Prevalence of Coronary Heart Diseases Risk Factors among Healthcare Male Students in KSAU-HS Riyadh, Saudi Arabia

Background: Coronary heart disease (CHD) is a condition in which plaque builds up on the inner walls of coronary arteries and can lead to blood clot formation. It is the leading cause of death worldwide. Developing coronary heart disease takes long period and its risk factors can be found in young people. Objectives: Study of risk factors that contribute to the pathogenesis of coronary artery disease. Methods: A cross-sectional study was done at King Saud bin Abdul-Aziz University in Riyadh. Non-probability convenience sampling was used to select 151 health care students. The data was collected through questionnaire and physical measurements. The data was entered and analyzed by SPSS. Original Research Article Elneama et al.; JPRI, 33(54A): 237-243, 2021; Article no.JPRI.76733 238 Results: More than half of the students eat fruits one or less time per week which accounts for 53.6%. Moreover, 28.5% of them eat vegetables one time or less per week. Regarding healthy food containing healthy fat such as fish, 76.2% of the students include healthy fat food in their diet more than two times per week. The percentage of those who eat fast food and consume soft drinks is 80.8% and 70.2% more than two times per week respectively. Furthermore, the percentage of the students who are smokers, either currently or occasionally is 49%. Concerning physical activity, 31.3% of the students exercise more than two times weekly, and only 7.3% of the students watch TV more than four hours per day. On the other hand, the majority which accounts for 54.3% of the students use computer, laptop, or tablet more than four hours per day. Regarding premature CAD, 3.3% of the students reported positive and 16.2% of them reported positive for CHD family history. Finally, 1.3% of the found to have DM.


INTRODUCTION
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include: coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, and deep vein thrombosis. CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause [1].
Coronary risk factors generally classified into two main categories: modifiable and nonmodifiable risk factors.

High Blood Pressure
A study by Allen et al found that people who have increases or decreases in blood pressure during middle age have associated higher and lower remaining lifetime risk for cardiovascular disease. This suggests that prevention efforts should continue to emphasize the importance of lowering blood pressure in order to avoid hypertension [2].

Cigarette Smoking
Cessation of cigarette smoking constitutes the single most important preventive measure for CAD. As early as the 1950s, studies reported a strong association between cigarette smoke exposure and heart disease. Persons who consume more than 20 cigarettes daily have a 2to 3-fold increase in total heart disease. Continued smoking is a major risk factor for recurrent heart attacks [3].

Diabetes Mellitus
A disorder of metabolism, diabetes mellitus causes the pancreas to produce either insulin deficiency or insulin resistance. Glucose builds up in the blood stream, overflows through the kidneys into the urine, and results in the body losing its main source of energy, even though the blood contains large amounts of glucose.

Obesity
Obesity is associated with elevated vascular risk in population studies. In addition, this condition has been associated with glucose intolerance, insulin resistance, hypertension, physical inactivity, and dyslipidemia [4,5].

Metabolic Syndrome
Metabolic syndrome is characterized by a group of medical conditions that places people at risk for both heart disease and type 2 diabetes mellitus. In the Kuopio Ischemic Heart Disease Risk Factor Study, patients with metabolic syndrome had significantly higher rates of coronary, cardiovascular, and all-cause mortality [6].

Mental Stress, Depression, Cardiovascular Risk
Depression has been strongly implicated in predicting CAD [7]. Adrenergic stimulation during stress can increase myocardial oxygen requirements, can cause vasoconstriction, and has been linked to platelet and endothelial dysfunction [8] and metabolic syndrome [9].
Coronary heart disease is a condition in which plaque builds up on the inner walls of coronary arteries and can lead to blood clot formation. The blockage of coronary arteries happens gradually over years, but eventually the plaque hardens or ruptures. At this point, it narrows the coronary arteries and prevents the flow of oxygenated blood to the heart [10]. CHD has many symptoms, but chest pain is considered as the most common symptom [11]. Other symptoms are shortness of breath, pain in the neck, weakness, and sweating [12]. The diagnosis of CHD depends on many aspects including history, physical examination and investigations. The following investigations are very important for healthcare providers to identify CHD [13]. Electrocardiography (ECG), and Blood tests (for fasting glucose and/or glycosylated hemoglobin, renal function, LFTs, TFTs, lipid profile, cardiac enzymes, ESR or CRP). Finally, coronary angiography may be used to confirm the diagnosis if the listed tests above indicates coronary heart disease.
According to World Health Organization (WHO) data published in 2014 [14], Saudi Arabia placed at 27th rank in the world for CVD. A research by Al-Nozha et al that was done in a communitybased national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70-years of selected households over a 5-year period between 1995 and 2000. They found a total of 17232 Saudi subjects were selected in the study, and 16917 participated (98.2% response rate). Four thousand and four subjects (23.7%), out of 16917 were diagnosed to have DM. Thus, the overall prevalence of DM obtained from this study is 23.7% in KSA [15]. Another study that was done during the educational year 2012-2013 at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. The results were the commonest risk factors of CHDs were daily intake of high fat diet (73.4%), physical inactivity (57.9%), overweight/or obesity (31.2%) and daily consumption of fast food (13.1%). Hyper-cholesterolemia (17.2%) and hypertension (9.3%) were also prevalent risk factors. Smoking prevalence was low (2.8%). Males had significantly higher mean scores for most of CHD risk factors compared to females (p < 0.05) [16]. Another study that was done in 2019, was conducted a cross-sectional survey at King Abdulaziz University Hospital in Jeddah. Patients started on lipid-lowering and/or antihypertensive and/or antidiabetic treatments without a history of established cardiovascular disease were interviewed. Two hundred and fifty high-risk individuals (80.0% female) were interviewed. Overall, 72% of the patients had been diagnosed with hypertension, 61.2% of patients had dyslipidemia, and approximately two-thirds of patients had diabetes mellitus [17].
This study emphasizes the importance of estimating the prevalence for CHD risk factors in healthcare male students in KSAU-HS, Riyadh. The aim of this study is to determine the prevalence of coronary heart diseases (CHD) risk factors among King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) male students in Riyadh, Saudi Arabia. Moreover, it aims to describe the prevalence of CHD risk factors.

METHODS
The study was conducted in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. It was a cross sectional study using confidence level of 95% and the sample size was limited number (250). The margin of error was calculated to be 6% within the expected outcome for one of the risk factors at 50%. The sampling technique was by dividing healthcare students into five groups. Selection was done by college and year. Then, non-probability convenience sampling which is a technique where the subjects are selected because of their accessibility to the researcher.
A non-probability convenience sampling was used on College of Medicine, Dentistry, Pharmacy, Applied Medical Sciences, and College of Science and Health Professions to give students a self-administered questionnaire. Questions about socio-demographic variables that include age, marital status, parent's education, and family income. The questionnaire also includes questions about risk factors of CHD including smoking, Diabetes Mellitus, hypertension, nutritional habits, type of fat used for cooking, fruits & vegetables consumption, physical activity, dyslipidemia, family history of premature CHD, and family history of obesity. After the self-administered questionnaire, four co-investigators performed physical measurements to complete the data.
Expected main outcomes were weight & height (BMI) using a weight & height scale, waist to hip conference ratio (WHR) using a meter, blood pressure (BP) using a sphygmomanometer, and random blood glucose (RBG) using a glucometer. There were five groups according to the colleges above, and the selection was done by convenience sampling. Aself-administered questionnaire was used; socio-demographic variables were the independent variables and risk factors of CHD was the main outcome variables.
SPSS was used for data entry and analysis. Categorical data such as smoking and physical inactivity was represented by percentages and frequencies. Chi Square test was used for comparing the categorical variables between the same groups. A p-value of <0.05 was considered to show a statistically significant difference.

RESULTS
The study population was composed of 151 health care student from AMS, COSHP, and medicine colleges. Table one shows sociodemographic information of the health care student enrolled in the study including: educational year, 11.3% were from the first year, 7.9% from the second year, 58.9% from the third year, 17.9% from the fourth year, and 4% from fifth year due to inavailabiility. Also, 68.2% of the father's education is collage or higher. However, 54.3% of the mother's education is collage or higher. Regarding family income, 58.3% earn more than 20,000 SAR each month.
Table two shows thatmore than half of the students eat fruits one time or less per week which accounts 53.6%. Moreover, 28.5% of them eat vegetables one or less time per week. Out of the students, 76.2% of them includefood containing healthy fat in their diet more than two times per week, 80.8% and 70.2% eat fast food and soft drink more than two times per week respectivly.
Regarding table three, the students who smoke account for 49%, ethier cuurently or occasionally. Only 31.3% of the studentsexercise more than two times weekly. Regarding watching TV, only 7.3% of the student watch TV more than four hours, while 54,3% of them use computer,laptop, or taplet more than four hours. Only small percent of the students report premature CAD family history 3.3%,while 16.2% of them report CHD family history. Finally, 1.3% of the found to have DM.

DISCUSSION
The current study looks at CHD risk factors not only among medical students but all health care students in King Saud bin Abdulaziz University for Health sciences. According to the US National Health and Nutrition Examination Surveys (NHANES) data among young adults aged 20-40 years (1999-2006) revealed that twothirds have at least one CVD risk factor [18]. Furthermore, about 90% of individuals with CHD have at least one risk factor as smoking, diabetes, hypertension [19]. A study shows that from 2003 obesity is becoming a pandemic [20]. These finding concur with results of study in King Fahd University in Dammam city, KSA 47.1% [21]. Comparable rates were also reported from two other Saudi studies one done among male medical students in Al-Qassim University 46.5% [22] and the other study was done among male students at King Saud University, Riyadh, KSA 54% [23]. These alarming high rates of overweight and obesity among Saudi young adult may need rapid targeted university intervention.
Study was done in 2011 showed that frequent fast-food eating (three or more) is associated with poorer diet quality, greater weight gain, also physical activity is considered protective against CHD [24]. However, our study showed that students who exercise accounts for only 31%. Sedentary life behaviors like watching TV and using computer increase risk of CHD 4.8%. We found that 92,7% watch TV up to four hours per day and 54% use computer, laptop, or tablet more than four hours per day.
According to Framingham risk score, the risk of developing CHD increases with increasing number of risk factors in an individual [25]. We found that 96% of our population have one risk factor or more, whereas 37% of them have at least two risk factors. After excluding high blood pressure as it needs more than one reading to be accurate, we found that 9% don't have any risk factor.
Finally, there were some limitations to this study. We did not achieve our sample size which was 250. Furthermore, dentistry and pharmacy students were not reachable. In addition, female students were excluded from the beginning. Cholesterol levels were not measured. The measurement of blood pressure was done in standard technique yet one reading is not enough.

CONCLUSION
According to Framingham risk score, the risk of developing CHD increases by increasing number of risk factors in an individual. We found that 96% of our population have one risk factor or more, whereas 37% of them have at least two risk factors. After excluding high blood pressure as it needs more than one reading to be accurate, we found that 9% don't have any risk factor. Finally, after reviewing the data results, we recommend annual medical checkup for all students. Also, there should be more effort in increasing the awareness of the student. Finally, the university should provide healthy diet and include physical activity in the schedule.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline participant consent and ethical approval has been collected and preserved by the authors.