 Kurdistan Journal of Applied Research (KJAR) Print-ISSN: 2411-7684 | Electronic-ISSN: 2411-7706 Website: Kjar.spu.edu.iq | Email: kjar@spu.edu.iq Patient’s Information Toward Some Modifiable Risk Factors of Ischemic Heart Disease Bayan Omar Sharif Aras Hamad Rasul Health Development and Training Center Nursing Department Directorate of Health- Slemani Administration Collage of Nursing Ministry of Health University of Raparin Slemani, Iraq Rania, Iraq Omerbayan82@gmail.com arashamad92@gmail.com Osman Ibrahim Mahmud Farman Nuri Abdulla Nursing Department Nursing Department Collage of Nursing Collage of Nursing University of Raparin University of Raparin Rania, Iraq Osman.ebrahim.7374@gmail.com Rania, Iraq farman.ns7090@uor.edu.krd Article Info ABSTRACT Volume 5 – Special Issue: 4th International Conference on the Health and Medical Science : Medical Researches Improve Life Quality (ICHMS 2020) DOI: 10.24017/science.2020.ICHMS2020.4 Article history: Received: 26 September 2020 Accepted: 04 October 2020 Ischemic heart disease (IHD), , is the condition of heart problems, caused by narrowed coronary arteries that supply oxygenated blood to the heart muscle. There is a shortage of study of bachelor students. The goal of this research was directed to assess level of patient’s information toward some modifiable risk factors of IHD at Rania teaching hospital in Kurdistan region of Iraq during the period of (20th October 2019 - 10th February 2020). A non- probability purposive sample of (143) patients; the study instrument was constructed of total (42) items for the purpose of data collection. The content validity of the instrument was determined through a panel of (12) experts. Reliability of the instrument was determined through the use of internal consistency reliability (split half) approach which was estimated as r = (0.83) the data were collected through the use of interview technique (face to face approach), the computer files is used to organizing and coding it. The data analyzed by Statistical approaches which includes: descriptive and inferential statistical and chi- square, data analysis (SPSS version 25). The outcome showed that most of the sample rang from the age (25- 40) years and most of them were male from urban, more than half of them were unemployed but nearly half of them were graduated from primary school. 32.2% of them diagnosed by cardiovascular disease. However more than half of them had a high level of information about IHD as a general, and the TV was the first source of their information but more than half Keywords: Ischemic heart disease, Patients, Rania Teaching Hospital, modifiable risk factors mailto:Omerbayan82@gmail.com Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 28 of them were overweight, 65% did not do regular exercise, 52.4% were relatively stressful. Also, the study demonstrated that there is no significant association between socio demographic data and level of patient’s information toward some modifiable risk factors of IHD, with age, gender, educational level and occupation with IHD, at p value greater than 0.05. The study recommended to ministry of health and directorate of health in Rania city to develop and supervise the center of dietary regimen and halls of exercise for the people to implement their information and practice it. Copyright © 2020 Kurdistan Journal of Applied Research. All rights reserved. 1. INTRODUCTION Ischemic heart disease or coronary heart disease is a coronary blood flow reduction caused by coronary artery atherosclerosis, also it often used to describe this syndrome and it is the leading cause of death and disability worldwide. Cardiovascular diseases (CVD) are one of the most serious problems of modern times [1]. According to the European Society of Cardiology (ESC) coronary artery disease (CAD) is defined as an episode of a reversible condition between the nutrient needs of the cardiac muscle and its demand that is associated with ischemia or hypoxia [2]. Aging of the population is one of the high occurrence frequency of predisposing factors for IHD, also it still the most frequent cause of deaths in the world. According to the World Health Organization (WHO), the number of deaths that return to IHD will increase from seven millions and two hundred thousand in 2002 to nearly eleven millions in 2020 [3]. Modifiable risk factor which collect the most frequent factors that can be eliminated or minimized by changing the lifestyle such as stressful situation, smoking cigarette, elevated glucose, hypertension, visceral obesity, lipid disorders and thrombotic conditions [4]. Both of traditional and non-traditional risk factors are contribute to developing of IHD in female and male [5]. Overweight or obesity, physical inactivity; unhealthy diet and stressful condition are other risk factors of IHD [6]. Healthy lifestyle and continuous interventions for prevention, is useful to reduce occurrence of CAD event rates greatly [7]. Healthy dietary pattern that emphasizes nutrient dense foods will significantly benefit public health; because high amount of sugars, sodium and Cholesterol in daily food lead to increasing CVD risk [8]. The higher consume of fruit and vegetable during young adulthood was associated with lower odds of prevalent coronary artery calcium [9]. Obesity, hypertension, dyslipidemia, and type 2 diabetes mellitus in humans are affected by excessive sugar consumption because it is playing a significant role in the epidemics of insulin resistance. Evidence on the relationship between eating of sugar and cardiovascular health has emerged since the last American heart association (AHA) scientific statement was published [10]. An expansion in cardiovascular yield with physical exercise and expanded skeletal muscle perfusion brings about increased myocardial oxygen request. Since myocardial oxygen extraction from the blood is as of now nearly seventy to eighty percent at resting conditions, the support of myocardial oxygen and supplement supply transcendently relies upon coronary blood stream. It has been demonstrated that customary exercise preparing prompts useful and morphologic changes of the vascular tree related with decreased coronary vascular obstruction [11]. Ischemic heart disease is a pathophysiological condition caused by the disproportion between the myocardial oxygen demand and its supply. Nutrition of the myocardium depends on the oxygen capacity of the blood and the amount of coronary flow [12]. The mortality from IHD has radically reduced throughout the last decades in western nations with greater focus on primary prevention and enhanced possible diagnosis and management of this disease, Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 29 the western lifestyles due to higher prevalence of cardiovascular risk factors while health care systems globalization often improved the adoption and still it is the main global cause of death according to the estimation of World health organization (WHO) and it accounted more than nine million deaths in 2016 especially in developing countries [13]. Epidemiological studies showed that smoking cigarette, lack of physical activity, unhealthy and irregular nutrition, stress, influences the behavior of health to a greater extent than genetic factors, quality of medical care or environmental conditions are considered as the elimination of harmful risk factors [14]. Excellent patient’s information can assist with treating numerous patients’ issues. Without great data forthright, it is exceptionally hard for any patient to settle on the correct choice with regards to their wellbeing and what treatment plan that best suits for them. In any case, when included, a well-educated patient is bound to stay with their concurred treatment plan than one who does not [15]. The ability of patients to read and understand the words and numbers they come across in a healthcare setting, is the term used to describe Health literacy. Most adults are comfortable reading healthy information written in language that could be understood by a typical twelve years old, but one in every five adults finds this difficult. More established individuals may have extra difficulties in the event that they have issues with seeing, hearing or thinking. Individuals with decreased wellbeing proficiency can benefit from outside intervention to comprehend complex thoughts if the specialist talks gradually, utilizing ordinary words, or if data is given in short areas instead of at the same time [16]. The support of nursing in cardiovascular recovery patients can improve wellbeing results and diminish the danger of another heart occasion. the most consequence for medical caretakers to meet the rehabilitative consideration requirements of clients through instruction, backing, observation and fortification, Recovering from heart issues mentally and genuinely is a perplexing procedure that the patients need proceed with care after release from the emergency clinic; and here and there after the cardiovascular sickness occasions the patients experience numerous issues concerning the consequence of the ailment or restoration, remembering worry about the arrival for their ordinary life. So the upsides of enough nursing help and the executives in cardiovascular restoration patients can improve wellbeing results and diminish the danger of another heart occasion. One of the most essential apparatus to meet the rehabilitative consideration needs of patients through guidance, backing, guideline and fortification is nursing practice [17]. The nurse plays a vital role in detecting and helping the patient's discomfort on a regular basis; that is the reason it is significant for attendants to apply clinical rules to the consideration of heart patients so as to lessen their suffering [18]. Additionally the expert or professional nurses assume a huge job in diminishing the worldwide weight and taking an interest to improving the result of the individual and networks, so the nurses also need knowledge and skill or practices that will help them to function as the contributor in a multidisciplinary team in solving cardiovascular disease [19]. 2. METHODS AND MATERIALS The present study was carried out through the application of quantitative design, a descriptive study and it was conducted patients at Rania teaching hospital in Rania city that has been implemented to assess Patient’s Information toward some modifiable risk factors of Ischemic Heart Disease at Rania teaching hospital during the period of 20th October 2019 to 10th February 2020. Administrative Arrangements An approval was issued for the instrument of the study, permission was granted from the College of Nursing/ University of Raparin, and Rania Directorate of Health to carry out this study at the Rania teaching Hospital in Rania district. Study setting The study was approved from Rania teaching Hospital (medical, surgical, coronary care unit and consultant unit for outpatients) in Rania city which are the main wards of this hospital. Sample of the Study Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 30 Non-probability (purposive sample) of (143) patients, (93) males and (50) females who were visited consultant unit and admitted in the medical, surgical and coronary care unit at Rania teaching Hospital. Criteria of including the study sample Both adult genders, males and females patients who were visited consultant unit and admitted in to medical, surgical and coronary care unit in Rania teaching hospital. Criteria for excluding the study sample Patients who refused to be interviewed or could not participate in the study. Tool of the study For the purpose of data collection, the study tool was constructed and based on extensive review of related literature and studies to assess patient’s level of information regarding ischemic heart disease. The study tool is composed of two parts which were distributed through the followings: (Part 1): Socio Demographic and clinical characteristics of the study This part consists of age, gender, marital status, monthly income, occupation, level of educational, residential area, body mass index (Part2): patient’s information and habit toward some modifiable risk factors of IHD, which include: Patients’ information and habit regarding exercise This part include these items: Information about relation of exercise and ischemic heart disease, doing regular exercise, time and type of it. Source of information. Patients’ information and habit regarding daily nutrition: This part consists of these items: Information and the main sources of healthy food that prevent IHD and eating healthy food daily. Patients’ information and habit concerning cigarette smoke This part consist these items: Information and source about relation of smoking and IHD, number and years of cigarette smoking, question about ex-smoker and if the patient past smoker, when did he or she quit smoking. Patient’s daily stress This part deals with level and the situation of stress. Patients’ information toward some modifiable risk factors of Coronary heart disease This part includes consist of the following: obesity, physical inactivity, very stressful situation, Hypertension, Diabetic Mellitus, Dyslipidemia, abdominal fat and smoking cigarette. Patient’s information toward the relation between the nutrition and IHD This part includes these items: excessive eating sweet, salty and high saturated fatty food, eating a low amount of fish, vegetable and fruit. Validity of the study tool The content validity of the tool was determined through a panel of (12) experts with average years of experience of 12.6 years, (mean= 12.6 years), in various field of science (Nursing, and Medicine) to investigate the clarity, relevancy and adequacy of the items of the tool. Experts were provided the instrument by their opinions about the suitability of the items included in the form. The majority of the experts agreed upon the items of the study with some comments and suggestions. In addition the experts' suggestions have been taken into consideration. So far, the modifications are employed and the final copy of the instrument is completed and become valid to be an appropriate tool for data collection. Pilot Study A pilot study was conducted on (15) male and female patients during the period of 20th October up to the 25th of October 2019. Reliability of the questionnaire Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 31 Reliability was conducted by the application of internal consistency reliability (split half), which was conducted at Rania teaching hospital from 15 patients of (medical, surgical, coronary care unit and consultant unit) were gathered for such reliability estimation. The reliability of the current study was (r= 0.83) for some risk factors of ischemic heart disease that put someone to developing coronary heart disease which indicated an acceptable reliability for the questionnaire. Rating and Scoring The items were rated and scored according to the following patterns: The three point types Likert scale Yes, No and Uncertain is scored as (2) for Yes,(1) for Uncertain and (0) for No. The two point Semantic scale Yes and No (2) for Yes, and (0) for No. Methods of data collection The data were collected through the utilization of adopted and constructed tool, interview technique. The data collection process was performed from the period of 26th November up to 14th of December 2019. Interviewing by the use of the questionnaire for demographic data and knowledge took about 10-15 minutes for each patient. Ten patients were dropped out from the study sample because they refused participate in the study, for this reason the total study sample remaining only 143 patients. Body Mass Index By using a tape measure and same weight scale for all patients, the researchers find out the BMI through formula: Weight by kilogram divided to height by (m)]2 Statistical Analysis The data were organized and coded into computer files, by using the Statistical Package for Social Science (SPSS, version 25). The two statistical approaches were used for data analysis, which include: Descriptive statistical data analysis: Such analysis was performed through the following: Frequency distribution Percentage % = Frequency / sample size × 100 Mean = Σⅺ / n Inferential statistical data analysis Such analysis was performed through the application of the following procedure: Cronbach Alpha Correlation Coefficient was employed for the determination of the instrument reliability. 3. RESULTS Table (1) Showed that highest age of the patients were between (25-40 years) (45.5%), (65.0%) of them were male, (28.0%) were graduated from primary school, (65.0%) were unemployed, (91.6%) from urban area but (51.7%) of them were overweight and (16.8%) were obese. Table1: Demographic and clinical characteristics of study participants (n = 143) Variables Categories F (%) Age (Years) 25 - 40 65 45.5 41 - 55 48 33.5 56 and more 30 21.0 Gender Male 93 65.0 Female 50 35.0 Marital Status Single 17 11.9 Married 115 80.4 Widow/er 11 7.7 Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 32 Educational Level Illiterate 32 22.4 Read and Write 27 18.9 primary school graduate 40 28.0 Intermediate and high school 22 15.4 College and Institute 22 15.4 Occupation Employed 52 36.4 Unemployed 85 59.4 Retired 6 4.2 Monthly Income Sufficient 55 38.5 Barely sufficient 57 39.9 Insufficient 31 21.7 Residential Area Urban 131 91.6 Rural 12 8.4 Body Mass Index Underweight 3 2.1 Normal weight 42 29.4 Overweight 74 51.7 Obese 24 16.8 Table (2) showed that (58%) of the participants had information about ischemic heart disease, and their source of information was TV (14%) but only (32.2%) of them was diagnosed by IHD. Table 2: Patient’s information about ischemic heart disease as a general Questions regarding ischemic heart disease Categories F % Do you have any information about ischemic heart disease as a general? No 60 42.0 Yes 83 58.0 If yes, which one is the most source of your information? Physician 41 28.7 My relatives 7 4.9 TV 20 14.0 Reading books 7 4.9 Internet 8 5.6 Are you diagnosed by cardiovascular disease? No 97 67.8 Yes 46 32.2 How many years do you diagnosed by cardiovascular disease? 1 - 4 18 12.6 5 - 9 19 13.3 ≥ 10 9 6.3 Table (3) demonstrated that (79.7%) of them had information regarding relation of cigarette smoking and IHD and TV was their source of information (32.9%) but only (28.7%) of them were current smoker and (14%) of them were smoked 20 cigarette daily within (11-20) years. Table 3: Patient’s information and habit regarding the relation of cigarette smoking and ischemic heart disease Questions regarding cigarette smoking Categories F (%) Do you have any information about the relation of smoking and ischemic heart disease? No 29 20.3 Yes 114 79.7 If yes, which one is the most source of your information? Physician 45 31.5 My relatives 6 4.2 TV 47 32.9 Reading books 3 2.1 Internet 13 9.1 Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 33 Are you a smoker? No 102 71.3 Yes 41 28.7 If Yes, how many years do you smoke? 1 - 10 8 5.6 11 - 20 9 6.3 21 - 30 6 4.2 31 ≤ 18 12.6 How many cigarettes do you smoke per day? 1- 10 10 7.0 11 - 20 20 14.0 21 ≤ 10 7.0 If No, are you: EX- Smoker 21 14.7 Passive Smoker 23 16.1 Never smoker 58 40.6 If you are an EX-smoker, when did you quit smoking? 1 - 7 10 7.0 8 - 14 5 3.5 15 ≤ 6 4.2 Table (4) demonstrated that (69.2%) of patients had information regarding relation of exercise and IHD and TV was their source of information (31.5%) but only (35%) had a regular exercise and (21.7%) of them walked. Table 4: Patient’s information and habit regarding relation of physical exercise and ischemic heart disease Questions regarding exercise Categories F (%) Do you have any information about relation of exercise and ischemic heart disease? No 44 30.8 Yes 99 69.2 If yes, which one is the most source of your information? Physician 32 22.4 My Relatives 4 2.8 TV 45 31.5 2.8 Reading book 4 Internet 14 9.8 Do you do exercise? No 93 65.0 Yes 50 35.0 How many times do you do exercise weekly, at least five days and at least 30 minutes for each day? 1-2 times 23 16.1 3-5 times 16 11.2 more than 5 times 11 7.7 Which of this exercise do you do? Walking 31 21.7 Running 8 5.6 Gym 8 5.6 Football 3 2.1 Table (5) showed that (74.1%) of patients had information regarding relation of healthy food that prevent IHD, and TV is the main source of their information (30.8%) but (89.5%) of them did not eat a healthy food. Table 5: Patient’s information and habit regarding healthy food Questions regarding healthy food Categories F (%) Do you have any information about healthy food that prevents ischemic heart disease? No 37 25.9 Yes 106 74.1 If yes, which one is the most source of your information? Physician 36 25.2 My Relatives 6 4.2 TV 44 30.8 Reading books 4 2.8 Internet 16 11.2 How often do you eat healthy food daily? (Plenty of fruits and vegetables, foods low in saturated fat, Not everyday 128 89.5 Everyday 15 10.5 Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 34 cholesterol, salt, sugar and high in fibre) Table (6) indicated that (52.4%) of patients was relatively stressful and (42.7%) of them were very stressful, but only (4.9%) of them were free from stress. Table 6: Patient’s daily stress Table (7) demonstrated that the highest level of patient’s information toward some modifiable risk factors of ischemic heart disease and information about ischemic heart disease as a general were (74.8%), and (79%)respectively. Table 7: level of patient’s information toward ischemic heart disease and it modifiable risk factors Variables Level of Information Low (%) Medium (%) High (%) Mean (SD) Level of Patients’ information about ischemic heart disease as a general 3 (2.1) 33 (23.1) 107 (74.8) 2.73 (.492) Level of Patients’ information toward some modifiable risk factors of Coronary heart disease 4 (2.8) 26(18.2) 113 (79.0) 2.76 (.489) Table (8) showed that the participants believe that obesity, physical Inactivity, very stressful situation, Hypertension, diabetic mellitus, dyslipidemia, abdominal fat, smoking cigarette, excessive eating high saturated fatty food, excessive eating high sweaty food, excessive eating high salty food, eating low amount of fish, eating low amount of vegetable, eating low amount of fruit (87.4%, 86.7%, 93.0%, 78.3%, 57.3%, 90.2%, 51.0%, 83.9%, 92.3%,73.4%, 77.6%,39.2%, 72.0% ) respectively are lead to coronary heart disease and can put someone at high risk of developing coronary heart disease. Table 8: Patient’s response rate regarding some modifiable risk factors of ischemic heart disease that can put someone at high risk of developing it Question regarding daily stress Categories F (%) How do you describe your daily psycho state? Very Stressful 61 42.7 Relatively stressful 75 52.4 Free from stress 7 4.9 Are the following leads to coronary heart disease and can put someone at high risk of developing coronary heart disease? Yes Uncertain No F % F % F % Obesity 125 87.4 10 7.0 8 5.6 Physical Inactivity 124 86.7 14 9.8 5 3.5 Very stressful situation 133 93.0 9 6.3 1 .7 Hypertension 112 78.3 25 17.5 6 4.2 Diabetic Mellitus 82 57.3 48 33.6 13 9.1 Dyslipidemia 129 90.2 10 7.0 4 2.8 Abdominal fat 73 51.0 45 31.5 25 17.5 Smoking cigarette 120 83.9 17 11.9 6 4.2 Excessive eating high saturated fatty food. 132 92.3 7 4.9 4 2.8 Excessive eating high sweaty food. 105 73.4 26 18.2 12 8.4 Excessive eating high salty food. 111 77.6 22 15.4 111 77.6 Eating a low amount of fish. 56 39.2 53 37.1 34 23.8 Eating a low amount of vegetable. 103 72.0 25 17.5 15 10.5 Eating a low amount of fruit. 105 73.4% 25 17.5 13 9.1 Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 35 Table (9) indicated that there was no significant relationship between levels of Patients’ information toward some modifiable risk factors of ischemic heart disease with age, gender, educational level, occupation and diagnostic and non-diagnostic patients with ischemic heart disease, at p value greater than 0.05. Table 9: Association between some socio-demographic data and level of Patients’ information toward some modifiable risk factors of ischemic heart disease Variables Low Medium High Total F (%) F (%) F (%) F (%) p- value Age 25 - 40 4 2.8 13 9.1 48 33.6 65 45.5 .401 41 - 55 0 0.0 8 5.6 40 28.0 48 33.6 ≥ 56 0 0.0 5 3.5 25 17.5 30 21.0 Gender Male 3 2.1 19 13.3 71 49.7 93 65.0 .596 Female 1 0.7 7 4.9 42 29.4 50 35.0 Educational Level Illiterate 0 0.0 5 3.5 27 18.9 32 22.4 .261 Read and Write 1 0.7 5 3.5 21 14.7 27 18.9 primary school graduate 3 2.1 5 3.5 32 22.4 40 28.0 Intermediate and high school 0 0.0% 3 2.1 19 13.3 22 15.4 College and Institute 0 0.0% 8 5.6% 14 9.8% 22 15.4% Occupation Employed 1 0.7% 13 9.1% 38 26.6% 52 36.4% .487 Unemployed 3 2.1% 13 9.1% 69 48.3% 85 59.4% Retired 0 0.0% 0 0.0% 6 4.2% 6 4.2% By Fisher’s exact test 4. DISCUSSION This chapter presents and discusses the results of the study with feasible support of the available literatures and related studies. The first part of the data analysis of the current study is about demographic and clinical characteristics, it showed that the highest age of patients were between 25-40 years old, more than half of them were male, level of education represented that highest level were graduated from primary school, and the majority of them were married and more than quarter of them were barely sufficient, most of patient’s residential area were lived from urban area‚ more than half of them were unemployed, more than half of them were overweight. Only marital status and employment in this outcome are agreement with the study done by Almalki in Saudi Arabia which reported that more half of their participants were unemployed married but disagree with level of education because the university was highest level of education of their population[20]. Also it is agree with the study done by (Fahs, et al., 2017) among the Lebanese population in 2017 which indicated that nearly half of their participants were overweight, more than three quarter were married and the male participants were more than female [21]. Concerning Patient’s information about ischemic heart disease as a general, more than half of the patients responded that they had information about ischemic heart disease as a general and TV was the first source of their information. Less than half of them diagnosed by cardiovascular disease for five to nine years. The researchers noted that the participant’s information regarding risk factors of ischemic heart disease was varied in the present study for Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 36 example some lifestyle factors that cause IHD, such as stressful situation, smoking cigarette, overweight and obesity, diabetic mellitus, hypertension, abdominal fat, dyslipidemia and unhealthy diet, was the baseline subject of the current topic amongst community members, but the researchers surprised by the skill and lack of the application of this information during their lives, and there are large number of people were on way to grow CVD, and in keeping with the evidence on the increasing occurrence of CVD that related to urbanization. Patient’s information regarding cigarette smoking, nearly three a quarter of the participants were not smoked cigarette but 16.1% of them were passive smoker and 7% were ex-smoker and they quit smoking between one to seven years, but nearly half of them were smoked eleven to twenty cigarette per day for more than thirty years. More than three a quarter of the patients had information about the relation of smoking and ischemic heart disease, the TV was the first and Physician was the second source of their information. The finding of the current study aggresses with the study done by (kirchberger et al., 2015) in Germany who mentioned that the current smoker was (30.9%) [22]. Regarding smoking the finding of the present study is agree with the study done by (Kumara, and Samarawickrama) in 2016 which done at medical clinics in teaching hospital Karapitiya, who mentioned that most of their participants had information about that the cigarette smoking is one of risk factors of IHD [23]. Induces oxidative stress, endothelial damage and dysfunction, is associated with significantly higher serum concentrations of total cholesterol and triglycerides, reduces the cardio protective HDL are related to basic ingredients of cigarette the nicotine and carbon monoxide, also promoting intravascular inflammation represents a significant risk factor for the development of atherosclerosis and cardiovascular disease. Also nicotine is responsible of deregulates cardiac autonomic function, boosts sympathetic activity, and increase heart rate. World health organization(WHO) reported tobacco continues lead to death of more than five millions people every year including more than six hundred thousand passive smokers people by cardiac disease, lung cancer, and other illnesses (Papathanasiou,et al.,2014) [24]. The results of the current study showed that participants who had information regarding relation of exercise and ischemic heart disease were more than half and the first source of their information was TV and physician was the second one 31.5%, 22.4% respectively. More than half of them did not do physical exercise but 11.2% of them were regularly walked. The result of the present study is agree with the study done by (Almalki,et al., 2019 ) in Saudi Arabia which indicated that 61.1% of their participants did not perform a regular exercise [20]. The finding of the current study showed that nearly three a quarter of the participant had information regarding relation of healthy food that prevent Ischemic heart disease, and TV was the first and physician was the second source of their information, but nearly most of them did not eat a healthy food daily such as fruit, vegetable and foods low in saturated fat, salt and sugar. This result is disagree with the result of the study done by (Fahs, et al., 2017) which indicated that nearly three quarter of their participants were eating fruit one to three times and more than half of them were consumed vegetable one to two times daily [21]. On other hands, the result of present study is agree with the study done in Nairobi by (Wekesah,et al.,2019), which mentioned that their participants had a lack of exact way to cook a healthy foods, [25]. The researchers return this result regarding unhealthy food preparation and consumption to stigma among the Kurdish people and community because if they do not use much more oil on food, people do not taste it and become not delicious; also if use low amount of sugar and salt, the relatives will ask about any chronic disease that prefer these types of food, because the Kurdish people are not consume a healthy food until they get a specific chronic disease. Also the result indicated that more than half of the participant had relatively stressful and less than half of the participant had very stressful but a lowest rate of them were free from stress, this result is disagree with the result of (Kurd,et al.,2014) while indicated that more than half of their participants had a high stress and less than quarter had relatively or moderate stress [26]. Also the current study demonstrated that nearly three quarter of patients had the high level of information about ischemic heart disease as general and nearly the majority of them Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 37 had the high level of information toward some modifiable predisposing factors of CHD. This result disagree with many studies such as (Boateng, et al.,2017) in Africa, (Khan, et al.,2006) and (Zuhaid,et al.,2014) which showed that the levels of awareness and information about CVD and risk factors of their studies were generally low [27,28, 29]. Most of patients believed that very stressful situations, dyslipidemia, excessive eating high saturated fatty food, the majority of them agree that obesity, physical inactivity and smoking cigarette, and nearly three quarter of patients believed that hypertension, excessive eating high salty and sweet food, eating a low amount of vegetable and fruit are put somebody at high risk and leads to increasing the chance of developing coronary heart disease. But a highest level of information regarding eating low amount of fish and person with abdominal fat were (39.2%, 51.0%) respectively, can put someone at high risk of developing coronary heart disease. The results of the current survey is agree with the study done in Dhaka, Bangladesh by (Mirza,et al., 2016) which informed that more than half of their participants recognized hypertension hyperlipidemia, fatty diet and smoking as possible risk factors for coronary artery disease [30];but disagree with the study done by (Awad,and Al-Nafisi,2014) in Kuwait which indicated that their participants knowledge concerning cardiovascular disease risk factors was moderate [31]. Also the current result is disagree with the study done by (Wartak, et al., 2011 ) in Western Massachusetts which showed that, one in five of the participants were not aware that the disease of diabetic mellitus is a predisposing factor for CVD [32]. However recognizing risk factors of cardiovascular disease is considered as significant first step in preventing heart disease , on other hands, the participants of the current study were more knowledgeable about cardiovascular disease in general, but the researchers believe that existing an information and understanding the risk of CVD alone without improving and practicing the information is not completely useful, Without best understanding of the risk factors about cardiovascular disease, the assessments may fail in this area so educational initiatives focused on improving knowledge of risk and the causal relationship between predisposing factors and CVD are needed. The result of the current study demonstrated that there are no significant association between level of patients information toward some modifiable risk factors of ischemic heart disease with age, gender, educational level, occupation, at P value greater than (0.05). A study done in Iraq by (Mohammad, et al., 2013) and was disagree with the current study and mentioned a significant associations between the risk factors of cardiovascular and the angiographic patients with IHD [33]. 5. CONCLUSION The findings of the present study highlighted a high level of information toward modifiable predisposing factors of IHD among participants while nearly most of them did not eat healthy diet and half of them overweight, relatively stressful and did not do physical exercise that considered as vital modifiable risk factors of ischemic cardiac disease. The findings of the current study targeted more modifying the relationship of knowledge and practice with modifiable risk factors toward IHD in particular is needed. The present study calls for efforts such as targeted public health education to increase the level of performing practices to protect the Kurdish people from risk factors of heart disease. Education can be provided to the public through the physicians and nurses before social media are need. Further study are needed in Kurdistan to assess the level of practice regarding modifiable risk factors of ischemic heart disease. Also the study recommended to the ministry of health and directorate of health in Rania city must supervise much more dependable center of dietary regimen, sport and fitness halls to implement people’s information and to practice it. Also the current study recommended to the nurses to encourage the people to practice their useful information and understanding them that information alone is not sufficient to maintain human’s healthy life. Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 38 REFERENCE [1] G. Lippi, M. Franchini, and G. Cervellin, "Diagnosis and management of ischemic heart disease," in Seminars in thrombosis and hemostasis, 2013, vol. 39, no. 02: Thieme Medical Publishers, pp. 202-213. [2] A. Pająk, "A new model of secondary prevention of cardiovascular disease in patients after acute coronary syndrome," J Kardiologia Polska= Polish Heart Journal, vol. 74, no. 4, 2016. [3] P. Jankowski et al., "Practice setting and secondary prevention of coronary artery disease," J Archives of medical science: AMS, vol. 14, no. 5, p. 979, 2018. [4] J. D. Wessler and A. J. Kirtane, "Patients who require non-cardiac surgery in acute coronary syndrome," J Current cardiology reports, vol. 15, no. 7, p. 373, 2013. [5] J. G. Mulle and V. Vaccarino, "Cardiovascular disease, psychosocial factors, and genetics: the case of depression," J Progress in cardiovascular diseases, vol. 55, no. 6, pp. 557-562, 2013. [6] R. Hajar, "Risk factors for coronary artery disease: historical perspectives," J Heart views: the official journal of the Gulf Heart Association, vol. 18, no. 3, p. 109, 2017. [7] R. D. Reid et al., "Effect of an intervention to improve the cardiovascular health of family members of patients with coronary artery disease: a randomized trial," Cmaj, vol. 186, no. 1, pp. 23-30, 2014. [8] M. R. Flock and P. M. Kris-Etherton, "Dietary Guidelines for Americans 2010: implications for cardiovascular disease," J Current atherosclerosis reports, vol. 13, no. 6, pp. 499-507, 2011. [9] M. D. Miedema et al., "Association of fruit and vegetable consumption during early adulthood with the prevalence of coronary artery calcium after 20 years of follow-up: The Coronary Artery Risk Development in Young Adults (CARDIA) Study," J Circulation, vol. 132, no. 21, pp. 1990-1998, 2015. [10] R. K. Johnson et al., "Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association," J Circulation, vol. 120, no. 11, pp. 1011-1020, 2009. [11] R. S. Bruning and M. Sturek, "Benefits of exercise training on coronary blood flow in coronary artery disease patients," J Progress in cardiovascular diseases, vol. 57, no. 5, pp. 443-453, 2015. [12] U. Vollmer-Conna, E. Cvejic, I. G. Smith, D. Hadzi-Pavlovic, and G. Parker, "Characterising acute coronary syndrome-associated depression: Let the data speak," J Brain, behavior, immunity, vol. 48, pp. 19-28, 2015. [13] A. N. Nowbar, M. Gitto, J. P. Howard, D. P. Francis, and R. Al-Lamee, "Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors From NCD Risk Factor Collaboration," J Circulation: Cardiovascular Quality Outcomes, vol. 12, no. 6, p. e005375, 2019. [14] H. A. Abderrahman, I. M. Al-Abdallat, and A. K. Idhair, "Age threshold for proper definition of premature coronary artery disease in males," J Journal of forensic legal medicine, vol. 58, pp. 45-49, 2018. [15] J. H. Fan, S. A. Lyons, M. S. Goodman, M. S. Blanchard, and K. A. Kaphingst, "Relationship between health literacy and unintentional and intentional medication nonadherence in medically underserved patients with type 2 diabetes," J The Diabetes Educator, vol. 42, no. 2, pp. 199-208, 2016. [16] S. Cornett, "Assessing and addressing health literacy," J Online Journal of Issues in Nursing, vol. 14, no. 3, 2009. [17] O. Kadda, C. Marvaki, and D. Panagiotakos, "The role of nursing education after a cardiac event," J Health science journal, vol. 6, no. 4, p. 634, 2012. [18] C. Gélinas, "Management of pain in cardiac surgery ICU patients: have we improved over time?," J Intensive Critical Care Nursing, vol. 23, no. 5, pp. 298-303, 2007. [19] D. M. Lanuza, P. M. Davidson, S. B. Dunbar, S. Hughes, and S. D. Geest, "Preparing nurses for leadership roles in cardiovascular disease prevention," J European Journal of Cardiovascular Nursing, vol. 10, no. 2_suppl, pp. S51-S57, 2011. [20] M. A. Almalki et al., "Population awareness of coronary artery disease risk factors in Jeddah, Saudi Arabia: a cross-sectional study," J International journal of general medicine, vol. 12, p. 63, 2019. [21] I. Fahs, Z. Khalife, D. Malaeb, M. Iskandarani, P. Salameh, and Practice, "The prevalence and awareness of cardiovascular diseases risk factors among the Lebanese population: a prospective study comparing urban to rural populations," J Cardiology Research, vol. 2017, 2017. [22] I. Kirchberger et al., "Are daylight saving time transitions associated with changes in myocardial infarction incidence? Results from the German MONICA/KORA Myocardial Infarction Registry," J BMC Public Health, vol. 15, no. 1, pp. 1-8, 2015. [23] W. Kumara and M. Samarawickrama, "Awareness of smoking among patients with Ischemic Heart Disease (IHD) attending medical clinics in Teaching Hospital Karapitiya," Proceedings in Medical, Allied Health, Basic and Applied Sciences, 9th International Research Conference – KDU, Sri Lanka,, 2016. [24] G. Papathanasiou, A. Mamali, S. Papafloratos, and E. Zerva, "Effects of smoking on cardiovascular function: the role of nicotine and carbon monoxide," J Health science journal, vol. 8, no. 2, p. 274, 2014. [25] F. M. Wekesah, C. Kyobutungi, D. E. Grobbee, and K. Klipstein-Grobusch, "Understanding of and perceptions towards cardiovascular diseases and their risk factors: a qualitative study among residents of urban informal settings in Nairobi," BMJ open, vol. 9, no. 6, p. e026852, 2019. [26] B. J. Kurd, M. I. Dar, M. Shoaib, L. Malik, Z. Aijaz, and I. Asif, "Relationship between stress and coronary heart disease," J Asian Cardiovascular Thoracic Annals, vol. 22, no. 2, pp. 142-147, 2014. [27] D. Boateng et al., "Knowledge and awareness of and perception towards cardiovascular disease risk in sub-Saharan Africa: A systematic review," J PLoS One, vol. 12, no. 12, p. e0189264, 2017. Kurdistan Journal of Applied Research | 4th International Conference on the Health and Medical Science: Medical Researches Improve Life Quality (ICHMS 2020) | 39 [28] M. S. Khan et al., "Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: a cross sectional study," J BMC cardiovascular disorders, vol. 6, no. 1, p. 18, 2006. [29] M. Zuhaid et al., "Knowledge of modifiable risk factors of cardiovascular diseases among patients with acute myocardial infarction," Journal of Ayub Medical College Abbottabad, vol. 26, no. 3, pp. 364-367, 2014. [30] A. Mirza et al., "Knowledge, attitudes and practices among patients with coronary artery disease in Dhaka, Bangladesh," Int J Community Med Public Health, vol. 3, pp. 2740-8, 2016. [31] A. Awad and H. Al-Nafisi, "Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey," J BMC public health, vol. 14, no. 1, p. 1131, 2014. [32] S. A. Wartak et al., "Patients' knowledge of risk and protective factors for cardiovascular disease," The American journal of cardiology, vol. 107, no. 10, pp. 1480-1488, 2011. [33] A. M. Mohammad, S. K. Sheikho, and J. M. Tayib, "Relation of cardiovascular risk factors with coronary angiographic findings in Iraqi patients with ischemic heart disease," American Journal of Cardiovascular disease research, vol. 1, no. 1, pp. 25-29, 2013. 1. INTRODUCTION 5. CONCLUSION