To our knowledge, this was the first study that assessed the knowledge and awareness of CVD risk factors in medical students and evaluated the effect of internal medicine rotations. The results showed that medical students, whether or not they completed their internal medicine rotation, had relatively good knowledge on the contribution of major risk factors to CVD, namely dyslipidemia, hypertension, diabetes and smoking. However, their knowledge about risk factors control and treatment (e.g. therapeutic targets and options) was extremely lacking. They were also less knowledgeable about their own CVD risk.
CVD is currently the major cause of death and disability, claiming almost 3 million lives annually, which amounted of nearly 30% of all deaths in China . The personal and economic impacts of CVD are devastating and are increasing. According to the INTERHEART study, 9 modifiable risk factors account for more than 90% of attributable risk for CVD globally, and smoking, dyslipidemia, diabetes mellitus and hypertension are the four strongest risk factors for CVD in China . It is therefore encouraging that both 3rd year and 4th year students had relatively good knowledge on the contribution of these four major risk factors to CVD. Over 90% of students of the two groups correctly identified that high LDL-C level, low HDL-C level, diabetes mellitus and smoking markedly increased chances of CVD, which is consistent with those of other countries [13, 14]. It was, as expected, much better than the knowledge of other adolescents of their age [15, 16]. In addition, current evidence has indicated that exposure to passive smoking can lead to a 70–80% increase in the risk of CVD, nearly as much as light smoking . Our results showed that the situation in reference to passive smoking is satisfactory. More than 80% of both group of students thought that passive smoking could have detrimental effects indistinguishable from active smoking.
Medical students are a target group of particular interest in many studies as they are future physicians, researchers and educators. Unfortunately, our results show that most of the students were unfamiliar with the latest Chinese guidelines for prevention of CVD, even at the end of internal medicine rotation . Although the knowledge of therapeutic targets for some risk factors was better among the 4th year students than the 3rd year students, it was still far from sufficient. About half of the 4th year students did not know the target blood pressure level for high-risk patients after the internal medicine rotation. It is worth noting that more than 90% of students would prescribe cholesterol-lowering therapy to high-risk patients; however, it was obvious that students had limited knowledge about some details of CVD risk factors treatment. The students from both groups were less aware that fibrates offer the most triglyceride reduction as monotherapy and optimal management of combined dyslipidemia. Only about 40% of the students in each group correctly indicated that regular exercise and dietary management could affect total cholesterol and HDL-C levels. In addition, students from both groups have long indicated that they feel their medical curriculum does not provide enough education about prevention and management of CVD. Therefore, based on the current medical education, it is not surprising that several recent studies have shown a failure to achieve the recommended targets for major risk factors in China [18–20]. Besides medical students, the fundamental knowledge of risk factors control among Chinese community physicians was also astonishingly poor according to a recent study, showing only 24% and 14% of the physicians reported the right optimal LDL-C level for CHD and diabetes patients, respectively .
In addition, there is sparse data about health status, particularly for CVD risk factors among Chinese medical students. In this study we found that although most medical students were aware that diabetes and dyslipidemia are the major causes of CVD, most of them were unfamiliar with their own blood glucose level and lipid profile. The most current data available by Popkin and colleagues showed that 1.7 million Chinese adolescents and children are diabetic and about 27.7 million are pre-diabetic. The percentage of diabetes among Chinese teenagers was four times as much as their American peers, and approximately 42% of Chinese children and adolescents have at least one of the following CVD factors: pre-diabetes or diabetes, hypertension, high TC, LDL-C, TG, or low HDL-C . Other large national surveys of serum lipids and lipoproteins have indicated that the mean serum total and LDL cholesterol and triglyceride levels were high and increasing in the Chinese population. Furthermore, the awareness, treatment, and control rates of hypercholesterolemia were relatively low . In view of the medical students as part of the young adult group, our results highlight the necessity for institutes and hospitals to assess health status and effective prevention of CVD in China targeting adolescents. They also need to learn how to evaluate their own CVD risk, and practice good health behaviors, as well as lifestyle choices.
There are several limitations in the present study. One of them is the subjective type of questions, which is not possible to be eliminated completely. Another limitation is that we compared two different grades of students, the contents and patterns of medical education they received might have been different. Further studies should evaluate the change at the beginning and the end of medical education in same population of medical students, to investigate whether medical education is sufficient in increasing the awareness of the need for prevention in cardiology. Finally, the number of individuals that included in this study was rather small. There is an urgent need to conduct assessments in a larger population to know if Chinese young medical students understand the importance of CVD risk factors that can affect their future health and practice.