Acta Medica Mediterranea, 2016, 32: 995
PROFILE OF CARDIOVASCULAR DISEASES RISK FACTORS IN KERMANSHAH CITY, WESTERN
IRAN: A NEED ASSESSMENT STUDY
SEYED MOHAMMAD MAHDI HAZAVEHEI1, SARA SHAHABADI2, SAEED BASHIRIYAN3, MANOOCHEHR KARAMI4, AFSHIN ALMASI5,
SEYEDEH ZEINAB HASHEMI2, MOHAMMAD REZA SAIDI6*
1
Professor of Health Education and Promotion, Department of public health, School of Public health and Research Center for
Health Sciences, Hamadan university of Medical Sciences, Hamadan, Iran - 2PhD student of Health Education and Promotion,
Department of public health, School of Public health and Research Center for Health Sciences, Hamadan university of Medical
Sciences, Hamadan, Iran - 3Assistant Professor of Health Education and Promotion, Department of public health, School of Public
health and Research Center for Health Sciences, Hamadan university of Medical Sciences, Hamadan, Iran - 4Assistant Professor of
Epidemiology, Department of Epidemiology, School of Public Health and Social determinants of Health Research Centre (SDHRC)
Hamadan University of Medical Sciences, Hamadan, Iran - 5Assistant Professor of Biostatistics, Department of Biostatistics and
Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran - 6Assistant Professor of
Cardiology, Department of Cardiology, School of Medicine and Cardiovascular Research Center, Kermanshah University of
Medical Sciences, Kermanshah, Iran
ABSTRACT
Introduction: Cardiovascular diseases (CVDs) are the number one causes of death in the world with 17.5 million deaths in
2012. The purpose of this paper is to determine the most important behavioral and non- behavioral risk factors for CVDs, among
patients with heart failures in Kermanshah, in order to design interventional health promotion programs for reducing CVDs risk factors.
Method and material: In this cross-sectional study 402 participants were selected from cardiovascular patients that hospitalized in Imam Ali Hospital (a referral hospital) for the first time, by consecutive sampling. Data on CVDs behavioral risk factors were
collected from a questionnaire that was mainly adopted from the core and the expanded questionnaires of WHO Stepwise approach.
Data on total cholesterol, Triglyceride, Fast Blood Sugar Blood Pressure and Body Mass Index were extracted from patient records
and to calculate Waist to Hip Ratio index, waist size and hip circumference were measured by interviewers.
Conclusion: Diet status was main priority for health promotion interventions, and then in order physical inactivity, alcohol
consumption and smoking are important for interventions. Obesity, especially abdominal obesity is an important risk factor for
CVDs. In these patients glucose impairments were higher than lipid disorders.
Key words: Need assessment, risk factors, cardiovascular diseases, Kermanshah.
Received February 05, 2016; Accepted March 02, 2016
Introduction
Cardiovascular diseases (CVDs) are the number
one causes of death in the world with 17.5 million
deaths in 2012 (1).Over 80% of CVD deaths take
place in low and middle-income countries(2).The
number of people, who die from CVDs, mainly
from heart disease and stroke, will increase to reach
23.3 million by 2030 (3). Unfortunately in recent
years decreased age of onset of CVDs(4). Studies
have shown that these diseases are increasing
worldwide due to changes in nutrition, physical
activity and smoking(5), so the medical condition
and lifestyle can increase the risk of CVDs(6). CVDs
risk factors may be divided in two categories: modifiable and non-modifiable. Smoking, alcohol consumption, physical inactivity and poor diet are considered modifiable risk factors or behavioral risk
factors(7). It is estimated that more than 70% CVDs
are preventable by reducing risk factors(8).
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Seyed Mohammad Mahdi Hazavehei, , Sara Shahabadi et Al
Materials and methods
This is a cross-sectional study that was conducted in Kermanshah city. Participants(n=402)
were selected consecutively from cardiovascular
patients that hospitalized in Imam Ali Hospital (as a
referral hospital) in Kermanshah city between June
2014 and July 2014.
The inclusion criteria were patients who have
been admitted for the first time and had been diagnosed CVDs for them in the past 3 months, and are
living in Kermanshah city. For assessment patient's
stress was used Cardiovascular Risk Assessment
Questionnaire (stress section), Derived from
Holmes and Rahe Stress Scale. Nutritional status
was assessed by 11 items included: fruit and vegetables consumption, type of oil for cooking, fish
consumption, diary consumption, fast food, soda
and salt consumption.
According to the recommends, diet status of
patients was divided in to 3 categories: poor, relatively favorable and good. Physical activity of the
patients was assessed in three modes: at their jobs,
in traveling to and from places and during leisure
activities. The intensity of physical activities was
categorized based on WHO guidelines Patients
were placed in to three categories based on the
stress points are obtained from questionnaire: -19
to20 low stress, 21 to 40 moderate stress and 41 and
above high stress. Data on non-behavioral risk factors (Total cholesterol, LDL, HDL, TG, FBS, BP
and BMI) were extracted from patient records and
to calculate WHR index, waist size and hip circumference were measured by interviewers. BMI>= 25
for all patients and WHR>0.8 for women and
WHR>0.9 for men was considered as an inappropriate index.
Results
Among 402 participants, 159 (39.6%) women
and 243(60.4%) men were participated in this study.
The mean (SD) age of the patients was 54.2(8.8).
Based on sex group men had better educational level
than women. About 40 % of patients were
employed. 93.7% of women were housewives and
they didn’t have any income. The majority of
patients was married (79.6%) and had more than 3
children. About 74 % had a civilian home and
45.3% had a genetic background of CVDs and there
was no significant difference between men and
women Another results are presented in 2 tables as
follows.
Discussion
The aim of this study was to determine prevalence and distribution of behavioral and non-behavioral risk factors of CVDs, in cardiovascular patients
that hospitalized in a referral hospital in
Kermanshah city, in order to design interventional
program to reduce CVDs risk factors based on priorities.
Unhealthy lifestyles such as physical inactivity
and unhealthy diets play an important role in
CVDs (10).The results of this study indicate that
unhealthy diet (include insufficient fruit, vegetable,
fish consumption and excessive salt consumption) is
the most important behavioral risk factors in CVDs
patients. Fruits and vegetables are good for preventing CVDs and increased fruits and vegetables consumption can help to reduce intake of fatty foods,
sugar and salt. Some studies have emphasized that
there is associated between fruits and vegetables
intake and the onset of CVDs(11, 12).
Physical inactivity, smoking and alcohol consumption were placed the next priorities.
Of course high stress as an independent risk
factor, after unhealthy diet, had a high prevalence in
Profile of cardiovascular diseases risk factors in Kermanshahcity...
patients. In Li etal and Prasanna Dahal et al studies,
high proportion of their participants had unhealthy
diet and most of them didn’t have physical activity(13,14). In all age groups physical inactivity except
29 to 40 year olds was higher in women, but smoking and alcohol consumption were higher in men.
The results of the Julia Truthmann and etal study
confirm these findings(15). In a study that done in
Somaliland, prevalence of physical inactivity was
higher in women, that is consistent with our study
and physical inactivity was associated with high
blood pressure, overweight and obesity(16).
Smoking is a CVDs risk factor, especially in
the development of premature CVDs. In Umesh
N.Khot study, more than 70% of patients under 45
years old were current smokers(17), but in our study
the prevalence of smoking was higher in the elderly
patients(61-74 year olds). According to a study carried out in India,there isn’t any protective association between alcohol intake and CVDs onset, but
also has a negative effect for CVDs risk(18).
In our study 40% of men had a history of alcohol use in their lifetime.About none behavioral risk
factors this study shows that, hypertension history
and diabetes were both important risk factors in
women, so that the difference between men and
women was significant. In the Yaghobi study(19), that
is done in Northwest Iran in 2007, participants had a
similar situation of Hypertension history and diabetes whit our study.Obesity is a major risk factor
for CVDs and it is necessary designing interventions
for weight loss both in the primary and secondary
prevention of CVDs(20). Our study shows that women
in WHR index were in worse condition than men
and prevalence of obesity was higher in women. In a
997
study that carried out in Dallas 84%of patients were
obese(BMI>=25kg/m2)(21). Neeltje M. Batelaan et al
showed in their study that stress and anxiety disorder were strongly associated with onset of CVDs(22).
Stress is associated with health behaviors and biological factors that can cause CVDs(23). In our study,
about 70% of patients had moderate and high stress.
This showed that stress has an important role in
onset CVDs, particularly in young people. In a qualitative study, patients and health care providers have
stated that stress is the most important cause of
CVDs(24).
About the biochemical risk factors, mean of
FBS in all age groups was higher than borderline
(100mg/dl) except 29-40 years, contrary Total cholesterol, LDL, HDL and TG were lower than border
line in all age groups and sex. Therefore based on
the results of this study seems to be FBS disorder
has a greater impact on the incidence of cardiovascular diseases than lipid disorders. Our study has
some limitations. One of them that was, we didn’t
have a control group without CVDs patients for
comparison, although based on the last national survey for risk factors of NCDs(25) the prevalence of
CVDs risk factors in Patients with these diseases
were higher than the prevalence in the general population. Another limitation was a survival bias,
because only patients whit CVDs who hospitalized
were included, while the CVDs risk factors may
have been caused sudden cardiac death(26).We
acknowledge that the existence of a behavioral risk
factors in a patient whit CVDs doesn't guarantee that
it plays an essential role to onset CVDs, because
other factors such as genetic and biochemical risk
factors can cause CVDs. However the casual roles
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Seyed Mohammad Mahdi Hazavehei, , Sara Shahabadi et Al
of behavioral risk factors are undeniable.
Conclusion
Among the behavioral and non-behavioral risk
factors in patients with cardiovascular diseases, the
prevalence of malnutrition was higher than other
risk factors, especially low fruits, vegetables and
fish consumption, and high salt intake. So, designing the health education interventions based on
behavioral change models and theories are very
important to improve diet, for reducing the onset of
CVDs.
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This study was a part of the PhD thesis of the sara shahabadi,
conducted in the University of medical sciences Hamadan and
Kermanshah. Both of these universities provided financial support. The authors would like to thank all participants who have
helped in this project.
_______
Corresponding author
Mohammad Reza Saidi. Assistant Professor of Cardiology,
Department of Cardiology, School of Medicine and
Cardiovascular Research Center, Kermanshah University of
Medical Sciences, Kermanshah, Iran. E-Mail1:
[email protected], E-Mail2:[email protected]