European Journal of Cardiovascular Medicine

Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide, posing a significant burden on healthcare systems and economies. In India, the prevalence of CVDs has been rising rapidly due to a combination of genetic predisposition, urbanization, and lifestyle changes.^1-3 Punjab, known for its vibrant culture and rich cuisine, is facing an alarming increase in cardiovascular health challenges attributed to dietary habits, sedentary lifestyles, and high prevalence of risk factors such as obesity, hypertension, diabetes, and tobacco use. Despite advancements in medical technology and healthcare services, awareness and preventive measures remain suboptimal, leading to late diagnoses and poor management of CVDs.^4,5

Public knowledge and awareness of cardiovascular risk factors play a pivotal role in reducing the incidence and impact of heart diseases. Early identification and modification of risk factors, such as unhealthy diet, physical inactivity, stress, and smoking, are crucial in preventing the progression of cardiovascular conditions.^6,7 However, studies have shown that many individuals, particularly in semi-urban and rural areas of Punjab, lack adequate knowledge about the risk factors, symptoms, and preventive strategies related to cardiovascular health. This lack of awareness often results in delayed healthcare-seeking behavior and an increased burden of preventable heart conditions.^8-11

Understanding the current level of knowledge about cardiovascular risk factors among the general population of Punjab is essential for designing effective public health interventions. Awareness campaigns and health promotion programs tailored to the local cultural context can significantly enhance public knowledge and encourage healthier lifestyle choices. Moreover, assessing the influence of socio-demographic factors such as age, gender, education, and occupation on cardiovascular health awareness can provide valuable insights for policymakers and healthcare providers to develop targeted strategies.

This study aims to evaluate the awareness and knowledge levels of the general public in Punjab regarding cardiovascular risk factors. By identifying gaps in understanding and areas requiring intervention, this research seeks to inform health education initiatives and promote heart-healthy behaviors, ultimately contributing to the reduction of the cardiovascular disease burden in the region.

Research Design

This study employed a descriptive, cross-sectional design to assess the awareness and knowledge of cardiovascular risk factors among the general public of Punjab. An online survey was conducted to systematically collect data on public understanding, perceptions, and awareness of cardiovascular health.

Study Area

The study was conducted in Punjab, a northern state of India with a diverse population consisting of both rural and urban residents. Punjab's unique socio-cultural and dietary patterns make it an important region for assessing cardiovascular health awareness.

Study Duration

The study was conducted over a period of three months, from August to October 2024, to ensure adequate data collection and representation of the target population.

Study Population

The target population included adults (aged 18 years and above) residing in Punjab. Participants were recruited from various demographic backgrounds, including different age groups, educational levels, occupations, and socio-economic statuses. The inclusion of both urban and rural populations allowed for a comprehensive understanding of cardiovascular awareness across the state.

Sample Size

A total of 400 participants were included in the study. The sample size was determined using a 95% confidence level, an estimated 50% awareness level of cardiovascular risk factors, and a 5% margin of error. An additional 5% was considered to account for potential non-responses.

Sampling Technique

A convenience sampling method was employed to recruit participants through online platforms such as social media (Facebook, WhatsApp, Instagram), email groups, and community forums to ensure broad outreach across the state.

Inclusion Criteria

• Individuals aged 18 years and above.
• Residents of Punjab for at least one year.
• Access to the internet and ability to read and respond to the survey in English or Punjabi.
• Willingness to provide informed consent.

Exclusion Criteria

• Individuals with medical or paramedical backgrounds to prevent bias in knowledge assessment.
• Non-consenting individuals.
• Incomplete survey responses.

Study Tool

A structured, pre-validated online questionnaire was used for data collection. The questionnaire was developed with input from cardiologists and public health experts and was made available in both English and Punjabi for accessibility. It comprised two major sections:

1. Socio-Demographic Details:

• Age, gender, education level, occupation, household income, and place of residence.

2. Knowledge and Awareness Assessment:

• The questionnaire included 20 multiple-choice questions covering the following areas:
• Common cardiovascular risk factors (e.g., hypertension, obesity, smoking, diabetes).
• Symptoms of cardiovascular diseases (e.g., chest pain, shortness of breath, dizziness).
• Preventive measures (e.g., diet modifications, regular exercise, stress management).
• The impact of lifestyle choices on heart health.
• The importance of regular health check-ups.

Scoring Criteria:

Knowledge scores were categorized as follows:

• Very Good: ≥80% correct responses
• Good: 60–79% correct responses
• Fair: 41–59% correct responses
• Poor:<40% correct responses

Data Collection Procedure

Data were collected using an online survey platform (Google Forms) to maximize reach and participation. The survey link was shared via social media platforms, community health groups, and email circulations to encourage voluntary participation. Participants were informed about the study's objectives and assured of confidentiality.

Data Analysis

The collected data were exported to Microsoft Excel and analyzed using Epi Info V7 software. Descriptive statistics, including frequencies and percentages, were used to summarize socio-demographic characteristics and knowledge levels. Chi-square tests were applied to examine associations between socio-demographic factors and knowledge levels, with a significance level set at p < 0.05.

Ethical Considerations

Participants provided informed consent electronically before starting the survey. Confidentiality and anonymity were maintained throughout the study, and participants were informed that they could withdraw from the survey at any time without any consequences.

A total of 400 participants completed the online survey, providing valuable insights into the awareness and knowledge of cardiovascular risk factors among the general public of Punjab.

Table 1: Socio-Demographic Characteristics of Participants

The socio-demographic characteristics of the study participants reflect a diverse population with a balanced gender distribution, consisting of 49.5% males and 50.5% females. The highest proportion of respondents (36.5%) belonged to the 26–35 age group, followed by those aged 36–45 years (25.0%), indicating that a majority of participants were within the economically active and reproductive age group. Educational attainment varied, with the largest percentage having completed secondary school (28.5%), followed closely by those with undergraduate degrees (27.0%), suggesting a relatively well-educated population. Regarding occupation, 34.0% of participants were engaged in service-related jobs, while 23.5% were involved in agriculture and labor, reflecting the region’s occupational diversity. Income distribution showed that 37.5% of respondents fell within the monthly income bracket of INR 10,001–20,000, highlighting a middle-income demographic that may influence healthcare access and affordability. Additionally, the majority of participants (60.0%) were from rural areas, underscoring the importance of targeted awareness campaigns to bridge the rural-urban health knowledge divide.

Table 2: Knowledge and Awareness Assessment of Cardiovascular Risk Factors

The assessment of awareness and knowledge about cardiovascular risk factors revealed a varied understanding among respondents. Encouragingly, a significant majority (85.5%) correctly identified anesthesiologists as the medical professionals responsible for administering general anesthesia, demonstrating a strong awareness of the professional roles involved in surgical care. However, knowledge gaps were evident in critical areas, such as the importance of fasting before surgery, with only 74.5% of participants recognizing its necessity. Similarly, misconceptions regarding the impact of lifestyle choices on heart health were observed, with 71.0% correctly identifying stress management techniques such as yoga and meditation as beneficial preventive measures. While 77.5% of participants were aware of the importance of regular exercise in heart disease prevention, only 65.0% recognized the ideal BMI range for heart health, indicating a need for greater emphasis on weight management education. Overall, the results suggest that while participants have a foundational understanding of cardiovascular health, targeted educational initiatives focusing on specific risk factors, preventive measures, and the importance of regular screenings are crucial to enhancing public awareness.

Figure-1: Knowledge Score Classification

The classification of knowledge scores provided valuable insights into the overall level of understanding of cardiovascular risk factors among participants. Approximately 35.0% of respondents demonstrated a "Good" level of knowledge, scoring between 12–15 points, indicating a moderate awareness that could be further improved through targeted educational interventions. Encouragingly, 27.5% of participants fell into the "Very Good" category, achieving scores between 16–20, reflecting a high level of awareness among a portion of the population. However, a notable 28.0% of respondents had "Fair" knowledge scores, suggesting gaps in understanding that may hinder their ability to make informed health decisions. Alarmingly, 9.5% of participants fell into the "Poor" category, emphasizing the need for widespread educational initiatives to ensure that all segments of the population have access to accurate and actionable information about cardiovascular health. These findings highlight the need for community outreach programs, healthcare provider engagement, and the use of digital media to enhance awareness and encourage proactive heart health management among the general public.

The findings of this study provide an in-depth understanding of the public’s awareness and knowledge regarding cardiovascular risk factors in Punjab. Cardiovascular diseases (CVDs) remain the leading cause of mortality and morbidity in India, and the high prevalence in Punjab necessitates a focused approach to improve awareness and promote preventive measures. The results indicate a moderate level of understanding among the general public regarding cardiovascular risk factors, symptoms, and preventive strategies, with notable gaps in critical areas that require targeted interventions.

The socio-demographic profile of the study participants presents valuable insights into the awareness landscape. The sample included a relatively balanced gender distribution, with a slightly higher representation of female participants. This demographic diversity allows for a better understanding of gender-specific differences in awareness and knowledge. A significant proportion of participants belonged to the 26–35 years age group (36.5%), followed by the 36–45 years group (25.0%), suggesting that the working-age population is more engaged in health-related discussions and digital platforms. The rural-urban divide in the study sample (68.5% rural, 31.5% urban) is crucial for identifying disparities in access to healthcare services and educational resources. Rural populations, despite facing significant barriers to healthcare access, demonstrated a keen interest in participating in the survey, reflecting their growing concern about cardiovascular health.

Education levels of the participants also played a key role in shaping awareness. The study found that 30.5% of respondents had an undergraduate degree, while 27.0% had completed secondary education. Despite this relatively high level of formal education, misconceptions and incomplete knowledge about cardiovascular health persist. Participants with higher educational attainment exhibited better understanding of risk factors and preventive strategies, while those with lower education levels demonstrated significant knowledge gaps, particularly in recognizing early symptoms of cardiovascular diseases and the importance of routine screenings.^12,13

In terms of knowledge assessment, the results revealed an encouraging awareness of well-known cardiovascular risk factors such as smoking, poor diet, and physical inactivity. A significant proportion (77.5%) of respondents correctly identified regular exercise as a key preventive measure for heart health, while 71.0% recognized stress management as an important factor. However, despite this awareness, practical application remains a challenge, as reflected by the lower understanding of less-discussed risk factors such as obesity (62.0%) and diabetes (65.0%). This indicates that while general awareness campaigns may have reached the population, there is a need for more comprehensive educational efforts that focus on actionable lifestyle modifications.^14,15

A major concern identified in the study is the lack of awareness about the early symptoms of cardiovascular diseases. While chest pain was correctly recognized by 75.5% of participants as a potential warning sign, other critical symptoms such as shortness of breath and dizziness were less well understood. Only 68.5% of respondents correctly identified shortness of breath as a sign of heart disease, and 64.0% were aware that dizziness could indicate cardiovascular issues. This gap in symptom recognition can lead to delays in seeking medical attention, resulting in adverse health outcomes. Public health initiatives should focus on educating individuals about the subtle and atypical presentations of heart disease, particularly in women and the elderly, who may present with non-classical symptoms.^13,15

Preventive healthcare practices were another key focus of this study. Encouragingly, 80.0% of respondents acknowledged the importance of regular health check-ups in preventing cardiovascular diseases. However, financial constraints and a lack of awareness about screening options were cited as major barriers to adherence. Participants with lower income levels were less likely to undergo regular check-ups due to cost concerns and a lack of understanding of the benefits of early detection. Additionally, misconceptions such as the belief that only individuals with symptoms require screening were prevalent, underscoring the need for targeted educational interventions that emphasize the role of preventive healthcare in reducing disease burden.^13,14

The impact of lifestyle choices on heart health was another area where mixed results were observed. While the majority (72.0%) of participants recognized the link between an unhealthy diet and cardiovascular disease, only 61.5% understood the importance of adequate sleep in maintaining heart health. The study findings suggest that while diet and exercise receive significant attention in public health campaigns, other critical lifestyle factors such as sleep hygiene, stress management, and mental well-being are often overlooked. Integrating these aspects into awareness programs can provide a more holistic approach to cardiovascular disease prevention.^15,16

The overall knowledge classification results further highlighted these gaps. While 35.0% of participants demonstrated a good level of knowledge, indicating a reasonable understanding of cardiovascular health, 28.0% fell into the fair category, signifying a need for more targeted interventions. Alarmingly, 9.5% of respondents had poor knowledge, indicating critical gaps that could hinder their ability to make informed health decisions. These findings align with national and international studies that emphasize the need for improved cardiovascular health literacy, particularly in regions with high-risk populations.^15-17

Socioeconomic factors and cultural beliefs emerged as significant influencers of cardiovascular health knowledge. In rural areas, traditional beliefs and reliance on home remedies often overshadow evidence-based medical advice, leading to delays in seeking appropriate care. Additionally, gender dynamics play a crucial role, with women in many households prioritizing the health needs of their families over their own, resulting in lower awareness and healthcare utilization among female respondents. Addressing these socio-cultural barriers requires culturally sensitive interventions that engage communities through trusted channels such as local healthcare providers and community leaders.^9,13,16

Healthcare professionals have a pivotal role in bridging the knowledge gap. The study findings suggest that doctor-patient communication needs to be strengthened to ensure that individuals receive clear, accurate, and actionable information about cardiovascular health. Incorporating cardiovascular health education into routine consultations and leveraging digital platforms to provide easy-to-understand resources can enhance knowledge and encourage positive health behaviors.^15-17

To address the identified gaps, several recommendations can be made. Firstly, public health campaigns should focus on comprehensive, culturally tailored educational programs that address misconceptions and emphasize preventive strategies. Secondly, leveraging digital platforms, such as social media and mobile health applications, can enhance outreach and engagement, particularly among younger populations. Additionally, collaboration with community organizations, healthcare providers, and policymakers is essential to implement sustainable initiatives that promote cardiovascular health awareness.

Limitations
This study has some limitations. The online survey may have excluded individuals without internet access, leading to selection bias and underrepresentation of certain groups, particularly in rural areas. Self-reported data may be subject to recall and social desirability biases, potentially affecting the accuracy of responses. Additionally, the convenience sampling method limits the generalizability of the findings to the entire population of Punjab. Future studies should include broader sampling methods to ensure a more representative assessment of cardiovascular health awareness.

This study underscores the importance of enhancing public awareness regarding cardiovascular risk factors, symptoms, and preventive measures among the general population of Punjab. While a significant portion of respondents exhibited a moderate understanding of heart health, critical gaps remain in recognizing early warning signs and implementing preventive strategies. The findings emphasize the need for targeted educational initiatives, improved healthcare access, and community-based interventions to address misconceptions and promote proactive health behaviors. Bridging these knowledge gaps through culturally appropriate programs and digital outreach can empower individuals to make informed lifestyle choices, ultimately contributing to the reduction of cardiovascular disease prevalence in Punjab.

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