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A comparative study on awareness of cardiovascular risk determinants among rural and urban women population of Davangere district, Karnataka, India

The prevalence of cardiovascular disease (CVD) is rising worldwide and it accounts for 17% of the total mortality. This acceleration in the prevalence of CVD has been attributed to the Prototype shift in lifestyle. This also including the changes in dietary pattern, principally more consumption of refined carbohydrates and saturated lipids, and physical indolence associated with progressive monetary growth and urbanization. 1


INTRODUCTION
The prevalence of cardiovascular disease (CVD) is rising worldwide and it accounts for 17% of the total mortality. This acceleration in the prevalence of CVD has been attributed to the Prototype shift in lifestyle. This also including the changes in dietary pattern, principally more consumption of refined carbohydrates and saturated lipids, and physical indolence associated with progressive monetary growth and urbanization. 1 Among Indians, CVD incline to transpire earlier in life than among any other ethnic group. 2 The perception of risk factors and their connotation to CAD has been investigated in numerous epidemiological studies in the United States and Europe. [3][4][5] Though prevalence of CVDs is lower in rural population, it is believed to increase owing to rapid urbanization and changing lifestyle patterns. 6 There were no much Indian studies available regarding the awareness level of cardiovascular disease determinants among rural and urban population. We intend to know the same in our study.

Objective
 To compare the awareness of cardiovascular risk determinants among rural and urban population of Davangere district

METHODS
A cross sectional study was conducted in rural field practice area and urban tertiary care. The study was carried out for a period of two month (July to august 2015) after getting ethical clearance from the institutional ethical committee. Data was collected by interviewing the patient attender coming to urban as well as rural hospital by using pre tested semi-structured questionnaire.

Sampling
Study sample size was calculated by estimating knowledge about CVDs among women to be 55.6% based on previous study with relative error of 20% was 83. 7 However, final sample size of 100 persons above 18 years of age was used considering with the nonresponse rate of 10%.

Inclusion criteria:
The entire patient's attender above 18 years will be included in the study.
Exclusion criteria: Who are not willing to participate in the study; Who already have cardiovascular disease.

RESULTS
Among them 100 were from urban area and 100 were from rural area. Mean age of study participants was found to be 51.01±5.9 years.  Questions related to awareness of the cardiovascular risk determinants were asked to the study participants. Majority of the study participants said yes to when asked whether the Person Always Knows When He Has Heart Diseases. Among them majority were from rural area. Majority of them agreed that family history plays a very important role. About 86% of the urban study participants agreed that older persons are at greater risk of heart disease. Majority of the study participants agreed that smoking causes heart disease. About 78% of rural population agreed that cessation of smoking reduces the risk of heart disease. About 42% of the rural person's agreed that high blood pressure is a risk factor developing heart disease.
Majority of the both rural and urban area patients were aware of the cholesterol is risk factor for the heart disease. Not much awareness was seen about the concept of HDL and LDL. Most of the study participants were aware about the overweight and obesity as the risk factor for the heart disease. Only half the study participants were aware of the physical activity can contribute to the reduction in the heart disease. There was low awareness about the diabetes as risk factor of the heart disease.
Majority of the study participants from urban area thought that stress is the major risk factor for the heart disease. Most of the study participants agreed that drinking alcohol can increase heart diseases. Eating vegetables can reduce heart disease was said by most of the study participants.

DISCUSSION
In the present study gender, educational level, income was highly correlated with awareness about the cardiovascular risk determinants.
A very worrisome finding in the current study was the respondents' low knowledge of heart attack or stroke warning symptoms. Two-fifths (40.7%) of the study participants were not aware of any heart attack symptoms, and only 8.5% could identify all symptoms. Chest pain was the most common known symptom (50.4%), which is close to that found in Beijing, but higher than that in Pakistan, and Nepal. [8][9][10] In contrast, a higher knowledge was reported by previous studies from North Ireland, Canada, Iran and Jordan, where chest pain was known by over 75% of respondents. [11][12][13][14] Shortness of breath was recognized by 48.0% of the study population, which is consistent to that reported in North Ireland, Canada and Jordan but higher than that in Pakistan and Nepal. 10 Iranians showed a higher knowledge than Kuwaitis regarding shortness of breath. 11 Pain in arms or shoulder' was identified by 41.2% of respondents, which concurs with that reported in Canada and Jordan , but higher than that reported by studies from North Ireland and Nepal. 11,12,14 Feeling weak, light-headed, or faint' was recognized by 25.4% of participants, which is close to that reported in North Ireland and Nepal but higher than that in Canada. 14 Failure to know heart attack symptoms may increase the delay in seeking early medical care that could lead to worse therapeutic outcomes.

CONCLUSION
The present study showed that rural women had more awareness as compared to urban women with respect to cardiovascular risk determinants. We would like to recommend health education should be given to the women with special focus to urban community regarding cardiovascular risk determinants.