Behavioral and psychosocial risk factors of coronary heart disease at young men and students of the city of Tashkent: prevalence, interrelations



The Cardiovascular Diseases (CD) among which the main share is the share of the coronary heart disease (CHD) are the most acute medical issue in industrially developed countries of the world including in Uzbekistan. Most studies discussed depression and anxiety as an important disorder that results in increase of cardiovascular incidents, re-admittance to hospital, and death in coronary artery patients. High level of disability and mortality from an ischemic heart disease among an able-bodied part of the population, high financial costs of treatment result in the significant economic damage [13] and define expediency of the scientific research directed to studying of the risk factors (RF) and mechanisms of development of an ischemic heart disease. Despite achievements of the modern medicine, process of mortality from an ischemic heart disease is noted that causes need of studying of FR of development of an ischemic heart disease among youth [4].

It became possible to obtain information on true scales of prevalence of the ischemic heart disease and factors influencing its development thanks to epidemiological approach in a preventive cardiology [11]. The most perspective in this plan is studying of the state of health of student's youth as this group of the population of Uzbekistan should realize such important social functions of society as professional, intellectual and moral [5]. Besides, from the practical point of view, studying of behavioral FR of an ischemic heart disease is represented especially urgent at young age as during this period of a population ontogenesis expression of biological factors is minimized [3].

However, psychosocial factors are not recognized clinically. Cardiologists frequently state that the psychosocial factors identified in the literature are not apparent in clinical practice. There are probably three reasons for this. First, psychosocial factors are risks rather than inevitable causes; they vary widely in importance for different patients, and will not be apparent in every case. Second, psychological characteristics such as hostility may only be elicited under appropriate provocation. Therefore, they are unlikely to be expressed during a typical clinical consultation. Finally, there is a tendency to search for psychosocial explanations only for patients who do not have other clear risk factors such as hypertension, diabetes, or smoking. Many clinicians work based on implicit models that place biological and psychosocial causes as alternatives. However, psychosocial factors may be associated with other risk factors. Among behavioral FR the most significant are — tobacco smoking, alcohol overconsumption, irrational food, low physical activity [4]. All these factors are caused by deformations of a modern way of life [5] and at the same time they are the most perspective for correction, both on individual, and at the population level. At the same time, a number of authors indicate that only a half of cases of emergence of CHD [10] is explained by dynamics of conventional FR. In this regard the increasing attention in scientific literature is paid to a problem of studying of psychosocial or not conventional FR CHD [2, 9]. Carry to not conventional FR: level of psych emotional pressure, personal uneasiness, depression, social gradient, knowledge and attitude towards health, etc. [1, 10]. So far the works devoted to studying of not conventional FR CHD in student's population aren't enough [4, 8].

Nature of relations of behavioral and psychosocial FR CHD remains a discussion subject. In this regard not only studying of quantity and quality characteristics of behavioral and psychosocial FR among young people, but also nature of their interrelation is obviously important. The analysis of works on questions of prevention of CHD among student's youth allows to draw a conclusion on certain gaps in scientific research in this national group [11]. Carrying out similar researches is especially urgent because implementation of preventive actions in early terms when it is created and there was no stereotype of an unhealthy conduct of life yet, is most perspective [3, 4]. Requiring scientific reasons the questions concerning knowledge of student's youth of FR CHD, a self-assessment and the attitude towards the health are insufficiently studied. Single scientific works are devoted to studying of medical activity of student's youth [3,11] while assessment of needs and requirements of specific population concerning preventive measures is a basis of development of the concept of quality of rendering the treatment-and-prophylactic help to the population [2, 10]. Along with studying of behavioral and psychosocial FR CHD in focal national groups, studying of knowledge of doctors of primary link of health care of modern problems CHD and their preventive readiness for correction of behavioral and psychosocial factors [9, 11] remains a priority problem. Especially the problem of participation of doctors of primary link of health care in prevention of tobacco smoking as representative of «Big Triad» of FR CHD is particularly acute. These literatures show that neither the cardio logical service, nor public health care manage to control effectively this FR in all national groups [5,11] yet.

The solution of the scientific problems designated above especially urgent in student's population of Tashkent which is traditionally positioned as the center of education, innovations and science in the Federation and where every sixth inhabitant is a student [2, 14]. So far complex researches of behavioral and psychosocial FR by an ischemic heart disease in student's population of Tashkent weren't conducted.

Research objective: To establish prevalence of behavioural and psychosocial risk factors of coronary heart disease and their interrelation at young men of students of the higher educational institutions (HEI) of Tashkent for improvement of a disease-prevention service in this group of the population.

Research problems:

1. To study prevalence behavioral (tobacco smoking, alcohol consumption, an irrational delivery, excess weight a body/obesity, low physical activity) and psychosocial (a psych emotional strain, personal uneasiness, a depression) ischemic heart disease FR at young men of students of the leading Higher Education Institutions of Tashkent.
2. To establish interrelation of tobacco smoking with other behavioral and psychosocial FR of an ischemic heart disease in the surveyed population.
3. To investigate interrelation of tobacco smoking with separate biological parameters at young men of students.
4. To define knowledge, the attitude towards the health and prophylaxis of CHD at young men of students of the 3rd course of Higher Education Institutions of Tashkent.
5. To estimate knowledge of experts of primary link of health care concerning modern aspects of prophylaxis of tobacco smoking and their readiness for carrying out preventive measures.

Scientific novelty of aresearch

Data on prevalence in the examined group of the population behavioral (tobacco smoking, alcohol consumption, an irrational delivery, low physical activity, excess weight a body/obesity) ischemic heart disease FR are new. It is shown that the examined group of the population is characterized by high prevalence of smoking, low physical activity, an irrational delivery, alcohol consumption.

For the first time among young men of students of the leading Higher Education Institutions of Tashkent with use of standard methods of epidemiological diagnostics prevalence psychosocial (a psych emotional strain, personal uneasiness, a depression) by ischemic heart disease FR depending on a profile of the got education is studied. It is shown that prevalence of separate categories of a psych emotional strain and personal uneasiness doesn't concede in the surveyed population to conventional risk factors.

It is established that in the surveyed population the status of smoking is bound to behavioral FR of an ischemic heart disease (alcohol consumption frequency, the level of physical activity) and separate biological parameters, and also to knowledge of influence of smoking on health of an individual.

Knowledge, the knowledge/attitude towards the health and prophylaxis of CHD at young men of students of Tashkent is for the first time studied. Unsatisfactory knowledge of students concerning prophylaxis CHD and low availability to them of the relevant information which is followed by high medical activity, readiness to bear responsibility for the health is taped and to participate in preventive actions.

New data concerning knowledge, readiness for preventive measures and equipment by methodical materials concerning prophylaxis of tobacco smoking among health workers of primary link of health care are received.

Practical importance

1. Revealed unfavorable epidemiological situation regarding behavioral and psychosocial risk factors of CHD among youth students from leading universities of Tashkent. The necessity of the development and implementation of measures of primary and secondary prevention, taking into account the identified patterns in the population studied.
2. The advantages of epidemiological diagnostic methods that identify features of population prevalence of coronary artery disease risk factors, which is important in the formation of a differentiated approach to the preventive measures among university students, taking into account the profile of the education.
3. The data on awareness, attitudes towards their health and prevention of CVD among students young men are the basis for the creation of science-based information and educational technologies for this population.
4. Revealed laws in relation to the awareness, attitudes towards the prevention of smoking among physicians in primary care use in the process of preparation and practice of health professionals. Developed a manual for physicians on smoking prevention is recommended for use in primary care to improve patient care who wish to stop smoking.
5. The data are the basis for further monitoring of the epidemiological situation and planning for the primary prevention against cardiovascular risk factors studied among university students and can be used in primary health care to assess the health status of the students and the allocation among these groups at high risk of CHD.

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