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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Knowledge on Cardio-cerebrovascular Disease and Health Behaviors among Middle-aged Postmenopausal Women at Risk

Kyung Ae Kim, MSN, RN1, Seon Young Hwang, Ph.D., RN2
Korean Journal of Adult Nursing 2016;28(4):424-435.
Published online: August 31, 2016

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Corresponding author: Hwang, Seon Young College of Nursing, Hanyang University, 222 Wangsimni-ro, Seondong-gu, Seoul 04763, Korea. Tel: +82-2-2220-0702, Fax: +82-2-2220-1163, E-mail: seon9772@hanyang.ac.kr
• Received: May 13, 2016   • Accepted: August 23, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study examined knowledge about cardio-cerebrovascular disease (CVD) and its relationship to health behaviors among middle-aged postmenopausal women with CVD risk factors.
  • Methods
    The study was a cross-sectional descriptive study. One hundred and thirty-six postmenopausal women were recruited from outpatient departments of four hospitals. The women were 60.69±6.5 years old. Self-reported questionnaires were administered, and waist-hip ratios (WHR) were measured.
  • Results
    Among the women, 72.8% reported hypertension, 19.1% reported diabetes, 33.8% reported hypercholesterolemia, and 24.2% reported angina pectoris. Moreover, 73.9% of the women reported not knowing of CVD prevention, and only 26.1% reported exercising regularly. A majority of the women (80.9%) had a WHR > 0.85. Multiple linear regression analysis after adjusting for age and marital status indicated that the risk of myocardial infarction and stroke increased (p<.001). Waist-hip ratio≤0.85 (p=.022) and living with family members (p=.006) were significant predictors of healthier behaviors (R2=0.21, p<.001). Knowledge of CVD and health behaviors were not correlated.
  • Conclusion
    Obese women and women who live alone are no more likely to practice health behaviors aimed at CVD prevention than their counterparts in the sample. Education and exercise interventions are needed, especially for obese women, to promote healthy behaviors among middle-aged postmenopausal women with CVD risk factors.
  • Key Words: Cardiovascular disease; Cerebrovascular disease; Knowledge; Health behavior; Waist-hip ratio
Figure 1.
Percentage of correct answer to myocardial infarction and stroke symptoms and risk factors.
kjan-28-424f1.jpg
Table 1.
Sociodemographic Characteristics of the Participants (N=136)
Characteristics Categories n(%) M±SD
Age (year) 45~59 52 (38.2) 60.7±6.5
60~69 84 (61.8)  
Education level ≥High school 74 (54.4)  
≤Middle school 58 (42.6)  
Marital status Married 104 (76.5)  
Widowed, single, divorced 32 (23.5)  
Living with Spouse or children 105 (82.0)  
Alone 23 (18.0)  
Household monthly income (10,000 won) ＜100 32 (24.1)  
100~300 53 (39.8)  
≥300 48 (36.1)  
Job Yes 43 (32.1)  
None or housewife 91 (67.9)  
Regular physical exercise ≥3/week 48 (26.1)  
＜3/week 51 (38.1)  
None 48 (35.8)  
Age at menopause     50.52±4.11 　
Experience of physical examination Yes 89 (65.9)  
No 46 (34.1)  
Education experience for CVD prevention Yes 36 (26.5)  
No 100 (73.5)  
Information source on CVD Television 81 (64.8)  
Hospital 37 (29.6)  
Public health center & newspaper 7 (5.6)  
Perceived risk of CVD incidence Occasionally & frequently 101 (74.3)  
None 35 (25.7)  
Awareness of AMI and stroke in the usual I know well & try to be careful 100 (73.5)  
Not mind 36 (26.5)  
Expected action when witnessed stroke or heart attack Call 119 117 (86.1)  
I don't know 19 (13.9)  
Awareness of CVD risk increase after menopause I know 56 (41.5)  
I don't know 79 (58.5)  
Hormone therapy experience Yes 29 (24.5)  
No 89 (75.5)  
Table 2.
Disease-related Characteristics of the Participants (N=136)
Variables Categories n(%) M±SD
Risk factors for CVD† Hypertension 99 (72.8)  
Diabetes 26 (19.1)  
Dyslipidemia 46 (33.8)  
Angina 33 (24.2)  
Arrhythmia, fat liver, arthritis 25 (18.3)  
CVD risk classification High risk‡ group
At risk§ group		 52 (38.2)
84 (61.8)		  
Family history† Yes 65 (47.8)  
Hypertension 40 (29.4)  
Angina, CAOD, Stroke 38 (28.0)  
Diabetes 22 (16.2)  
Etc 2 (1.5)  
Waist-hip ratio (n=131) ＞0.85 106 (80.9) 0.93±0.75
≤0.85 25 (19.1)
Body mass index (kg/m2) ≤25 41 (30.1) 24.93±4.03
＞25~29 37 (27.2)
≥30 58 (42.7)
Waist-height ratio (n=131) ＞0.52 53 (40.5) 0.54±0.08
≤0.51 78 (59.5)

CVD=cardiocerebrovascular disease; CAOD=coronary artery occlusive disease;

†Multiple response;

‡High risk includes the presence of documented CVD, diabetes, end-stage renal disease, 10-year predicted risk for CVD ≥10%;

§At risk includes the presence of ≥1 major risk factors, metabolic syndrome, evidence of subclinical vascular disease, treated hypertension.

Table 3.
Knowledge and Health Behavior for CVD Prevention (N=136)
Variables Categories n (%) or M±SD
Knowledge for CVD prevention Nicotine in cigarettes makes it increased your blood pressure, pulse 98 (72.1)
Even if you smoke yourself, secondhand smoke is harmful to health 133 (97.8)
Moderate exercise is good treatment for smoking cessation 103 (75.7)
After drinking alcohol shed a lot of sweat in the sauna Alcoholic minutes to exit the sweat liquor wakes up soon 110 (80.9)
Regardless of the amount of drinking, do not drink at least three days in order to protect the liver 91 (66.9)
Egg yolk, quail egg, and shrimp should be restricted because it contains a lot of cholesterol 104 (76.5)
When consumed for a long time, salty foods can be elevated blood pressure 125 (91.9)
Excessive intake of high-carbohydrate (rice, bread, chocolate, coffee, etc.), it would increase the triglycerides 99 (72.8)
Fiber foods is good to prevent the accumulation of cholesterol and obesity 113 (83.1)
Weight control is helpful in hypertension, diabetes, hyperlipidemia prevention 125 (91.9)
Exercises reduces LDL increases the HDL 115 (84.6)
It is effective in preventing metabolic syndrome that shorten the high intensity (running, soccer) than to continue the light exercises (walking, cycling slowly) 71 (52.2)
Rapid and nervous personalities are more vulnerable to stress than relaxed and optimistic personality 119 (87.5)
Health behavior for CVD prevention Regularly measure blood pressure 3.53±1.14
Regularly measure blood glucose 2.66±1.36
According to the doctor's prescription and taking medication 4.16±1.04
It has received regular checks complications 3.21±1.33
Has maintaining a standard body weight 2.76±1.19
It maintains a waist circumference within the normal range 2.69±1.17
Keeping the amount of food 3.15±1.16
Maintain a low salt diet 3.02±1.23
Each time you eat a meal of vegetables other than kimchi. 3.54±1.01
30 minutes/once, and exercise more than 3 times a week 2.85±1.44
30 minutes/once, and exercise more than 5 times a week 2.49±1.37
Do not drink 4.35±1.04
No smoking 4.69±0.94
It has good stress management 3.07±1.16
Sleep more than seven hours a day enough 2.94±1.26
Sum 49.10±9.64

CVD=cardio-cerebrovascular disease; HDL=high-density lipoprotein; LDL=low-density lipoprotein.

Table 4.
Predicting Factors on Health Behavior for CVD Prevention (N=136)
Variables B SE β t p
(Constant) 24.71 10.34   2.39 ＜.001
Age 0.14 0.13 .09 1.10 .274
Marital status 2.10 1.06 .19 1.98 .057
Living with family 6.27 2.27 .26 2.76 .007
Waist-hip ratio (≤0.85) 4.49 1.97 .19 2.28 .024
Awareness of AMI and stroke in the usual 3.25 0.86 .31 3.77 ＜.001
R2=.21, Adjusted R2=.17, F=6.05, p＜.001

CVD=cardio-cerebrovascular disease; AMI=acute myocardial infarction.

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Figure & Data

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    Knowledge on Cardio-cerebrovascular Disease and Health Behaviors among Middle-aged Postmenopausal Women at Risk
    Korean J Adult Nurs. 2016;28(4):424-435.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.424
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    Knowledge on Cardio-cerebrovascular Disease and Health Behaviors among Middle-aged Postmenopausal Women at Risk
    Korean J Adult Nurs. 2016;28(4):424-435.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.424
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    Knowledge on Cardio-cerebrovascular Disease and Health Behaviors among Middle-aged Postmenopausal Women at Risk
    Image
    Figure 1. Percentage of correct answer to myocardial infarction and stroke symptoms and risk factors.

    Figure 1.

    Knowledge on Cardio-cerebrovascular Disease and Health Behaviors among Middle-aged Postmenopausal Women at Risk

    Sociodemographic Characteristics of the Participants (N=136)

    Characteristics Categories n(%) M±SD
    Age (year) 45~59 52 (38.2) 60.7±6.5
    60~69 84 (61.8)  
    Education level ≥High school 74 (54.4)  
    ≤Middle school 58 (42.6)  
    Marital status Married 104 (76.5)  
    Widowed, single, divorced 32 (23.5)  
    Living with Spouse or children 105 (82.0)  
    Alone 23 (18.0)  
    Household monthly income (10,000 won) ＜100 32 (24.1)  
    100~300 53 (39.8)  
    ≥300 48 (36.1)  
    Job Yes 43 (32.1)  
    None or housewife 91 (67.9)  
    Regular physical exercise ≥3/week 48 (26.1)  
    ＜3/week 51 (38.1)  
    None 48 (35.8)  
    Age at menopause     50.52±4.11 　
    Experience of physical examination Yes 89 (65.9)  
    No 46 (34.1)  
    Education experience for CVD prevention Yes 36 (26.5)  
    No 100 (73.5)  
    Information source on CVD Television 81 (64.8)  
    Hospital 37 (29.6)  
    Public health center & newspaper 7 (5.6)  
    Perceived risk of CVD incidence Occasionally & frequently 101 (74.3)  
    None 35 (25.7)  
    Awareness of AMI and stroke in the usual I know well & try to be careful 100 (73.5)  
    Not mind 36 (26.5)  
    Expected action when witnessed stroke or heart attack Call 119 117 (86.1)  
    I don't know 19 (13.9)  
    Awareness of CVD risk increase after menopause I know 56 (41.5)  
    I don't know 79 (58.5)  
    Hormone therapy experience Yes 29 (24.5)  
    No 89 (75.5)  

    Disease-related Characteristics of the Participants (N=136)

    Variables Categories n(%) M±SD
    Risk factors for CVD† Hypertension 99 (72.8)  
    Diabetes 26 (19.1)  
    Dyslipidemia 46 (33.8)  
    Angina 33 (24.2)  
    Arrhythmia, fat liver, arthritis 25 (18.3)  
    CVD risk classification High risk‡ group
    At risk§ group    		 52 (38.2)
    84 (61.8)    		  
    Family history† Yes 65 (47.8)  
    Hypertension 40 (29.4)  
    Angina, CAOD, Stroke 38 (28.0)  
    Diabetes 22 (16.2)  
    Etc 2 (1.5)  
    Waist-hip ratio (n=131) ＞0.85 106 (80.9) 0.93±0.75
    ≤0.85 25 (19.1)
    Body mass index (kg/m2) ≤25 41 (30.1) 24.93±4.03
    ＞25~29 37 (27.2)
    ≥30 58 (42.7)
    Waist-height ratio (n=131) ＞0.52 53 (40.5) 0.54±0.08
    ≤0.51 78 (59.5)

    CVD=cardiocerebrovascular disease; CAOD=coronary artery occlusive disease;

    †Multiple response;

    ‡High risk includes the presence of documented CVD, diabetes, end-stage renal disease, 10-year predicted risk for CVD ≥10%;

    §At risk includes the presence of ≥1 major risk factors, metabolic syndrome, evidence of subclinical vascular disease, treated hypertension.

    Knowledge and Health Behavior for CVD Prevention (N=136)

    Variables Categories n (%) or M±SD
    Knowledge for CVD prevention Nicotine in cigarettes makes it increased your blood pressure, pulse 98 (72.1)
    Even if you smoke yourself, secondhand smoke is harmful to health 133 (97.8)
    Moderate exercise is good treatment for smoking cessation 103 (75.7)
    After drinking alcohol shed a lot of sweat in the sauna Alcoholic minutes to exit the sweat liquor wakes up soon 110 (80.9)
    Regardless of the amount of drinking, do not drink at least three days in order to protect the liver 91 (66.9)
    Egg yolk, quail egg, and shrimp should be restricted because it contains a lot of cholesterol 104 (76.5)
    When consumed for a long time, salty foods can be elevated blood pressure 125 (91.9)
    Excessive intake of high-carbohydrate (rice, bread, chocolate, coffee, etc.), it would increase the triglycerides 99 (72.8)
    Fiber foods is good to prevent the accumulation of cholesterol and obesity 113 (83.1)
    Weight control is helpful in hypertension, diabetes, hyperlipidemia prevention 125 (91.9)
    Exercises reduces LDL increases the HDL 115 (84.6)
    It is effective in preventing metabolic syndrome that shorten the high intensity (running, soccer) than to continue the light exercises (walking, cycling slowly) 71 (52.2)
    Rapid and nervous personalities are more vulnerable to stress than relaxed and optimistic personality 119 (87.5)
    Health behavior for CVD prevention Regularly measure blood pressure 3.53±1.14
    Regularly measure blood glucose 2.66±1.36
    According to the doctor's prescription and taking medication 4.16±1.04
    It has received regular checks complications 3.21±1.33
    Has maintaining a standard body weight 2.76±1.19
    It maintains a waist circumference within the normal range 2.69±1.17
    Keeping the amount of food 3.15±1.16
    Maintain a low salt diet 3.02±1.23
    Each time you eat a meal of vegetables other than kimchi. 3.54±1.01
    30 minutes/once, and exercise more than 3 times a week 2.85±1.44
    30 minutes/once, and exercise more than 5 times a week 2.49±1.37
    Do not drink 4.35±1.04
    No smoking 4.69±0.94
    It has good stress management 3.07±1.16
    Sleep more than seven hours a day enough 2.94±1.26
    Sum 49.10±9.64

    CVD=cardio-cerebrovascular disease; HDL=high-density lipoprotein; LDL=low-density lipoprotein.

    Predicting Factors on Health Behavior for CVD Prevention (N=136)

    Variables B SE β t p
    (Constant) 24.71 10.34   2.39 ＜.001
    Age 0.14 0.13 .09 1.10 .274
    Marital status 2.10 1.06 .19 1.98 .057
    Living with family 6.27 2.27 .26 2.76 .007
    Waist-hip ratio (≤0.85) 4.49 1.97 .19 2.28 .024
    Awareness of AMI and stroke in the usual 3.25 0.86 .31 3.77 ＜.001
    R2=.21, Adjusted R2=.17, F=6.05, p＜.001

    CVD=cardio-cerebrovascular disease; AMI=acute myocardial infarction.
    Table 1. Sociodemographic Characteristics of the Participants (N=136)

    Table 2. Disease-related Characteristics of the Participants (N=136)

    CVD=cardiocerebrovascular disease; CAOD=coronary artery occlusive disease;

    Multiple response;

    High risk includes the presence of documented CVD, diabetes, end-stage renal disease, 10-year predicted risk for CVD ≥10%;

    At risk includes the presence of ≥1 major risk factors, metabolic syndrome, evidence of subclinical vascular disease, treated hypertension.

    Table 3. Knowledge and Health Behavior for CVD Prevention (N=136)

    CVD=cardio-cerebrovascular disease; HDL=high-density lipoprotein; LDL=low-density lipoprotein.

    Table 4. Predicting Factors on Health Behavior for CVD Prevention (N=136)

    CVD=cardio-cerebrovascular disease; AMI=acute myocardial infarction.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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