assessment of mi myocardial infarction risk factors among post-mi

5
International Journ Internat ISSN No: 24 @ IJTSRD | Available Online @ www.i Assessment Risk Yadav A 1 , Sh 1 M.Sc. Nursing, 2 Associ Himalayan College of Nu ABSTRACT Introduction: The identification of r important to reduce the risk of myocard Material and Methods: A quan experimental research study was condu the risk level & various risk factors of M post-MI patients, and to find the assoc level of MI with socio-demographic var MI patients. Seventy post-myocardi patients were selected as sample that w purposive sampling technique from a hospital in Dehradun. The data were using self-reported risk assessment tool. study results shows that the majority 6 the study participants were with the diag with MI. The majority 64 (91.4%) participants had not attended any programme on CAD/Heart disease pr study results shows that majority 58 participants were having moderate risk this study the risk factors which were MI were like male with 41 to 60 years than ideal weight, smoking habits, sweet diets, personality type-A, no reg and Diabetes mellitus. The associatio level with the co-morbidity (includ hypertension or both) was statistically the level of 0.05 significance. Conc concluded that the people after the M moderate and severe risk of developing M Key Words: Risk factors, Myocardi Awareness, Lifestyle practices, Modi Practices, Post-Myocardial infarction nal of Trend in Scientific Research and De tional Open Access Journal | www.ijtsrd 456 - 6470 | Volume - 3 | Issue – 1 | Nov ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 20 t of MI (Myocardial Infarction Factors Among Post-MI harma R K 2 , Prakash K 3 , Pugazhendi S 4 iate Professor, 3 Vice Principal, 4 Dean Faculty of ursing, SRHU, Jolly Grant, Dehradun, Uttarakha risk factors is dial infarction. ntitative non- ucted to assess MI among the ciation of risk riables of post- dial infarction was selected by a tertiary care e collected by . Results: The 69 (98.6%) of gnosis of CAD of the study y educational revention. The 8 (82.86%) of of MI. As per identified for s, weight more stress, eating egular exercise on of MI risk ding diabetes, significant at clusion: It is MI attack had MI. ial Infarction, ified Lifestyle INTRODUCTION The incidence of MI in the wo than 80% of the cardiovascul developing countries. An Ind lack of awareness relating t diseases. By identifying risk can be identified and by the variations in the lifestyle prac can reduce the risk of MI. 1 Globally, about 17.5 million occurred due to the cardio vas (75%) of these deaths occu countries where the mortality heart diseases is rapidly continuously increasing in th This type of increase is made industrialization, and the rela known as epidemiological tran MATERIAL AND METHOD A non-experimental quantitat conducted to assess the leve factors of MI among the post- the association of MI risk demographic variables of pos 70 samples were selected for purposive sampling technique hospital in Dehradun. After ta from each study participant, assessment tool (r=0.89) was regarding the risk of Myocard post-MI patients. The Data fo analyzed by using SPSS sof 17.00. evelopment (IJTSRD) d.com v – Dec 2018 018 Page: 1073 n) f Nursing and, India orld varies greatly. More lar diseases occur in the dian Population shows a to risk factors of heart factors, the risk of MI e help of which further ctices will be made that of the deaths in 2012 scular diseases. Majority urred in the developing y rate from the coronary declining; but it is he developing countries. due to the urbanization, ated lifestyle variations, nsition. 2 DS tive research study was el of risk and the risk -MI patients, and to find level with the socio- st-MI patients. The total the final study by using e from the tertiary care aking the written consent , the self-reported risk used to collect the data dial Infarction among the or the final analysis were ftware program version

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Introduction The identification of risk factors is important to reduce the risk of myocardial infarction. Material and Methods A quantitative non experimental research study was conducted to assess the risk level and various risk factors of MI among the post MI patients, and to find the association of risk level of MI with socio demographic variables of post MI patients. Seventy post myocardial infarction patients were selected as sample that was selected by purposive sampling technique from a tertiary care hospital in Dehradun. The data were collected by using self reported risk assessment tool. Results The study results shows that the majority 69 98.6 of the study participants were with the diagnosis of CAD with MI. The majority 64 91.4 of the study participants had not attended any educational programme on CAD Heart disease prevention. The study results shows that majority 58 82.86 of participants were having moderate risk of MI. As per this study the risk factors which were identified for MI were like male with 41 to 60 years, weight more than ideal weight, smoking habits, stress, eating sweet diets, personality type A, no regular exercise and Diabetes mellitus. The association of MI risk level with the co morbidity including diabetes, hypertension or both was statistically significant at the level of 0.05 significance. Conclusion It is concluded that the people after the MI attack had moderate and severe risk of developing MI. Yadav A | Sharma R K | Prakash K | Pugazhendi S "Assessment of MI (Myocardial Infarction) Risk Factors Among Post-MI" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-1 , December 2018, URL: https://www.ijtsrd.com/papers/ijtsrd19154.pdf Paper URL: http://www.ijtsrd.com/other-scientific-research-area/other/19154/assessment-of-mi-myocardial-infarction-risk-factors-among-post-mi/yadav-a

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Page 1: Assessment of MI Myocardial Infarction Risk Factors Among Post-MI

International Journal of Trend in

International Open Access

ISSN No: 2456

@ IJTSRD | Available Online @ www.ijtsrd.com

Assessment Risk Factors Among Post

Yadav A1, Sharma R K1M.Sc. Nursing, 2Associate Professor

Himalayan College of Nursing

ABSTRACT Introduction: The identification of risk factors is important to reduce the risk of myocardial infarction. Material and Methods: A quantitative nonexperimental research study was conducted to assess the risk level & various risk factors of MI among the post-MI patients, and to find the association of risk level of MI with socio-demographic variables of postMI patients. Seventy post-myocardial infarction patients were selected as sample that was selected by purposive sampling technique from a tertiary carehospital in Dehradun. The data were collected by using self-reported risk assessment tool. study results shows that the majority 69 (98.6%) of the study participants were with the diagnosis of CAD with MI. The majority 64 (91.4%) of the studyparticipants had not attended any educational programme on CAD/Heart disease prevention. The study results shows that majority 58 (82.86%) of participants were having moderate risk of MI. As per this study the risk factors which were identified for MI were like male with 41 to 60 years, weight more than ideal weight, smoking habits, stress, eating sweet diets, personality type-A, no regular exercise and Diabetes mellitus. The association of MI risk level with the co-morbidity (including diabetes, hypertension or both) was statistically significant at the level of 0.05 significance. Conclusion:concluded that the people after the MI attack had moderate and severe risk of developing MI. Key Words: Risk factors, Myocardial Infarction, Awareness, Lifestyle practices, Modified Lifestyle Practices, Post-Myocardial infarction

International Journal of Trend in Scientific Research and Development (IJTSRD)

International Open Access Journal | www.ijtsrd.com

ISSN No: 2456 - 6470 | Volume - 3 | Issue – 1 | Nov

www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 2018

Assessment of MI (Myocardial InfarctionRisk Factors Among Post-MI

, Sharma R K2, Prakash K3, Pugazhendi S4 Associate Professor, 3Vice Principal, 4Dean Faculty of Nursing

Nursing, SRHU, Jolly Grant, Dehradun, Uttarakhand

The identification of risk factors is important to reduce the risk of myocardial infarction.

A quantitative non-experimental research study was conducted to assess the risk level & various risk factors of MI among the

MI patients, and to find the association of risk demographic variables of post-

myocardial infarction patients were selected as sample that was selected by purposive sampling technique from a tertiary care hospital in Dehradun. The data were collected by

reported risk assessment tool. Results: The study results shows that the majority 69 (98.6%) of the study participants were with the diagnosis of CAD with MI. The majority 64 (91.4%) of the study participants had not attended any educational programme on CAD/Heart disease prevention. The study results shows that majority 58 (82.86%) of participants were having moderate risk of MI. As per this study the risk factors which were identified for

e like male with 41 to 60 years, weight more than ideal weight, smoking habits, stress, eating

A, no regular exercise and Diabetes mellitus. The association of MI risk

morbidity (including diabetes, sion or both) was statistically significant at

Conclusion: It is concluded that the people after the MI attack had moderate and severe risk of developing MI.

Risk factors, Myocardial Infarction, , Modified Lifestyle

INTRODUCTION The incidence of MI in the world varies greatly. More than 80% of the cardiovascular diseases occur in the developing countries. An Indian Population shows a lack of awareness relating to risk factors of heart diseases. By identifying risk factors, thcan be identified and by the help of which further variations in the lifestyle practices will be macan reduce the risk of MI.1

Globally, about 17.5 million of the deaths in 2012 occurred due to the cardio vascular diseases. Majority (75%) of these deaths occurred in the developing countries where the mortality rate from the coronary heart diseases is rapidly declining; but it is continuously increasing in the developing countries.This type of increase is made due to the urbanization, industrialization, and the related lifestyle variations, known as epidemiological transition. MATERIAL AND METHODSA non-experimental quantitative research study was conducted to assess the level of risk and the risk factors of MI among the post-the association of MI risk demographic variables of post70 samples were selected for the final study by using purposive sampling technique from the hospital in Dehradun. After taking the written consent from each study participant, assessment tool (r=0.89) was used regarding the risk of Myocardial Infarctionpost-MI patients. The Data for the final analysis were analyzed by using SPSS software program version 17.00.

Research and Development (IJTSRD)

www.ijtsrd.com

1 | Nov – Dec 2018

Dec 2018 Page: 1073

Myocardial Infarction)

f Nursing

Uttarakhand, India

The incidence of MI in the world varies greatly. More than 80% of the cardiovascular diseases occur in the developing countries. An Indian Population shows a lack of awareness relating to risk factors of heart

es. By identifying risk factors, the risk of MI the help of which further

variations in the lifestyle practices will be made that

Globally, about 17.5 million of the deaths in 2012 occurred due to the cardio vascular diseases. Majority (75%) of these deaths occurred in the developing countries where the mortality rate from the coronary

es is rapidly declining; but it is continuously increasing in the developing countries. This type of increase is made due to the urbanization, industrialization, and the related lifestyle variations, known as epidemiological transition.2

METHODS experimental quantitative research study was

conducted to assess the level of risk and the risk -MI patients, and to find

risk level with the socio-demographic variables of post-MI patients. The total 70 samples were selected for the final study by using purposive sampling technique from the tertiary care

fter taking the written consent each study participant, the self-reported risk

was used to collect the data regarding the risk of Myocardial Infarction among the

The Data for the final analysis were analyzed by using SPSS software program version

Page 2: Assessment of MI Myocardial Infarction Risk Factors Among Post-MI

International Journal of Trend in Scientific

@ IJTSRD | Available Online @ www.ijtsrd.com

RESULTS 1. Socio-demographic characteristics of the study participants.(A) Frequency & Percentage of Socio

S. No.

Variables

(A) Socio-demographic variables:

1. Age in years : • 36-55 years • 56-75 years

2. Gender : • Female • Male

3. Occupation : • Businessman & Employee • Farmer & Housemaker

4. Co-morbidity : • No • Yes (including hypertension, T

5. Educational status : • Primary & High school • Intermediate and above

6. Marital status : • Married • Widow / Widower

7. Type of Family : • Joint • Nuclear

8. Family history of other illness :• No • Yes

9. Monthly Income (in Rs.) : • < 15000 • > 15000

10. Area of Residence : • Rural • Urban

11.

Have you attended any educational programme on CAD / heart disease prevention : • No • Yes

12. Sources of health related information :• Printed Media (Newspaper).• Electronic Media

13. Type of Personality: • Type A • Type B

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456

www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 2018

demographic characteristics of the study participants. Frequency & Percentage of Socio-demographic variables of the study participants.

Variables Frequency (f)

demographic variables: 30 40 15 55 40 30

(including hypertension, T2 diabetes mellitus, and both)

24 46 45 25 53 17 59 11

Family history of other illness : 42 28 45 25 51 19

Have you attended any educational programme on CAD / heart 64 6

Sources of health related information : Printed Media (Newspaper).

(TV/ Radio/Internet)

20 50 47 23

Table No. 1

Research and Development (IJTSRD) ISSN: 2456-6470

Dec 2018 Page: 1074

of the study participants. N=70

Frequency

Percentage (%)

42.9 57.1 21.4 78.6 57.1 42.9 34.3 65.7 64.3 35.7 75.7 24.3 84.3 15.7 60.0 40.0 64.3 35.7 72.9 27.1 91.4 8.6 28.6 71.4 67.1 32.9

Page 3: Assessment of MI Myocardial Infarction Risk Factors Among Post-MI

International Journal of Trend in Scientific

@ IJTSRD | Available Online @ www.ijtsrd.com

(B) Frequency & Percentage of Clinical variables of the study participants.

S. No. (B) Clinical variables:

1. Diagnosis: • CAD with MI • DCMP with MI

2.

Duration of Illness (when he/she was diagnosed as CAD) :< 1 year 1 – 3 Year 4 – 6 Year

3.

How many times you have suffered MI ?:1 time 2 times 3 times >3 times

4.

Duration of stay in hospital :1 day 2 days 3 days 4 days >4 days

5. Treatment Undergoing/ Underwent Procedure :• CAG with pharmacological management.• CAG, pharmacological management with CAP.

2. Level of risk of MI among study participants

The bar diagram no. 1 shows that majority 58 (82.86%) of participants were having moderate risk of MI. Hence, all the study participants already had MI attack. So, the preon moderate risk or on high risk got the MI attack

3. Description of the various risk factors of the MI among study participants:

0

Moderate risk

High risk

Age (51-60 Years)

Sex (Male 41-60 Years)

Weight above Ideal weight

No regular exercises

Tobacco smoking

Eating Sweet diets

Stress manifestations

Personality type-A

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456

www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 2018

Frequency & Percentage of Clinical variables of the study participants.

Variables Frequency(f)

69 1

Duration of Illness (when he/she was diagnosed as CAD) : 50 16 4

How many times you have suffered MI ?: 27 29 10 4

Duration of stay in hospital : 10 28 21 5 6

Undergoing/ Underwent Procedure : CAG with pharmacological management. CAG, pharmacological management with CAP.

30 40

Table No. 2 Level of risk of MI among study participants

Diagram no. 1 The bar diagram no. 1 shows that majority 58 (82.86%) of participants were having moderate risk of MI. Hence, all the study participants already had MI attack. So, the pre-MI risk shows that all the participants either

the MI attack

Description of the various risk factors of the MI among study participants:

Diagram no. 2

82.86

17.14

20 40 60 80

40

75.754.3

4054.3

67.1

0 20 40 60 80

60 Years)

60 Years)

Weight above Ideal weight

No regular exercises

Tobacco smoking

Eating Sweet diets

Stress manifestations

A

Research and Development (IJTSRD) ISSN: 2456-6470

Dec 2018 Page: 1075

N=70 Frequency Percentage

(%)

98.6 1.4 71.4 22.9 5.7 38.6 41.4 14.3 5.7 14.3 40.0 30.0 7.1 8.6 42.9 57.1

The bar diagram no. 1 shows that majority 58 (82.86%) of participants were having moderate risk of MI. MI risk shows that all the participants either

82.86

100

75.7

82.9

94.3

80 100

Page 4: Assessment of MI Myocardial Infarction Risk Factors Among Post-MI

International Journal of Trend in Scientific

@ IJTSRD | Available Online @ www.ijtsrd.com

As per this study the bar diagram no. 2 illustrates that the risk factors which were identified for MI were like age with the age group of 51 to 60 years, gender including male with 41 to 60 years, weight more than ideal weight, smoking habits, stress, eating sweet diets, personality type 4. Association between Risk Assessment score for MI and selected socio

S. No. Variables

1.

Co-morbidity : • No � Yes (including hypertension,

T2 diabetes mellitus, and both)

The table no. 3 shows that there was statistically significant association between the level of risk of MI and the co-morbidity at the level of 0.05 significance. DISCUSSION The perspectives of the findings have been discussedwith reference to the research problem, concept, objectives with the study findings of other studies. The assessment of level of risk, risk factors assessment of post-MI patients in tertiary care hospital of Dehradun, Uttarakhand was assessed.1. Discussion on the assessment of the level of the

risk of MI among post-MI patients:The findings of the study revealed that the majority 58 (82.86%) of participants were having moderate risk of MI, 12 (17.14%) were having high risk of MI, where as no one was on low risk. The outcomes of the study project are promotedprevious study done by Lanas F, et al. (2007)shows that, the risk factors were reponsibleeight percent of the population-attributable risk 2. Discussion on the risk factors of MI among

post-MI patient: The findings of the study showed that the more than one-third 28 (40%) of the study participants were in the age group of 51 to 60 years. Nearby half 32 (45.7%) of the study participants were males with the age group of 41 to 60 years. The majority 45 (64.3%) of the study participants were without any close relative with CAD. More than half 38 (54.3%) of the study participants were with the body weight of 2 to 8 kg above the ideal weight. About 28 (40%) of the study participants were having active occupation with no regular exercises. More than half 38 (54.3%) of the study participants used to smoke, but now stopped. More than one-fourth 19 (27.1%) of the study participants were non-vegetarian & used to eat foods

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456

www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 2018

As per this study the bar diagram no. 2 illustrates that the risk factors which were identified for MI were like age with the age group of 51 to 60 years, gender including male with 41 to 60 years, weight more than ideal

ing sweet diets, personality type-A, no regular exercise and Diabetes mellitus.

Association between Risk Assessment score for MI and selected socio- demographic variables.N=70

Below Median (< 39)

At & Above

Median (> 39)

Chi-square

df

(including hypertension, diabetes mellitus, and both)

18 13

6 33

13.964

1

0.0001

Table no. 3 The table no. 3 shows that there was statistically significant association between the level of risk of MI and the

morbidity at the level of 0.05 significance.

The perspectives of the findings have been discussed with reference to the research problem, concept, and

with the study findings of other studies. The assessment of level of risk, risk factors

MI patients in tertiary care hospital of Dehradun, Uttarakhand was assessed.

ion on the assessment of the level of the MI patients:

The findings of the study revealed that the majority 58 (82.86%) of participants were having moderate risk of MI, 12 (17.14%) were having high risk of MI, where

promoted by a Lanas F, et al. (2007), which

were reponsible for eighty-attributable risk. 3

of MI among

The findings of the study showed that the more than third 28 (40%) of the study participants were in

the age group of 51 to 60 years. Nearby half 32 (45.7%) of the study participants were males with the

0 years. The majority 45 (64.3%) of the study participants were without any close relative with CAD. More than half 38 (54.3%) of the study participants were with the body weight of 2 to 8 kg above the ideal weight. About 28 (40%) of the

were having active occupation with no regular exercises. More than half 38 (54.3%) of the study participants used to smoke, but now stopped.

fourth 19 (27.1%) of the study vegetarian & used to eat foods

cooked in oil, but don't eat fried foods, cream of milk, butter/ghee, cheese, eggs, etc. Majority 58 (82.9%) of the study participants were used to eats sugar, sweets, cakes, ice-creams, etc. Majority 66 (94.3) of the study participants used to wish to be happy as others to be. Majority 47 (67.1%) of the study participants were having type-A personality. The results of this research projectprevious research study done by RK (2017), which reveals that the risk factors including hyperglycemia, obesity, physical activity, dietary habits, and stress were detected more prevalent in plain area while smoking, hypertension and personality type were more common in hilly area of Uttarakhand.4

3. Discussion on association between the level o

risk score of post-MI patients with their sociodemographic variable:

The present study findings revealed that association of MI risk level with hypertension and diabetes mellitus or both statistically significant. Hence, it participants who were having any co(associated illness), had more risk of MI. The study project findings are study conducted by Leon BM, Maddox TM (2015). The study findings revealed that as the diabetes continues to elevateddiseases - through both of thefactors and the direct response cardiovascular diseases - can also be elevate. 5

Research and Development (IJTSRD) ISSN: 2456-6470

Dec 2018 Page: 1076

As per this study the bar diagram no. 2 illustrates that the risk factors which were identified for MI were like age with the age group of 51 to 60 years, gender including male with 41 to 60 years, weight more than ideal

A, no regular exercise and Diabetes mellitus.

demographic variables.

p- value

Significance

0.0001

Sig

The table no. 3 shows that there was statistically significant association between the level of risk of MI and the

ut don't eat fried foods, cream of milk, butter/ghee, cheese, eggs, etc. Majority 58 (82.9%) of the study participants were used to eats sugar, sweets,

creams, etc. Majority 66 (94.3) of the study participants used to wish to be happy as others seem to be. Majority 47 (67.1%) of the study participants

A personality.

results of this research project are promoted by a done by Rawat H, Sharma

which reveals that the risk factors , obesity, physical activity,

dietary habits, and stress were detected more prevalent in plain area while smoking, hypertension and personality type were more common in hilly area

Discussion on association between the level of MI patients with their socio-

The present study findings revealed that the level with the co-morbidity of

hypertension and diabetes mellitus or both was Hence, it is interpreted that the

participants who were having any co-morbidity (associated illness), had more risk of MI.

findings are promoted by a previous Leon BM, Maddox TM (2015).

The study findings revealed that as the incidence of elevated, linked cardiovascular

of the traditional cardiac risk response of diabetes over can also be anticipated to

Page 5: Assessment of MI Myocardial Infarction Risk Factors Among Post-MI

International Journal of Trend in Scientific

@ IJTSRD | Available Online @ www.ijtsrd.com

CONCLUSION The study concludes that the people, who were on moderate or severe risk of MI, had MI attack. So, conclusion is that the people who have undergone the MI attack they must modify the life style practices, so as to reduce the reoccurrence of MI. ACKNOWLEDGEMENT A successful research is only be conducted by proper guidance & coordination of the researcher. I would like to be very much thankful for the precious guidance from my guide and experts. I extend my special thanks for the validators for validating tools for the study. My heartfelt thanks to all the study subjects for their participation in completion of the study. REFERENCES 1. Saeed O, Gupta V, Dhawan N, Streia L, Shin JS,

Ku M, Bhoi S and Verma S. Knowledge of modifiable risk factors of Coronary Atherosclerotic Heart Disease (CASHD) among a sample in India. 2009; 9: 2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19192310

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456

www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec 2018

people, who were on moderate or severe risk of MI, had MI attack. So, conclusion is that the people who have undergone the MI attack they must modify the life style practices, so

cessful research is only be conducted by proper the researcher. I would

like to be very much thankful for the precious experts. I extend my

special thanks for the validators for validating tools study. My heartfelt thanks to all the study

subjects for their participation in completion of the

Saeed O, Gupta V, Dhawan N, Streia L, Shin JS, Knowledge of

modifiable risk factors of Coronary Atherosclerotic Heart Disease (CASHD) among a

2009; 9: 2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19192310

2. Kayaniyil S, Ardem C, Winstanley J, Parsons C, Brister S, Oh P, Stewart DE and Grace SL. Degree and correlation of cardiac knowledge and awareness among cardiac inpatients. 2009 Apr ;75(1) :99-107. Available from: https://www.ncbi.nlm.nih.gov/pmc/a935489/

3. Lanas F, Avezum A, Bautista LE, Diaz R, Luna M, Islam S, Yusuf S. Risk Factors for Acute Myocardial Infarction in Latin America: The INTERHEART Latin American Study. Circulation. 2007;115:1067http://circ.ahajournals.org/content/115/9/1067

4. Rawat H. (2017). A study to assess various risk factors causing coronary artery disease among population residing in hilly and plain area of selected community area Uttarakhand, India.

5. Leon BM, Maddox TM. (2015).cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes6(13): 1246–1258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600176/

Research and Development (IJTSRD) ISSN: 2456-6470

Dec 2018 Page: 1077

Kayaniyil S, Ardem C, Winstanley J, Parsons C, P, Stewart DE and Grace SL. Degree

and correlation of cardiac knowledge and awareness among cardiac inpatients. 2009 Apr

107. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2

Lanas F, Avezum A, Bautista LE, Diaz R, Luna M, Islam S, Yusuf S. Risk Factors for Acute Myocardial Infarction in Latin America: The INTERHEART Latin American Study. Circulation. 2007;115:1067-1074. Available from: http://circ.ahajournals.org/content/115/9/1067

Rawat H. (2017). A study to assess various risk factors causing coronary artery disease among population residing in hilly and plain area of

community area Uttarakhand, India.

Leon BM, Maddox TM. (2015). Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and

d J Diabetes. 2015 Oct 10; Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4