An optimal state of cardiovascular health, as outlined by the American Heart Association, encompasses seven components, including health behaviors and factors, which comprise maintaining a healthy diet, engaging in ≥150 min of moderate physical activity, maintaining a body mass index (BMI) ≤25 kg/m², having normal blood pressure, normal glucose levels, normal cholesterol levels, and not smoking [1]. Globally, cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality, resulting in substantial social and economic costs [2]. The total number of CVD cases, deaths, and disability-adjusted life years have increased [2-4]. Furthermore, CVDs are non-communicable diseases that pose an alarming threat to human health and are the leading cause of decreased quality of life (QoL) [3],[5].

Cardiovascular risk factors are associated with an increased occurrence of developing CVD. Cardiovascular risk factors include age, sex, smoking, physical inactivity, family history, abnormal cholesterols and low-density lipoproteins, obesity, high blood pressure, and diabetes [6]. CVD risk factors are classified into modifiable and non-modifiable. The non-modifiable ones include age, sex, race, and heredity [7]. CVDs are prevented by altering the modifiable risk factors, which include physical activity, tobacco usage, alcohol consumption, and dietary intake [7]. Addressing modifiable risk factors is essential for mitigating the morbidity and mortality associated with CVD. Some risk factors significantly increase CVD risk. Furthermore, the risk of myocardial infarction (heart attack) and ischemic stroke increases over time, making CVD complex and multifaceted [6].

The QoL of undergraduates varies significantly based on their workloads, social interactions, extracurricular activities, and personal circumstances. Balancing academic responsibilities, personal time, and social engagement is key to maintaining a positive QoL. Effective time management, self-care, and seeking support when needed are essential for students [8],[9].

CVD prevalence in sub-Saharan Africa has increased, constituting >20% of total fatalities and 7% of disability-adjusted life years. Nigeria has experienced an increase in CVD owing to urbanization and westernization, with CVD now contributing to 11% of mortalities. The increased susceptibility to CVD among undergraduates is associated with modifiable risk factors that stem from their behaviors and lifestyles.

Understanding how behaviors and lifestyle choices contribute to an increased risk of CVD among undergraduates is crucial. Research on the relationship between cardiovascular risk factors and QoL is limited. This study aimed to determine the relationship between cardiovascular risk factors and QoL among undergraduates.

Research Design and Population

This was a cross-sectional study. We recruited 364 students from the departments of Medical Rehabilitation, Nursing Science, Environmental Health Science, Human Nutrition and Dietetics, Medical Laboratory Science, Radiography, Human Physiology, and Human Anatomy who had never had a cardiac problem in the College of Health Sciences, Nnamdi Azikiwe University, Nnewi campus, Nigeria.

We excluded students who were sick during the study, taking antibiotics, insulin, lipid-lowering drugs, or contraceptives. Additionally, students with a history of hypertensive heart disease, heart failure, or any underlying cardiac disease were also excluded. We also considered factors such as glycemic index and cholesterol levels in our analysis.

Data Collection

Ethical approval was obtained from the Faculty of Health Sciences and Technology, Ethical Review Committee of Nnamdi Azikiwe University, Nnewi Campus. This study strictly adhered to the Declaration of Helsinki. Information, such as age, sex, and medical history, was collected. We objectively measured their weight, height, BMI, and blood pressure, and we administered the International Stress Management Association and World Health Organization QoL Brief Version questionnaires. The Framingham risk score was used to predict CVD risk.

Statistical Analysis

Data were analyzed using SPSS version 25. Data are presented as mean ± standard deviation, frequencies, and percentages. Spearman rank order correlation was used to determine the correlation between cardiovascular risk, stress level, and QoL. Statistical significance was set at P<0.05.

Socio-demographic profiles of the participants A total of 364 undergraduates, comprising 186 males (51.1%) and 178 females (48.9%), participated in this study. The participants had a mean age of 22.80±2.35 years, BMI of 23.85±4.44 kg/m2, and systolic blood pressure of 125.21±16.10 mmHg (Table 1).

Table 1: Socio-demographic profiles of the participants.

Cardiovascular Risk, Stress Level, and Qol of the Participants

The mean cardiovascular risk of the participants was 0.98±1.14, representing a low cardiovascular risk. The mean stress level among the participants was 12.32±3.80, representing a moderate stress level. The participants’ QoL domain scores passed the 50th percentile, with the participants scoring the highest and lowest in general health and environmental domains, respectively (Table 2). Most participants (98.9%) had low cardiovascular risks, with a few (1.1%) having a moderate risk. Most participants (56.9%) experienced moderate stress levels, followed by high (39.6%) and low stress levels (3.6%) (Table 3).

Table 2: Cardiovascular risk, stress level, and quality of life amongst undergraduates.

Table 3: Cardiovascular risk and stress levels amongst undergraduates.

Spearman Rank Order Correlation between Cardiovascular Risk, Stress Level, and Qol among Undergraduates

A significant positive correlation was observed between cardiovascular risk and stress levels among the participants (rho=0.153; P=0.003), indicating that individuals with higher stress levels had significantly higher cardiovascular risk. Aside from the environmental health domain of the QoL, cardiovascular risk had a significant negative correlation with other QoL domains (P<0.05), indicating a higher cardiovascular risk for individuals with lower QoL. The stress levels of the participants had a significant negative correlation with each of their QoL domains (P<0.05), indicating that individuals with higher stress levels also had poorer QoL scores (Table 4).

Table 4: Spearman rank order correlation between cardiovascular risk, stress level, and quality of life among undergraduates.

This study aimed to determine the relationship between cardiovascular risk factors and QoL among undergraduates at the College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus. The mean BMI and systolic blood pressure were within normal limits, which could be attributed to the role of health education, potential sex differences, and health behavior patterns, which is similar to previous studies, except for different sex differences [10],[11].

The mean cardiovascular risks of the participants, using the Framingham risk score, were low. The low cardiovascular risk observed is attributed to the participants' relatively young age and their enrollment in a college of health, indicating a higher level of health-related education, which is similar to a previous study [12].

Most participants had moderate stress levels, followed by high and low stress levels, which may be linked to academic pressures, the challenging environment of medical college, personal responsibilities, and the implementation of effective adaptive coping mechanisms. This is similar to a previous study [13].

The participants had QoL domain scores exceeding the 50th percentile. The participants exhibited the highest and lowest scores in the general health and environmental domains, respectively. The inclination towards higher scores in the general health domain may stem from a perceived sense of control and personal responsibility for well-being among participants. This positive perception of individual health may also be influenced by the emphasis on personal health and patient care in medical education. However, lower scores in the environmental domain may be attributed to factors like living conditions, campus environment, or local surroundings. These external factors can contribute to participants rating their environmental well-being less favorably.

These findings are similar to those reported, where participants had the highest scores in the general health domain (76.94), while they had the lowest scores in the environmental health domain (56.06), with all QoL domain scores exceeding the 50th percentile [14]. These findings suggest a strong pattern in how participants evaluate their QoL, emphasizing the importance of general health and potential challenges in the environmental health domain. In contrast, a study reported higher environment domain scores than other domains [15]. The reasons for this could be variations in disciplines, student populations, schools, and geographic areas.

Cardiovascular risk had a significant negative correlation with the general health and physical domains of QoL among undergraduates, implying that the higher the cardiovascular risk, the lower the general health or domains of QoL. This could be associated with the demanding nature and workload in health colleges that lead to reduced sleep, restricted mobility, fatigue, and challenges in completing everyday tasks. This contributes to a decline in the physical domain and general health.

Cardiovascular risk had a significant negative correlation with psychological and social domains of QoL among undergraduates, implying that the higher the cardiovascular risk, the lower the psychological and social domains of QoL. This could be attributed to increased stress, limitations in social activities, social isolation, and low socioeconomic status, which is similar to previous studies that categorized psychosocial risk factors related to QoL into two groups: (1) emotional factors, encompassing affective disorders like depression, anxiety, anger, and hostility; (2) chronic stressors, including low socioeconomic status, limited social support, work-related stress (academic stress owing to workload), marital stress, and caregiver strain in connection with CVDs [16-18]. Psychosocial risk factors were prevalent among individuals with CVD, indicating that developing CVDs owing to increased cardiovascular risk could lead to a decline in the psychological and social domains of QoL.

No significant correlation was observed between cardiovascular risk and the environmental health domain. Recognizing other factors, such as environmental challenges, exposure to environmental pollutants and stressors, pollution, climate, access to clean water and air, or proximity to potential environmental hazards, may contribute to environmental health, and further research should be conducted to understand better the complex interplay between cardiovascular risk and environmental health.

The stress levels of the participants had a significant negative correlation with each of their QoL domains, implying that individuals with higher stress levels also had poorer QoL. The stress is attributed to factors such as academic pressure, perfectionist standards, and the demanding nature of the healthcare practice, involving emotionally stressful situations that could have contributed to a deterioration in the QoL domains, which is similar to a previous study [19]. Therefore, the impact may not be limited to impairments in student QOL but could potentially affect patient care and relationships with patients. This study had some limitations. This study's cross-sectional design limits the ability to establish causality between cardiovascular risk factors and quality of life among undergraduates. Additionally, the self-reported nature of some data may introduce bias, and the focus on students from health-related fields may not be generalizable to the broader undergraduate population.

Ethical Considerations

Consent to Participate

The participants provided written informed consent.

Consent for Publication

Not applicable.

Declaration of Conflicting Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding Statement

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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