The Cardiovascular diseases (CVDs) are group of disorders of the heart and blood vessels and they include coronary heart disease, cerebrovascular diseases, deep vein thrombosis and pulmonary embolism and some other disorders of heart [1]. Around 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Among these three-quarters of CVD deaths take place in low and middle-income countries. According to the WHO data published in 2017, Coronary Heart Disease deaths in Nepal reached 18.72% of total deaths [2]. CVDs are the leading cause of deaths in both developed and developing countries. In 2008, 30% (17.5 million people) of global all-cause mortalities were from CVDs. Of these, 6.2 and 7.3 million were due to stroke and coronary heart disease (CHD), respectively. It is expected to increase to 23.3 million by 2030 [3].
According to the heart disease and stroke statistics 2019 reported that cardiovascular disease remains the leading cause of death in United States, responsible for 840,768 deaths in 2016. But from 2006 to 2016, the US death rate from CVD decreased by 18.6% and from coronary heart disease by 31.8% [4]. CVD mortality rates in the South Asian countries are much higher than the East Asian countries [5]. South Asian countries have an increasing trend of risk factors for coronary heart disease (CHD) along with their economic development [6]. The South Asian countries Nepal, India, Pakistan, Sri-Lanka and Bangladesh contribute most to the worldwide CVDs burden [7]. In Nepal, it is estimated that 5.6% of people living in the mountains, 1.5% in the hills and 5% of people in the Terai region suffer from CVDs [8]. That’s why; cardiovascular diseases (CVDs) are the leading causes of death globally including Nepal [2, 3, 4, 8]. In Nepal, the estimated age-standardized death rates caused by CVD (Ischemic Heart Disease and Cerebrovascular Diseases) were 152 and 82 per 100,000 population respectively in 2008 [9]. Moreover, 13.8% of industrial workers of Nepal were diagnosed with CVD in 2016 [10]. The deaths due to Non Communicable Diseases (NCDs: cardiovascular disease, diabetes, cancer and respiratory disease) have increased from 60% in 2014 to 66% of in 2018 of all deaths in Nepal [11].
According to Texas Heart Institute (THI) the main risk factors for cardiovascular diseases are hypertension, cigarette smoking, high fat level, diabetes, obesity and physically inactive and the minor risk factors contain stress due to anxiety, sex hormone intake, birth-control pills and alcohol drinking [12]. Furthermore, the major modifiable risk factors are tobacco smoking, physical inactivity, unhealthy dietary intake, high cholesterol and stress, eating fast food and carbonated drinks and non-modifiable risk factor are Age, Family history, Sex, Ethnicity [12, 13]. According to WHO, smoking, harmful use of alcohol, physical inactivity, unhealthy diets, obesity, hypertension, diabetes and hyperlipidemia are the established risk factors of CVDs. Smoking is estimated to cause nearly ten per cent (10%) of all CVDs followed by physical inactivity (6%), and overweight and obesity (5%). Also, low fruits and vegetables intakes caused death of approximately 16 million people [14, 15].
National NCD risk factors survey 2013 detected considerably high proportions of smoking (18.5%), alcohol consumption (17.4%), insufficient fruits and vegetables consumption (98.9%) and obesity (4%) among Nepalese [16]. It is emerging as a major killer even in Nepal where mortality attributed to CVD has swiftly increased from 22–25% between 2004 and 2008. Most cardiovascular diseases share common risk factors like tobacco use, physical inactivity, unhealthy diet, harmful use of alcohol, diabetes, high blood pressure and raised lipid. Among them, behavioural risk factors unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol, alone contribute 80% of coronary heart disease and cerebrovascular disease [12, 13, 17].
There are several risk factors contributing to hypertension, such as age, gender and ethnicity. It is common in men over 45 years and women over 55 years. Positive family history being overweight and obese is also additional risk factors. Other life style factors that contribute to hypertension are smoking, stress cell phone use and physical inactivity, consumption of alcohol, increase salt intake reduce potassium take [18]. In Nepal, hypertension was the most prevalent risk factor for CVD which ranged from 26.0–38.9%. [19]. Nepal’s high prevalence of underlying behavioural risk factors, particularly tobacco and alcohol consumption and poor cardiovascular health knowledge, is a matter of concern.[20].
According to the Surgeon General’s Report on smoking and health in 2014 smoking is a major cause of cardiovascular disease (CVD) and causes approximately one of every four deaths from CVD. Also, exposure to second hand smoke causes heart disease in non-smokers. More than 33,000 non-smokers die every year in the United States from coronary heart disease caused by exposure to second hand smoke. Exposure to secondhand smoke can also cause heart attacks and strokes in non-smokers [21]. Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That's because people with diabetes, particularly type 2 diabetes, may have the contribute to their risk for developing cardiovascular disease are high blood pressure (hypertension), abnormal cholesterol, high triglycerides, obesity, lack of physical activity, smoking[22]. STEPS survey of Nepal in 2013 detected hyper cholesterol in 23.0%, smoking in 19.0%, overweight in 21.0%, raised blood glucose in 4.0%, physical inactivity in 3.0%, and harmful use of alcohol in 2.0% [23]. A study conducted in Jhaukhel, Duwakot; Nepal, revealed that median percentage scores for knowledge, attitude and practice/behavior were 79.3, 74.3 and 48 respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Only 14.7% had a highly satisfactory attitude and 19.5% had satisfactory attitude and 13.9% had highly satisfactory practices. The study concluded that poor knowledge, unfavorable attitude and highly adverse behavior regarding cardiovascular health [24]. A study in Lamjung district, Nepal, the results found that smoking 24.1%, harmful use of alcohol 10.7%, insufficient intake of fruit and vegetables 72%, low physical activity 10.1%, overweight and obesity 59.4%, hypertension 42.9%, diabetes 16.2%, dyslipidemia 56.0% was common risk factors of cardio vascular disease. The study concluded that the risk factors of cardiovascular disease was high in rural population of Nepal [25]. Moreover, the study in Sitapaila village development committee, Kathmandu revealed that the majority of respondents were female, one third of respondents were Brahmin and Chhettri and over a quarter of respondents (29.1%) did not attend school. Cardio vascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%) and high triglyceride levels (10.8%). The study concluded that there was high prevalence of cardio vascular risk factors among study respondents [26].
Cardio vascular disease is the one of the major health problem in the developed and developing countries. It is the one of the most cause of death globally. Most of the previous studies showed that the knowledge was poor and attitude was negative towards cardio vascular disease. The outcomes of studies showed that need for better awareness regarding risk factors of cardio vascular disease among general people. Cardio vascular disease has gained worldwide attention and this is noted as one of the major challenges in the public health; there is a pressing need to study the trend of attitude towards Cardio vascular disease among general people. Thus, it is necessary to recognize knowledge and attitude of general people about this issue in order to make plans for medical challenge. However, few studies have assessed the Knowledge and attitude on CVD risk factors in Nepal and none in the mid-western part of Nepal. This study, therefore, has attempted to assess the knowledge and attitude regarding risk factors of cardio vascular disease among general people residing in Dhamboji-1, Nepalgunj, Banke, Province number 5; Nepal.