CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 179 Modifiable and non-modifiable risk factors Predisposing risk factors for CVD are categorised into non-modifiable risk factors such as age, gender, inherited lipoprotein disorders and family history of CVD; and modifiable risk factors such as smoking, diabetes mellitus, hypertension, obesity, dyslipidaemias, lack of exercise, sedentary lifestyle, psychosocial stress, poor oral hygiene and type A personality.14 The most important risk factors related to an increased risk of coronary artery disease are smoking, followed by hypertension, abdominal obesity and diabetes.14 Dyslipidaemia, hypertension and diabetes are risk factors that have become pre-eminent targets for predisposing to CVD.3 Therefore, treatment modification and the assessment and monitoring of these risk factors are the major focus of clinical care, research, treatment guidelines and measures of hospital performance. Emphasis must be placed on the underlying causes of hypertension, diabetes, and dyslipidaemia. Lifestyle risk factors such as dietary habits, physical inactivity, obesity and smoking strongly influence the recognised cardiovascular risk factors and affect novel pathways of risk, such as inflammation, oxidative stress, vascular endothelial dysfunction, thrombosis–coagulation and arrythmia.3 Lifestyle modification may help to reduce age-related increases in aortic stiffness. Patient adherence to intervention measures is therefore crucial to ensure the prevention of deleterious consequences. Review of patient knowledge, understanding and perception of CVD and their risk factors The assessment of CVD knowledge and awareness among the general public would provide realistic insights to advance public health policies toward modifiable risk factors for CVD.11 Table 1. Characteristics and findings of the studies included Author, country Study design Sample size (male:female) Perception and awareness of cardiovascular health Perception and awareness of risk factors and lifestyle modifications Perception and awareness of signs and symptoms Related factors CVD Aminde et al.,16 Cameroon Community-based cross-sectional survey 1162 M = 445 F = 717 Low awareness Cited risk factors: smoking, unhealthy diet, lack of exercise, obesity, stress and high blood pressure Shortness of breath for heart attacks and sudden numbness for strokes Level of education, income bracket and family history Awad and Al-Nafisi,19 Kuwait Cross-sectional survey. Quantitative study (census sampling) 816 M = 330 F = 486 Low CVD knowledge Well-cited risk factors: smoking, obesity, unhealthy diet and physical inactivity Chest pain 50%, dyspnoea 48%, pain 41%, weakness 25%, confusion 36% Females had a greater understanding than males Muhihi et al.,2 Tanzania Randomised controlled study. Community-based face-to-face interviews 3000 M = 778 F = 2222 Low CVD knowledge Cited risk factors: Stress, obesity, cholesterol and physical inactivity Shortness of breath, loss of consciousness, headache, dizziness, vomiting Geographical location (rural area) and level of education Oladapo et al.,14 Nigeria Descriptive, crosssectional survey 1585 M = 689 F = 896 Low awareness Cited risk factors: stress, tobacco use, hypertension, diabetes N/A Level of education and demographic area Surka et al.,15 South Africa Cross-sectional survey. Qualitative study (FGDs). Purposive sampling 28 M = 4 F = 24 Most respondents familiar with CVD terminology but lacked insight into CVD conditions Cited risk factors: alcohol, smoking, stress and unhealthy diet N/A Geographical location (township) Winham and Jones,20 USA Cross-sectional survey. Quantitative study 172 M = 62 F = 110 Low to moderate CVD knowledge Cited risk factors: smoking, unhealthy diet, physical inactivity N/A Level of education Yuqiu and Wright,21 South Africa Cross-sectional survey Quantitative study (Census sampling) 551 M = 302 F = 249 Low CVD knowledge Cited risk factors: obesity, alcohol, diabetes, stress, lack of physical activity N/A Lower education was associated with less knowledge Heart attack Ahmed et al.,9 Malaysia Cross-sectional, observational study Total = 393 M = 204 F = 189 Low awareness Cited risk factors: smoking, obesity, diabetes, unhealthy diet, stress N/A Level of education and income bracket Heart failure and COPD Gallager et al.,10 Australia Prospective, descriptive, interview-based survey 118 Adherent to medication. Low medication knowledge Higher adherence among females, patients with concurrent conditions, younger age and taking fewer medicines N/A Younger patients had higher medication knowledge, gender, additional co-morbidities Hypertension Jongen et al.,18 South Africa Mixed qualitative and quantitative study 451 M = 222 F = 229 Low-to-moderate CVD knowledge Cited risk factors: stress, alcohol, salt intake, exercise, smoking, diet, family history Elevated blood pressure makes you sick Geographical location (rural area) Stroke Donker et al.,11 Ghana Cross-sectional study 693 M = 374 F = 319 Low awareness Cited risk factors: alcohol intake, hypertension, smoking, previous stroke, high cholesterol, heart disease, diabetes Numbness (unilateral), slurred speech, severe headache, numbness on either side, weakness on either side and dizziness Level of education and income bracket Kaddumukasa et al.,17 Uganda Cross-sectional survey 377 M = 117 F = 260 Low awareness Cited risk factors: old age, hypertension, diabetes, cholesterol, obesity, stress, unhealthy diet and lack of exercise Dizziness, diplopia, headache, difficulty speaking, tiredness, fever, sweating, body weakness, paralysis, fainting and numbness Demographic area, income bracket, age and level of education.
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