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Original Research (Original Article) 


Abdullah Muzil Albadrani et al, 2020;4(3):593–599.

International Journal of Medicine in Developing Countries

Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study

Abdullah Muzil Albadrani1,Saleh Sulaiman Al-Ajlan1, Abdullah Saer E. Alharbi1, Abdulelah Saud Alharbi1, Saif Mohammed Radhi Alharbi1

Correspondence to: Abdullah Muzil Albadrani

*Qassim College of Medicine, Qassim, Saudi Arabia.

Email: abdull4h95 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 22 December 2019 | Accepted: 31 December 2019


ABSTRACT

Background:

Coronary artery disease is a severe cardiovascular disorder and remains one of the major causes of death in adults older than 35 years. Saudi patients have a significantly higher prevalence of risk factors for coronary artery disease than the western population. Although there is no definite cure for coronary artery disease, the mainstay in the prevention of disease by tight control of risk factors. Thus, the current study aims to assess public awareness of coronary artery disease risk factors in Saudi Arabia.


Methodology:

A cross-sectional study was conducted in Qassim during August 2019 to September 2019 by using online survey questionnaire to assess participants' awareness of 12 coronary artery disease risk factors, namely: obesity, smoking, lack of physical activity, fast food intake, soft drink intake, age risk, cardiovascular disease, hyperlipidemia, diabetes mellitus, and hypertension; as well as, family history of cardiovascular disease, hyperlipidemia, diabetes mellitus, and hypertension.


Results:

Among the total of 1,041 respondents, 22.4% were male. The mean age was 23.26 ± 6.55 years. Approximately, 99.7% were Saudi and almost 71.3% had a university education. Smoking, obesity, hyperlipidemia, and fast food intake were the most commonly identified risk factors, reported as 95.1%, 94%, 87.8%, and 87.1% of participants.


Conclusion:

In this study, we aimed to assess the public awareness of coronary artery disease risk factors. The study showed that there is a clear lack of knowledge and awareness of coronary artery disease risk factors in Qassim, Saudi Arabia. We recommended that the healthcare sector in Saudi Arabia should focus on public health education programs about the disease.


Keywords:

Public, awareness, coronary artery disease, risk factors, Qassim, Saudi Arabia.


Introduction

Coronary artery disease (CAD) is a major public health problem worldwide and considered as one of a serious cardiovascular disorder that affecting approximately men and women in developed countries [14]. Although the clear reduction in coronary heart disease associated mortality, CAD still one of the tremendous death causes in adults over 35 years. Hence, emphasis on its primary and secondary prevention was given great attention by health authorities in western countries [3]. In the Middle Eastern regions; the prevalence of CAD has been reported to range from 5.4% to 13.4%. [5,6]. In Saudi Arabia, there is a clear lack of data concerning the actual prevalence of CAD, but in 2004 a prevalence of 5.5% was reported among individuals between 30 and 70 years [7]. CAD is characterized by atherosclerosis in coronary arteries and can be asymptomatic, and is usually used to refer to the pathologic process affecting the coronary arteries (usual atherosclerosis) [8,9]. The prevention of CAD disease is the major core to reduce CAD-associated morbidity and mortality. This because of all existence highly effective therapies for CAD that should be taken for life and a curative agent remains elusive. Tight control of risk factors is critical to prevent CAD. Several risk factors for CAD have been shown. They are either modifiable risk factor (i.e., hypertension, hypercholesterolemia, smoking, diabetes mellitus, lack of physical activity, obesity, and psychological stress) or non-modifiable risk factors (such as old age, male gender, family history of CAD, and certain ethnicities) [10]. CAD risk factors burden is significantly high in the Middle Eastern region, including Saudi Arabia [5]. It was noted that patients in the Middle East have at least three risk factors for the disease. In addition, hypertension was epidemic in >80% of these patients, smoking and diabetes were approximately widespread among half of the patients, and dyslipidemia was prevalent among at least one third [5]. Moreover, the great majority of those patients had at least one uncontrolled risk factor that reflecting poor awareness about the disease [5]. A study in Saudi Arabia reported similar results and data, at which approximately half of the patients had at least three risk factors, obesity, and hypertension, were found in half of the patients, and three quarters had dyslipidemia [6]. Another study in Al-Qassim, Saudi Arabia, reported that physical inactivity (74%) and overweight/obesity, (25%/29%) were the most common risk factors, as well as women over the age of 30, have a higher number of risk factors than the younger women (20–24 years) [11]. Awareness and knowledge and about the risk factors for CAD are essential for the prevention of the disease, not only among physicians but also among the general public. Therefore, the objective of the present work was to assess public awareness levels of the risk factors for CAD in Qassim, Saudi Arabia.


Subjects and Methods

A cross-sectional study was conducted in Qassim, Saudi Arabia during the period from August 2019 to September 2019 by using an online survey questionnaire to assess participants’ awareness of CAD risk factors. Participants were selected randomly through volunteer sampling, meaning that any volunteer was welcome to complete the study questionnaire without any limitation in age or sex. The questionnaire consisted of two parts: one to collect sociodemographic criteria and another one to assess the awareness about CAD risk factors. At the end of the questionnaire, an email was provided for any inquiries from the participants about any unclear questions. The socioeconomic variables included that were in the questionnaire were participants’ age, gender, nationality, social status, functional status, and level of education. Such diseases specified to the family and personal medical histories, such as hypertension, diabetes mellitus, and dyslipidemia (high cholesterol or triglycerides levels), were also included in the questionnaire. CAD risk factors awareness was assessed through yes/no questions asking the respondents even though they believed or not certain factors were risk factors for CAD. Twelve CAD risk factors were included in the questionnaire, namely: obesity, smoking, lack of physical activity, fast food intake, soft drink intake, age risk, cardiovascular disease, hyperlipidemia, diabetes mellitus, and hypertension; as well as, family history of cardiovascular disease, hyperlipidemia, diabetes mellitus, and hypertension. All data were analyzed using Statistical Packages for Social Sciences (SPSS) version 21. A p-value cut off point of 0.04 at 95% CI used to determine statistical significance. Numbers and percentages were used to presents all categorical variables while the mean ± standard deviation was used to summarize all continuous variables. Data were exactly protected for confidentiality when conducting this study. Ethical approval was obtained before starting data collection.

Table 1. Demographic characteristics of all respondents (n = 1041).

Characteristics Variables N (%)
Age Age 1041 (100)
Gender Male 233 (22.4)
Female 808 (77.6)
Nationality Saudi 1038 (99.7)
Non-Saudi 3 (2.1)
Housing Qassim 1041 (100)
Social status Single 835 (80.2)
Married 187 (18)
Divorced 19 (1.8)
Functional status Student 689 (66.2)
Unemployed 240 (23.1)
Employee 112 (10.8)
Educational level Primary 1 (0.1)
Intermediate 5 (0.5)
Secondary 222 (21.3)
Diploma 57 (5.5)
BA 742 (71.3)
M.A. 11 (1.1)
Ph.D. 3 (0.3)

Results

A total of 1,041 participants responded. Male participants comprised 22.4% of the recruited participants (n = 233). Saudi respondents constituted the largest percentage and almost came close to the total eye were reached (99.7%) of the respondents. The mean ± SD age of all study participants was 23.26 ± 6.55 years. All the respondents (100%) live in Qassim. More than half (80.2%) of the respondents were single, and 66.2% were students. Concerning the Educational level, 71.3% have a BA (Table 1). Among the demographic variables, only social and functional status were statistically significantly different among the studied participants (p-values are <0.05) (Table 2). Awareness for coronary artery disease of all respondents in frequencies and percentages is presented in Table 3. Considering awareness of risk factors, the awareness scores ranged from 0 to 12 with a mean ± SD of 8.360 ± 1.879. In taking of the fast food was found to be the risk factor that the participants were most frequently (84%) aware of. Most respondents drink soft drinks (69.3%) in addition to (50.4%) of the respondents whose families were diabetic. Table 4 presented awareness of the different CAD risk factors studied. Table 5 presents a comparison of awareness of each of the risk factors included in the questionnaire with the mean awareness score. It was noted that awareness of each risk factor for CAD has not significantly associated with public awareness, except Do you have high blood pressure? (p-values are <0.05).The relation between awareness and the demographic variable (educational level); and between awareness and risk among respondents was highly significant p-values are (0.01) as presented in Tables 6 and 7, respectively.

Table 2. Comparison of the awareness score across the demographic characteristics among participants’ groups (n = 1,041).

Characteristics Variables Mean ± SD p-value
Age Age 23.26 ± 6.55 0.475
Gender Male 8.338 ± 1.764 0.343
Female 8.363 ± 1.879
Nationality Saudi 7.333 ± 2.082 0.152
Non-Saudi 8.304 ± 1.829
Social status Single 8.583 ± 2.055 0.000
Married 8.632 ± 2.166
Divorced 8.218 ± 1.850
Functional status Student 8.458 ± 1.787 0.025
Unemployed 9.027 ± 2.094
Employee 8.000 ± 2.366
Educational level Primary 7.790 ± 2.128 0.475
intermediate 8.324 ± 1.801
Diploma 8.425 ± 1.837
Secondary 8.636 ± 2.730
BA 5.667 ± 5.132
M.A. 8.438 ± 2.235
Ph.D. 8.338 ± 1.764

Table 3. Awareness for coronary artery disease of all respondents in frequencies and percentages (total 12 risk factors) (n = 1,041).

Awareness N (%)
Do you think smokers are more likely to develop the cardiovascular disease?
No 51 (4.9)
Yes 990 (95.1)
Do you think that not exercising regularly (at least 30 minutes of walking a day for 5 days) increases the incidence of cardiovascular disease?
No 212 (20.4)
Yes 829 (79.6)
Do you think eating fast food increases the risk of cardiovascular disease?
No 134 (12.9)
Yes 907 (87.1)
Do you think that soft drinks increase the risk of cardiovascular disease?
No 396 (38)
Yes 645 (62)
Do you think age is related to cardiovascular disease?
No 423 (40.6)
Yes 618 (59.4)
Do you think that having a family member with heart disease increases your risk of cardiovascular disease?
No 724 (69.5)
Yes 317 (30.5)
Do you think that high cholesterol increases the risk of cardiovascular disease?
No 127 (12.2)
Yes 914 (87.8)
Do you think high blood sugar (diabetes) increases the risk of cardiovascular disease?
No 471 (45.2)
Yes 570 (54.8)
Do you think obesity increases the risk of cardiovascular disease?
No 62 (6)
Yes 979 (94)
Do you think that anxiety and stress increase the risk of cardiovascular disease?
No 236 (22.7)
Yes 805 (77.3)
Do you think that males are more likely to develop cardiovascular disease than females?
No 730 (70.1)
Yes 311 (29.9)
Do you think that high blood pressure increases the risk of cardiovascular disease?
No 223 (21.4)
Yes 818 (78.6)

Discussion

The current study showed that there is a clear lack of knowledge and awareness of CAD risk factors among the general public in Saudi Arabia. It is well known that the adequate knowledge and awareness of individual risk factors for the development of CAD is necessary to prevent the disease and to reduce its mortality [12,13]. Educating the population about modifiable risk factors is the key strategy to reduce the incidence and spread of the disease [14,15]. While the large majority of participants who completed the survey questionnaire were highly educated (71.3% had university education), the highest overall score was 12. The overall awareness of the 12 risk factors was included in the survey questionnaire ranged from 0 to 12, with an average of 8.360 ± 1.879. The mean age of the studied sample was 23.26 years as young age and this young age may be due to distributing the survey online and that most elderly people in Saudi Arabia do not use the Internet. These results were in harmony with that result of Almalki [16]. who also reported the mean age of the studied sample was 32 years. Similar to the present results, much of the literature from different developing African countries and Middle Eastern countries that have reported inadequate awareness of CAD risk factors among the general public [17,18]. In addition to Ammouri et al. [19] who reported that among 114 respondents from Oman studied in 2012, ~60% had a bit knowledge scores regarding CAD risk factors. Similarly, a study in Cameroon, Aminde [20] found that more than half of the recruited participants (53%) of 1,162 participants had a significant lack of knowledge about the CAD risk factors. On the other hand, in a study conducted in American, (1,702 participants) approximately half of the participants had adequate knowledge about CAD. Seven risk factors questions about CAD were included in the questionnaire, and 37% of participants could identify all of them; average participants could identify 4.9 factors [21]. Another study was conducted also in the United States and reported that among 3,226 American–Indian participants, awareness about CAD risk factors was 90% for most risk factors [22]. The inadequate knowledge and awareness among the general public in Saudi Arabia in this study may reflect unsuitable public health education, and this indicates the necessity of urgent intervention from healthcare authorities in Saudi Arabia to enhance the education of the public about coronary heart disease. In the present study, negative dietary behaviors (such as junk food and soft drinks) were the most common risk factors among the study participants, and physical activity deficiency decreased by 84%, 69.3%, and 73.9% of respondents, respectively. The most common family disease known that was a risk factor for CAD was a family history of diabetes was. It was identified by 62.5% of participants. A family history of hypertension, dyslipidemia, CAD was determined. In a study was conducted in the United States, obesity was found to be the most commonly recognized risk factors for CAD, hypertension, and dyslipidemia (identified by more than three-quarters of respondents), while diabetes mellitus, dietary habits, and exercise were identified by only ~65% of participants [21]. The overall awareness scores of the participants in this study were positively correlated with awareness of each factor. Participants who identified that smoking, diabetes, lack of physical activity, bad eating habits, history of lung disease, history of vascular stroke, family history of diabetes, dyslipidemia, hypertension, or CAD are more likely to have higher levels of public awareness, That is, they were more aware of risk factors than who did not identify these risk factors as CAD risk factors. This underscores the importance of educating the public in Saudi Arabia about CAD, risk factors and prevention techniques. The results of this study indicated that educational efforts should be made targeting different segments of the population in Saudi Arabia, especially from lower socioeconomic classes. Such limitation to the present study that it was a cross-sectional study that may have led to differential misclassification so, the results of this study can't be generalized to the whole population, and we recommend conducting a further study on a multicentric basis to cover wider population.

Table 4. Awareness of risk factors for coronary artery disease of all respondents in frequencies and percentages (total 12 risk factors) (n = 1,041).

Are you a smoker?
No 979 (94)
Yes 62 (6)
Do you exercise regularly?
No 769 (73.9)
Yes 272 (26.1)
Do you eat fast food?
No 167 (16)
Yes 874 (84)
Do you drink soft drinks?
No 320 (30.7)
Yes 721 (69.3)
Have you ever been diagnosed with cardiovascular disease?
No 998 (95.9)
Yes 43 (4.1)
Do you suffer from high cholesterol (diagnosed by a doctor)?
No 990 (95.1)
Yes 51 (4.9)
Is there a patient with high cholesterol in the family (father-mother - brothers)?
No 651 (62.5)
Yes 390 (37.5)
Are you diabetic?
No 1023 (98.3)
Yes 18 (1.7)
Is there a diabetic patient in the family (father-mother - brothers)?
No 516 (49.6)
Yes 525 (50.4)
Do you have high blood pressure?
No 1,008 (96.8)
Yes 33 (3.2)
Is there a hypertensive patient in the family (father-mother- brothers)?
No 528 (50.7)
Yes 513 (49.3)
Is there a member of your family (father-mother- brothers) that has already been diagnosed with cardiovascular disease by a doctor?
No 776 (74.5)
Yes 265 (25.5)

Table 5. Relationship between mean awareness score and knowledge regarding CAD risk factors. (n = 1,041).

CAD risk factors Awareness Mean ± SD p-value
Do you smoke? No 8.354 ± 1.831 0.693
Yes 8.452 ± 2.539
Do you exercise regularly? No 8.372 ± 1.881 0.736
Yes 8.327 ± 1.876
Do you eat fast food? No 8.252 ± 1.855 0.415
Yes 8.381 ± 1.884
Do you drink soft drinks? No 8.525 ± 1.828 0.059
Yes 8.287 ± 1.898
Have you ever been diagnosed with cardiovascular disease? No 8.365 ± 1.877 0.710
Yes 8.256 ± 1.941
Do you suffer from high cholesterol (diagnosed by a doctor)? No 8.342 ± 1.873 0.178
Yes 8.706 ± 1.973
Is there a patient with high cholesterol in the family (father - mother - brothers)? No 8.313 ± 1.919 0.299
Yes 8.439 ± 1.810
Are you diabetic? No 8.348 ± 1.872 0.113
Yes 9.056 ± 2.209
Is there a diabetic patient in the family (father-mother - brothers)? No 8.298 ± 1.928 0.293
Yes 8.421 ± 1.830
Do you have high blood pressure? No 8.329 ± 1.868 0.003
Yes 9.303 ± 1.992
Is there a hypertensive patient in the family (father-mother - brothers)? No 8.271 ± 1.961 0.119
Yes 8.452 ± 1.788
Is there a member of your family (father-mother- sibling) that has already been diagnosed with cardiovascular disease by a doctor? No 8.333 ± 1.901 0.415
Yes 8.442 ± 1.815

Table 6. The relationship between awareness and education level of respondents.

Educational level Correlation coefficient p-value
Degree of awareness 0.112 0.01

Table 7. The relationship between awareness and risk among respondents.

Risk factors among respondents Correlation coefficient p-value
Degree of awareness 0.072 0.01

Conclusion

In this study, we aimed to assess public awareness of coronary artery disease risk factors. The study showed that there is a clear lack of knowledge and awareness of coronary artery disease risk factors in Qassim, Saudi Arabia. Therefore, we recommended that the healthcare sector in Saudi Arabia focusing on public health education programs about CAD to reduce the incidence and prevalence of this serious disease.


List of Abbreviations

CAD Coronary artery disease
SPSS Statistical Packages for Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was approved by local Research Ethics Committee at Almaarefa university.


Author details

Abdullah Muzil Albadrani1,Saleh Sulaiman Al-Ajlan1, Abdullah Saer E. Alharbi1, Abdulelah Saud Alharbi1, Saif Mohammed Radhi Alharbi1

  1. Qassim College of Medicine, Qassim, Saudi Arabia

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How to Cite this Article
Pubmed Style

Albadrani AM, Al-Ajlan SS, Alharbi ASE, Alharbi AS, Alharbi SMR. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. IJMDC. 2020; 4(3): 593-599. doi:10.24911/IJMDC.51-1572217065


Web Style

Albadrani AM, Al-Ajlan SS, Alharbi ASE, Alharbi AS, Alharbi SMR. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. http://www.ijmdc.com/?mno=71363 [Access: March 28, 2020]. doi:10.24911/IJMDC.51-1572217065


AMA (American Medical Association) Style

Albadrani AM, Al-Ajlan SS, Alharbi ASE, Alharbi AS, Alharbi SMR. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. IJMDC. 2020; 4(3): 593-599. doi:10.24911/IJMDC.51-1572217065



Vancouver/ICMJE Style

Albadrani AM, Al-Ajlan SS, Alharbi ASE, Alharbi AS, Alharbi SMR. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. IJMDC. (2020), [cited March 28, 2020]; 4(3): 593-599. doi:10.24911/IJMDC.51-1572217065



Harvard Style

Albadrani, A. M., Al-Ajlan, . S. S., Alharbi, . A. S. E., Alharbi, . A. S. & Alharbi, . S. M. R. (2020) Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. IJMDC, 4 (3), 593-599. doi:10.24911/IJMDC.51-1572217065



Turabian Style

Albadrani, Abdullah Muzil, Saleh Sulaiman Al-Ajlan, Abdullah Saer E. Alharbi, Abdulelah Saud Alharbi, and Saif Mohammed Radhi Alharbi. 2020. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. International Journal of Medicine in Developing Countries, 4 (3), 593-599. doi:10.24911/IJMDC.51-1572217065



Chicago Style

Albadrani, Abdullah Muzil, Saleh Sulaiman Al-Ajlan, Abdullah Saer E. Alharbi, Abdulelah Saud Alharbi, and Saif Mohammed Radhi Alharbi. "Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study." International Journal of Medicine in Developing Countries 4 (2020), 593-599. doi:10.24911/IJMDC.51-1572217065



MLA (The Modern Language Association) Style

Albadrani, Abdullah Muzil, Saleh Sulaiman Al-Ajlan, Abdullah Saer E. Alharbi, Abdulelah Saud Alharbi, and Saif Mohammed Radhi Alharbi. "Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study." International Journal of Medicine in Developing Countries 4.3 (2020), 593-599. Print. doi:10.24911/IJMDC.51-1572217065



APA (American Psychological Association) Style

Albadrani, A. M., Al-Ajlan, . S. S., Alharbi, . A. S. E., Alharbi, . A. S. & Alharbi, . S. M. R. (2020) Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study. International Journal of Medicine in Developing Countries, 4 (3), 593-599. doi:10.24911/IJMDC.51-1572217065