respondents

 The study is limited in terms of its specified location

 The study is limited in terms of the instruments used in the study

 The study is limited in terms of the research design

Reference

Coronary Heart Disease Risk Factors. (2014, September). Retrieved from

https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease-risk-factors

Lynch, E., Kiang, L., Katarina, K., & Philip, G. (2006, October). Public Health and

Epidemiology. Retrieved from https://academic.oup.com/aje/article/164/12/1171/76645

Ammouri, A. (2016, May). Knowledge of Coronary Heart Disease Risk Factors among a

Community Sample in Oman. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868518/

Coronary Heart Disease Risk Factors. (2014, September). Retrieved from

https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease-risk-factors

Almas, A. (2008, October). Knowledge of coronary artery disease (CAD) risk factors and

coronary intervention among university students. Retrieved from

https://ecommons.aku.edu/

Introduction to Coronary Artery Disease. (2017). Retrieved from

https://www.thrombosisadviser.com/coronary-and-peripheral-artery-

disease/?gclid=EAIaIQobChMIyPWRypSZ2gIVzBwrCh3BWgZ2EAAYASAAEgLhGP

D_BwE

Artery Disease. (2016, November). Retrieved from

https://medlineplus.gov/coronaryarterydisease.html

Association, A. H. (2017, April 26). Coronary Artery Disease - Coronary Heart Disease.

Retrieved from heart.org:

http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-

Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp#.WqnAwB1ubIW
awareness. (n.d.). Dictionary.com Unabridged. Retrieved March 23, 2018 from Dictionary.com

website http://www.dictionary.com/browse/awareness\

knowledge. (n.d.). Dictionary.com Unabridged. Retrieved March 23, 2018 from Dictionary.com

website http://www.dictionary.com/browse/knowledge

practice. (n.d.). Dictionary.com Unabridged. Retrieved March 23, 2018 from Dictionary.com

website http://www.dictionary.com/browse/practice