الفهرس 
Definition of Coronary Heart DiseaseOnly 14 pages are availabe for public view
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Abstract
Despite the recent advances in prevention and treatment, cardiovascular and in particular CHD disease remains a major public health problem in both developed and developing countries as well as in Palestine. Many studies have addressed the problems related to the incidence, morbidity, mortality, and prevention of CHD from an epidemiologic point of view worldwide.
The aim of the present study was to estimate the prevalence of CHD risk factors among university students, to assess the CHD risk among them using a suitable scoring system, to identify how they perceive their risk of CHD, to construct a program of risk reduction for those in the high risk group (high-risk intervention strategy), and to evaluate the effect of the implemented educational intervention program in improving knowledge and perceiving risk of CHD among participants.
The study design used was cross-sectional design for preliminary data collection; then a pretest-post design was applied. The study was carried out at the three main universities in Gaza Strip-Palestine. The study sample was composed 501 subjects out 575 with a response rate of 87%, the Framingham risk score assessment was applied to 361 participants (72% response rate) who gave a blood sample for lab tests to complete the data for risk scoring. The period of the study extended from May 2008 to May 2009. Participants were subjected to the following activities:
1. Self administered questionnaire: include socio-demographic data, medical history of chronic diseases, family history about CHD, lifestyle related to smoking, dietary habits, and physical activity, knowledge and perception about CHD risk factors, signs and symptoms, complications and prevention.
2. Anthropometric measurements: include weight, height, and calculation of body mass index.
3. Arterial blood pressure measurement: the mean of two readings was recorded after 10 minutes rest at the clinic using mercury sphygmomanometer while the subject in a sitting position.
4. Laboratory tests: serum total cholesterol, LDL-C, HDL-C, triglycerides, and fasting blood sugar.
A preliminary assessment as a pretest was done to identify the high risk group; first the Framingham was applied to calculate the risk score as it seems that all participant were in the low risk category (<10%) and this was because of the age factor which negatively affect the equation, then aggregate of risk factors was done. Every participant who had 2 or more risk factors was included in the intervention program. Three months later a posttest evaluation was done using the questionnaire and same data collection methods.
The study revealed the following results:
Socio-demographic data:
About 55% of the participants were from second year and 45% from the third year. The mean age was 20.8 ±2.07 years, male were slightly older than females, 6.6% were married; females show higher percentage than males (9.1% Vs 3.7%). The highest percentage of participant was from college of education and related specialties (47.7%) followed by college of science and related specialties (39.9%)
Medical history
The prevalence of hypertension was 3.6% (3% Vs 4.3%) male to female. On examination, the mean systolic and diastolic blood pressure was (114.2 Vs 74.6 mmHg); both systolic and diastolic blood pressure were higher among males than among females and there was s statistically significant difference in both measurements (116.7 mmHg Vs 111.2 mmHg), and (76.2 mmHg Vs 72.6 mmHg) respectively.
Prevalence of DM was only 0.4% and it was reported by male students only. On examination the mean blood sugar level was 82.9 mg/dl, it was slightly higher among females but there was no statistically significant difference between them.
The prevalence of hypercholesterolemia was 2.6% there was an equal prevalence among male and female participants with no statistical significant difference. On examination the mean total cholesterol level was 151.4 mg/dl, it was much higher among females than males (156.6 mg/dl Vs 146.8 mg/dl) with a statistical significant difference. The mean levels of LDL-C (88 mg/dl Vs 85.5 mg/dl) and HDL-C (52.4 mg/dl Vs 42.6 mg/dl) were higher among females than among males. There was a statistical significant difference in HDL-C level, but not in LDL-C level. The mean of triglycerides was much higher among males than among females (105.8 mg/dl Vs 78.7 mg/dl) with a mean of 93.1 mg/dl and there was a statistical significant difference between them.
History of smoking
Smoking was more prevalent among males than among females (33.1% Vs 1.7%) with a total prevalence of 19%. Out of the smokers there was about 29.4% smoked Argil, 58% smoked manufactured cigarettes, and 15 % smoked both. Only 15% of the participants classified as heavy smoker (consuming ≥20 cigarettes/day), the prevalence of narghile smoking in the total sample was 10.3%.
Family history of CHD
The prevalence of family history of CHD was 14.2%, it was more prevalent among males than females participants (14.4% Vs 13.9%) but with no statistical difference. Thirty percent of the participants reported family history of premature death.
History of leisure time physical activity
Physical inactivity was slightly higher among females than males (42% Vs 37%) with an overall prevalence of 39.3%.
Body mass index
Overweight and obesity were more prevalent among males than among females (30.7% Vs 22.5% and 9.6% Vs 5.6%). The overall prevalence of overweight and obesity was 26.9% and 7.8% and there was a statistically significant difference between males and females. The mean of BMI was (24.3 ±4.1 kg/m2 Vs 23.6 ±4.1 kg/m2), while the mean weight was (1.74 ±0.06 m Vs 1.59 ±0.05m)
Dietary habits
Green leafy vegetables were less frequently eaten by the study participants. Only 14.8% had three and more servings per day males show higher percentage than female participants (18.1% Vs 10.8%). It was statistically significant.
Fresh fruits and fruit juice; fifty eight percent of the participants reported three and more times of eating fresh fruits, while 50% take 3 and more fruit juice servings/week (53% Vs 46.8%) male to female. There was no statistically significant difference between male and female participants.
Fish consumption; fourteen percent of the participants reported that they ate tow or more fish servings per week. There was no statistical significant difference between male and female participants.27% of the participants reported that they did not eat any fish serving per week.
Eggs consumption; thirty nine percent of the studied sample ate four and more eggs per week, male participants show higher percentage than females (52.2% Vs 24.2%), and there was a significant statistical difference between them..
Knowledge about CHD
There was a statistically significant difference in the total Knowledge score of CHD between male and female participants. Female students tend to be more knowledgeable than males. Over all score revealed that there is fair knowledge about all aspects of CHD including knowledge of risk factors, signs and symptoms, complications, risk reduction, and diet rich in cholesterol.
CHD Risk perception
The overall level of perceived risk was moderate among both male and female participants, but males tend to be more highly perceived risk than females, and there was a statistically significant difference between them. On the other hand, in spite of the presence of risk factors, students in general tend to overestimate their health status as they assume that they have an excellent health
In post intervention the study results revealed that:
There was a dramatic increase in both levels; knowledge (from 8.5 points to 22.9 points) and risk perception of CHD (from 31.6 points to 51.2 points)
There was a reduction in the percentage of those who used to smoke cigarettes (from 23.1% to 15.4%), but there was an increase in the percentage who used argil (from 25.7% to 55.6%).
There was a reduction in BMI percentage in regard to overweight (57.1% to 48.4%) and obesity (23.1% to 20.1%) and there was a significant statistical difference between pre and post intervention.
Logistic regression analysis
The results revealed that 2 significant predictors were extracted out of 7 variables that entered the multiple regression analysis model. Age and sex were accompanied by higher level of total perception (p<0.05).
The following conclusion recommended
1. Health education and health promotion programs for schools/universities, and communities including the following areas (healthy lifestyle, heart healthy diet, physical activity, ideal body weight, and periodic medical checkup)
2. Health care services; (an integrated multiple risk factors screening programs like hypertension and diabetes, in addition to obesity) for those aged ≥20 year who attending the primary health care centers and for university students before admission.
3. Non health sector including; anti smoking campaigns for prevention and cessation of smoking, developing public policy and legislation to support healthy lifestyle like food labeling, opportunities for physical activity, etc.
4. Further research needed to be implemented on larger sample to test knowledge and perception of the public in regard to their risk for heart disease, including school children and community so that education could be provided in a more focused manner. While more studies should focus on screening of cardiovascular risk factors in general at early age; 20 years and over in order to discover the high-risk individuals and start early lifestyle modification and risk management.