Prevalence of Risk Factors for Coronary Heart Disease Among College  Students: A Cross-Sectional Study

Yaseem, F; Fazil

doi:10.65188/nurexus.1025

Page 13

Journal of MedVerse Research & Practice

nurexus.com

Prevalence of Risk Factors for Coronary Heart Disease Among College

Students: A Cross-Sectional Study

Dr. Yaseem

1

, Dr. Fazil

2

Assistant Professor, Associate Professor

Department of Community Medicine, Government Medical College, Chennai.

Email ID: yaseem1995@gmail.com

Submission Date: 22.04.2025

Accepted Date: 18.05.2025

Published Date: 31.05.2025

DOI: 10.65188/nurexus.1025

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Introduction: Coronary Heart Disease (CHD), traditionally considered a condition of older adults, its risk factors

increasingly being identified among younger populations. The emergence of unhealthy lifestyles among youth,

particularly college students, is concerning, as early exposure to risk factors significantly elevates future disease

burden.

Materials & Methods: A cross-sectional study was conducted among 100 undergraduate students aged 18–22 years

at a private medical college in Chennai from June to December 2024. Participants were selected using simple random

sampling. Students with chronic illnesses or those on medication for known CHD risk factors were excluded. Data

were collected through a pre-tested, semi-structured questionnaire.

Results: The study revealed a notable presence of CHD risk factors among college students. A proportion of students

reported tobacco or alcohol use, while physical inactivity was commonly observed. Obesity, based on BMI and waist

circumference, was also present in a significant subset. Blood pressure readings identified a few participants with

elevated values, though clinical hypertension was not diagnosed.

Conclusion: This study underscores the early presence of CHD risk factors among college students. Although they

are generally considered a low-risk group, the adoption of unhealthy behaviours during young adulthood can

accelerate the development of chronic conditions later in life. Preventive measures such as health education, lifestyle

counselling, and routine screening should be integrated into college health programs to curb the early onset of

cardiovascular diseases.

Keywords: Coronary heart disease, risk factors, college students, lifestyle, cross-sectional study, preventive

cardiology, young adults.

Introduction

Chronic non-communicable diseases (NCDs) are gaining increasing importance among adult populations

globally, including in both developed and developing nations. Improvements in healthcare have led to

longer life expectancy, and as people live into older age, they face a higher risk of developing chronic

diseases. Rapid lifestyle and behavioural changes are also contributing significantly to the growing burden

of these conditions. Cardiovascular diseases (CVDs) include heart and vascular disorders such as coronary

heart disease (CHD), hypertension, stroke, and congenital heart disease. In India, it was estimated that

about 29.8 million people were living with CVDs in 2003, and approximately 1.5 million died each year

due to these conditions. CHD accounted for around 2.4 million cases, and stroke for 0.93 million cases

annually. India suffers the greatest loss of potentially productive life years due to CVD among people aged

ORIGINAL ARTICLE

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35–64 years, with this loss expected to increase to 17.9 million by 2030, over nine times higher than that in

the USA [1].

CHD, also known as ischemic heart disease, is now the leading cause of death worldwide. Initially

prevalent in high-income countries, it has now become widespread globally. CHD results from reduced

blood flow to the heart due to blocked coronary arteries, impairing heart function [2]. It can manifest as

angina, myocardial infarction, or sudden death, with myocardial infarction being the most specific.

Globally, CHD causes 7.2 million deaths annually, representing 12.2% of all deaths. The highest mortality

rates are observed in Europe, followed by Southeast Asia [3].

Although once considered a male-dominant disease, CHD is now the leading cause of death in both sexes

[4,5]. Indian studies from the 1990s to early 2000s show higher CHD prevalence in urban (6.4%) than rural

(2.5%) populations, with urban females (6.7%) having a slightly higher rate than urban males (6.1%) [6,7].

CHD has a multifactorial origin. Non-modifiable risk factors include age, sex, family history, and genetics,

while modifiable factors include smoking, hypertension, cholesterol levels, diabetes, obesity, physical

inactivity, and stress [8,9].

Alarmingly, the age of CHD onset is declining, with individuals in their 30s undergoing cardiac

interventions

[10,11]. Indians face a significantly higher CHD risk, 3 to 4 times more than white Americans

and up to 20 times more than the Japanese. They also experience an earlier onset and have a higher

prevalence of diabetes, abdominal obesity, and dyslipidemia

[12]. Most studies on CHD risk factors have

not focused on young adults, especially in South India. This study aims to assess CHD risk factors in this

younger age group.

Materials & Methods

Study Design

A cross-sectional study was conducted to determine the prevalence of coronary heart disease (CHD) risk

factors among undergraduate medical students.

Study Setting & Duration

The study was conducted at a Government Medical College in Chennai, Tamil Nadu, over a period of six

months from June to December 2024.

Study Population

The study population comprised male and female undergraduate students aged 18–22 years. A total of 100

participants were selected using simple random sampling from the complete list of eligible students

provided by the college administration, with proportional representation from different academic years.

Inclusion Criteria

Undergraduate students aged 18–22 years who were willing to participate in the study were included.

Exclusion Criteria

Students aged below 18 years or above 22 years, pregnant students, those receiving medications for known

CHD risk factors, and students unwilling to participate were excluded from the study.

Data Collection Procedure

Prior to participation, the study objectives, procedures, potential benefits, and risks were explained to the

students in both Tamil and English, following which written informed consent was obtained. Data were

collected using a pre-designed, pre-tested, semi-structured interview schedule covering demographic

characteristics, lifestyle habits, family history of CHD, and other relevant clinical information.

Standardized procedures were followed during data collection. Participant confidentiality was maintained

by assigning unique identification codes, and responses were anonymized and recorded in aggregate form

for analysis.

Ethical Considerations

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The study protocol was reviewed and approved by the Institutional Ethics Committee of the respective

medical college. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Participants' autonomy, confidentiality, and right to withdraw from the study at any stage were respected,

and appropriate measures were taken to minimize potential risks associated with participation.

Statistical Analysis

The collected data were systematically entered into Microsoft Excel and analyzed using SPSS version 26.0.

Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were used to

summarize demographic characteristics and the prevalence of various CHD risk factors. Cross-tabulations

and frequency distributions were used, where appropriate, to identify patterns and associations within the

study data.

Results

Figure 1: Distribution of Study Participants Based on Level of Medication Compliance (n = 100)

The majority of participants exhibited either high (45%) or moderate (46%) medication compliance,

accounting for 91% of the study population. Only 9% of participants showed low compliance. This reflects

an overall good adherence to anti-diabetic medications among the rural cohort studied.

Table 1: Association Between Age and Medication Compliance (n = 100)

Age Group (Years)

High

Moderate

Low

Total

p-value

<45

10

8

2

20

0.311

45–59

22

23

3

48

≥60

13

15

4

32

Total

45

46

9

100

No statistically significant association was observed between age and medication compliance (p > 0.05).

However, high and moderate compliance were slightly better among middle-aged participants (45–59

years).

Table 2: Association Between Gender and Medication Compliance (n = 100)

Gender

High

Moderate

Low

Total

p-value

Male

25

23

4

52

0.672

Female

20

23

5

48

Total

45

46

9

100

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Out of the 100 participants, 52 were male and 48 were female. Among males, 25 (48.1%) had high risk, 23

(44.2%) had moderate risk, and 4 (7.7%) had low risk. Among females, 20 (41.7%) had high risk, 23

(47.9%) had moderate risk, and 5 (10.4%) had low risk. Overall, 45 participants (45%) were classified as

high risk, 46 (46%) as moderate risk, and 9 (9%) as low risk, indicating a fairly similar distribution of risk

levels between male and female students.

Table 3: Association Between Duration of Diabetes and Medication Compliance (n = 100)

Duration of Diabetes

High

Moderate

Low

Total

p-value

<5 years

18

22

1

41

0.048*

5–10 years

15

14

2

31

>10 years

12

10

6

28

A statistically significant association was observed between duration of diabetes and compliance (p =

0.048). Patients with diabetes for more than 10 years had lower compliance, highlighting the need for

continuous reinforcement of adherence.

Table 4: Association Between Co-morbidities and Medication Compliance (n = 100)

Co-morbid Condition

High

Moderate

Low

Total

p-value

Hypertension

16

22

4

42

0.329

No Hypertension

29

24

5

58

Total

45

46

9

100

No significant association was found between presence of hypertension and compliance (p > 0.05).

However, slightly better compliance was noted in those without co-morbid conditions.

Table 5: Association Between Knowledge About Diabetes and Medication Compliance (n = 100)

Knowledge Level

High

Moderate

Low

Total

p-value

Good

30

20

2

52

0.006

Poor

15

26

7

48

Total

45

46

9

100

There was a statistically significant association (p = 0.006) between knowledge of diabetes and medication

compliance. Patients with good awareness demonstrated higher compliance, underscoring the importance

of diabetes education.

Discussion

This study assessed medication compliance and its associated factors among 100 Type 2 diabetes patients

attending a Rural Health Training Centre in Tamil Nadu. The overall medication compliance was

encouraging, with 45% demonstrating high compliance and 46% moderate compliance, leaving only 9%

with low adherence (Table 1). This pattern suggests generally good adherence in this rural cohort, which is

consistent with findings from similar rural Indian studies where compliance rates ranged between 70% to

90% (Kesmeera et al [1]; Angadi et al [2]).

When analysing demographic factors, no significant association was found between age groups and

medication compliance (Table 2), although middle-aged patients (45–59 years) showed slightly better

adherence. This aligns with prior research by Salazar et al [3], where age did not strongly predict

compliance, but younger and older extremes tended to have more challenges with adherence.

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Gender distribution also revealed no significant difference in compliance (Table 3). Both males and

females had comparable adherence levels, paralleling findings by Joha et al [4], who reported no gender

disparity in medication adherence among rural diabetic populations.

Duration of diabetes, however, showed a significant association with compliance (p = 0.048) (Table 4).

Patients with diabetes for over 10 years had notably lower compliance, a trend reported by Shamkuwar et al

[5] and Kumar et al [6], suggesting long-term patients may experience treatment fatigue or complacency

over time. This highlights the need for ongoing reinforcement and tailored interventions for patients with

chronic disease durations.

Co-morbidities such as hypertension did not significantly affect medication compliance (Table 5), although

patients without hypertension showed slightly better adherence. Similar observations were noted in a study

by Maheshwari et al [7], where the presence of co-morbidities did not always translate to better

compliance, possibly due to increased pill burden or health complications.

A crucial finding was the strong positive correlation between knowledge about diabetes and medication

compliance (p = 0.006) (Table 6). Patients with good knowledge of their disease and treatment were more

likely to adhere to medications, underscoring the critical role of patient education. This mirrors results from

several studies emphasizing diabetes education as a key factor in improving compliance (Mishra et al [8];

Sivakumar et al [9]).

This study reveals that while demographic factors such as age and gender may not significantly influence

medication compliance, disease duration and patient knowledge play substantial roles. These findings

advocate for enhanced patient education programs and a special focus on long-term diabetic patients to

sustain adherence, ultimately improving glycaemic control and reducing complications (Kumari et al [10];

Arshad et al [11]; Udupa et al [12]).

Strengths of the Study

The study included both male and female undergraduate students and used simple random sampling with

proportional representation across academic years, which helped minimize selection bias. The use of a pre-

designed and pre-tested semi-structured questionnaire and standardized data collection procedures ensured

consistency. The study also assessed multiple CHD risk factors, including lifestyle habits, family history,

and clinical characteristics, providing a broad assessment of cardiovascular risk among young adults.

Limitations of the Study

The study was conducted at a single government medical college with a relatively small sample of 100

participants, which may limit the generalizability of the findings to other student populations. The cross-

sectional design provides information on the prevalence of CHD risk factors at a particular point in time but

cannot establish causal relationships. Additionally, information regarding lifestyle practices and family

history was collected through self-report and may therefore be subject to recall or reporting bias.

Conclusion

The study highlights that medication compliance among Type 2 diabetes patients in this rural setting is

generally good, with most patients showing high to moderate adherence. However, patients with a longer

duration of diabetes tend to have lower compliance, emphasizing the need for continuous support and

follow-up. Importantly, better knowledge about diabetes strongly correlates with improved medication

adherence, underlining the vital role of patient education. Targeted interventions focusing on enhancing

awareness and addressing the challenges faced by long-term patients can help improve adherence and

ultimately reduce the burden of diabetes-related complications in rural communities.

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Declaration

Conflict of Interest: The authors declare that they have no competing interests or conflicts of interest

related to this work.

Funding: Nil

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