Knowledge of modifiable risk factors of heart disease among patients with Acute Myocardial Infarction in a tertiary care hospital Karachi, Pakistan : a cross sectional study

Progressive urbanization and changes in lifestyles and behavior contribute to the rising burden of cardiovascular disease (CVD). The burden of CVD is rapidly rising in South Asian countries including Pakistan. Prevention of coronary heart disease (CHD) is the most effective way in fighting with epidemic of this illness in our country. Knowledge of modifiable risk factors for heart disease has been identified as a prerequisite for change, although knowledge alone is insufficient but is assumed to be a key component of behavioral decision making about CVD risk-reduction behaviors. A hospital based cross-sectional was conducted in Karachi, with the objectives, to estimate the level of knowledge of modifiable risk factors (1) fatty food consumption, (2) smoking, (3) obesity and (4) exercise of heart diseases and to identify the factors associated with being knowledgeable among patients with first acute myocardial infarction in a tertiary care hospital Karachi, Pakistan. This cross sectional study was conducted from July 2003 to February 2004 at National Institute of Cardiovascular Disease (NICVD) in Karachi, which although a tertiary care hospital, is the initial point-of-care for a large majority patient with heart disease in Karachi. Patients admitted to NICVD with their first acute myocardial infarction during the study period were eligible to participate. A total of 720 subjects were interviewed by a trained data medical officer using structured questionnaire. The mean age (SD) of the study subjects was 54 years (± 12), 78% subjects were male, and 89% were married. Only 16% subjects had completed more than ten years of education. The majority of study subjects belonged to low socioeconomic strata (income Rs 4500/ month). In addition to that, 66Yo of the subjects were living in an extended family system. Almost half of the study subjects (42%) identified two risk factors of heart disease and only 20% of the individuals, could name all four modifiable risk factors of heart disease: Multiple logistic regression analysis revealed that years of education and type of family V system were significantly associated with knowledge in three out of four dimensions investigated. Moreover, sex, marital status, ethnicity, exercise, tobacco use, types of family system, certain health seeking behavior, and income were significantly associated with being knowledgeable with at least one modifiable risk factor of heart disease. However, the predictors of being knowledgeable varied for each of the four modifiable risk factors of heart diseases. Our findings highlight lack of adequate knowledge about risk factors for heart disease in the Pakistani population. Therefore, there is strong need for aggressive and targeted strategies education about association of such factors with CVD. These programs must be sensitive to the attitude, perception and capabilities of those individuals whom they are design to help