Document Type : Original Article(s)


1 PhD Student, Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 Instructor, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Biostatistics and Epidemiology AND Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Cardiovascular diseases (CVD) are the second leading cause of death, after accidents, in Iran. This study was performed to assess the change in levels of knowledge about 8 risk factors of CVD and its associated determinants the Iranian general population.METHODS: The current repeated cross-sectional study included 3014 people in 2004, 3012 in 2005, and 4719 in 2007, aged older than 19 years. Knowledge about 8 risk factors (high blood pressure, nutrition, physical inactivity, smoking, diabetes, heredity, stress, and obesity) as the major causes of CVD was evaluated using latent transition analysis (LTA).RESULTS: The most widely known CVD risk factors were nutrition and physical inactivity followed by stress. In addition, old age, low level of education, male gender and low socioeconomic status (SES) level were the significant determinants of low knowledge levels of CVD risk factors. Besides, individuals’ knowledge of CVD risk factors increased across the time.CONCLUSION: Public knowledge of CVD risk factors has increased; however significant gaps continue to exist, particularly among the elderly, less-educated people, people in low socioeconomic status level and men. Future intensified educational efforts by policymakers are necessary for improving knowledge of CVD, particularly among high-risk groups.


  1. Mukattash TL, Shara M, Jarab AS, Al-Azzam SI, Almaaytah A, Al Hamarneh YN. Public knowledge and awareness of cardiovascular disease and its risk factors: a cross-sectional study of 1000 Jordanians. Int J Pharm Pract 2012; 20(6): 367-76.
  2. Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study. Arch Iran Med 2013; 16(3): 138-44.
  3. World Health Organization. Cardiovascular diseases (CVDs) [Online]. [cited 2013]; Available from: URL:
  4. World Health Organization. Noncommunicable diseases (NCD) country profiles [Online]. [cited 2014]; Available from: URL:
  5. Alm-Roijer C, Stagmo M, Uden G, Erhardt L. Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease. Eur J Cardiovasc Nurs 2004; 3(4): 321-30.
  6. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004; 113(1 Pt 1): 112-8.
  7. Nasrabadi T, Goodarzi Zadeh N, Shahrjerdi A, Hamta A. The Effect of Education on Life Style Among Patients Suffering from Ischemic Heart Disease. J Mazand Univ Med Sci 2010; 20(79): 72-9. [In Persian].
  8. Kim EM, Hwang SY, Kim AL. Knowledge of stroke and heart attack symptoms and risk factors among rural elderly people: a questionnaire survey.Korean Circ J 2011; 41(5): 259-64.
  9. Kirkland SA, MacLean DR, Langille DB, Joffres MR, MacPherson KM, Andreou P. Knowledge and awareness of risk factors for cardiovascular disease among Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992. CMAJ 1999; 161(8 Suppl): S10-S16.
  10. Schneider AT, Pancioli AM, Khoury JC, Rademacher E, Tuchfarber A, Miller R, et al. Trends in community knowledge of the warning signs and risk factors for stroke. JAMA 2003; 289(3): 343-6.
  11. Lynch EB, Liu K, Kiefe CI, Greenland P. Cardiovascular disease risk factor knowledge in young adults and 10-year change in risk factors: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol 2006; 164(12): 1171-9.
  12. Winham DM, Jones KM. Knowledge of young African American adults about heart disease: a crosssectional survey. BMC Public Health 2011; 11: 248.
  13. Mosca L, Jones WK, King KB, Ouyang P, Redberg RF, Hill MN. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women's Heart Disease and Stroke Campaign Task Force. Arch Fam Med 2000; 9(6): 506-15.
  14. Hickey A, Holly D, McGee H, Conroy R, Shelley E. Knowledge of stroke risk factors and warning signs in Ireland: development and application of the Stroke Awareness Questionnaire (SAQ). Int J Stroke 2012; 7(4): 298-306.
  15. Zeng Y, He GP, Yi GH, Huang YJ, Zhang QH, He LL. Knowledge of stroke warning signs and risk factors among patients with previous stroke or TIA in China. J Clin Nurs 2012; 21(19-20): 2886-95.
  16. Reeves MJ, Rafferty AP, Aranha AA, Theisen V. Changes in knowledge of stroke risk factors and warning signs among Michigan adults. Cerebrovasc Dis 2008; 25(5): 385-91.
  17. Ebrahimi-Mameghani M, Toupchian O, Farsad Naimi A, Nurmohammadi A. Womens knowledge and attitude toward cardiovascular diseases risk factors and its relation with obesity and biochemical factors. Med J Tabriz Univ Med Sci 2011; 33(2): 7-12. [In Persian].
  18. Sabzevari S, Mohammad Alizadeh S, Borhani P, Pishcar Mofrad Z. Kerman population's knowledge,attitude and practice about prevention of myocardial infarction. J Rafsanjan Univ Med Sci 2002; 1(4): 275-84. [In Persian].
  19. Jalali F, Haj Ahmadi M, Hosseinpour M, Zaman Angari M, Asadi A. Knowledge, attitude and practice of Babol's population towards clinical symptoms and risk factors of cardiovascular disease. J Babol Univ Med Sci 2004; 6(1): 43-9. [In Persian].
  20. Mazloomi Mahmodabadi SS, Shahbazi H, Motlagh Z, Momeni Sarvestani M, Sadeghzadeh J. The study of knowledge, attitude and practice of Yazd restaurant chefs in preventing cardiovascular diseases risk factors in 2010. Toloo-E-Behdasht 2011; 10(1): 14-27. [In Persian].
  21. Sadeghian S. The knowledge of hospitalized patients about major risk factors of i.h.d in university hospitals of Tehran. Daneshvar Med 2001; 8(35): 55-60. [In Persian].
  22. Dostkam H, Hosseinian E, Fatehi GH. Prevalence of myocardial infarction without ST segment in patients with primary diagnosis of unstable angina in the Ardabil Bouali hospital. J Ardabil Univ Med Sci 2006; 6(1): 37-43. [In Persian].
  23. Sarrafzadegan N. Study of knowledge and practice of Isfahan city's population about cardiovascular disease risk factors. Nabz 1996; 4(5): 18-26.
  24. Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi FN, Shahrokhi S, et al. Isfahan Healthy Heart Programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
  25. Sarrafzadegan N, Baghaei A, Kelishadi R, Malekafzali H, Boshtam M, Amani A, et al. Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevention and Control 2006; 2(2): 73-84.
  26. Collins LM, Lanza ST. Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. New York, NY: Wiley; 2010.
  27. Roohafza H, Sadeghi M, Shirani S, Bahonar A, Mackie M, Sarafzadegan N. Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran. Croat Med J 2009; 50(4): 380-6.
  28. Maracy MR, Feizi A, Bagherynejad M. The prevalence and correlated determinants of hypertension and type 2 diabetes: A large community-based study in Isfahan, Iran. Pak J Med Sci 2012; 28(2): 247-52.