Perception of cardiovascular diseases among women attending primary health care centers in Erbil city, Iraq


  • Nazleen Shakir Mala Ahmed Department of Basic Sciences, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Ali Shakir Dauod Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Karwan Hawez Sulaiman Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.



Cardiovascular diseases, Perception, Primary health care, Erbil city


Background and objective: Worldwide, cardiovascular diseases remain the leading cause of death in both genders. Good knowledge about cardiovascular disease symptoms, risk factors, and protective measures can improve the public’s preventive practice and overall future health outcomes. This study aimed to assess women's awareness of cardiovascular diseases and preventive measures.

Methods: A cross-sectional study was conducted in Erbil city, Iraq. The data were collected from 674 women aged 18 years and above, using convenience sampling method, who attended 12 primary health care centers in six municipalities in Erbil City. The study period was from the 1st of October 2019 to the end of February 2020. An interview questionnaire was used to collect the study data from the participants to assess the women's knowledge of cardiovascular diseases, their attitudes and challenges.

Results: The mean age ± standard deviation of the women was 37.6 ± 13 years. Only 15.3% of women could recognize cardiovascular diseases as the number one leading cause of death. More than 90% of them had poor cardiovascular disease knowledge scores. Recognition of coronary artery disease symptoms, cardiovascular disease risk factors, and preventive measures was made by less than 50% of them. The multiple regression analysis showed that age, body mass index, socioeconomic status, employment, and educational level independently predicted cardiovascular disease knowledge.

Conclusion: Awareness of cardiovascular diseases among women was poor. Thus, proper institutional foundations, mass media campaigns, other media, and community programs can prompt public discussion of health issues to change women’s health behavior and reduce future health consequences from cardiovascular diseases.


Metrics Loading ...


Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics – 2018 update: A report from the American Heart Association. Circulation. 2018;137(12):e467–92.

Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260–344.

Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;397(10159):1736–88.

WHO. Iraq Health Profile. Cairo; 2017. (Accessed March 20, 2019, at

Woodward M. Cardiovascular Disease and the Female Disadvantage. Int J Environ Res Public Health. 2019;16(7):1165.

DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438–51.

Garcia M, Mulvagh SL, Merz CNB, Buring JE, Manson JAE. Cardiovascular disease in women: Clinical perspectives. Circ Res. 2016;118:1273–93.

Humphries KH, Izadnegahdar M, Sedlak T, Saw J, Johnston N, Schenck-Gustafsson K, et al. Sex differences in cardiovascular disease – Impact on care and outcomes. Front Neuroendocrinol. 2017;46:46–70.

Newson L. Menopause and cardiovascular disease. Post Reproductive Health. 2018;24:44–9.

Podfigurna A, Męczekalski B. Cardiovascular health in patients with premature ovarian insufficiency. Management of long-term consequences. Prz Menopauzalny. 2018;17:109–11.

Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307:813–22.

Mosca L, Hammond G, Mochari-Greenberger H, Towfghi A, Albert MA, Harvey-Berino J, et al. Fifteen-year trends in awareness of heart disease in women: Results of a 2012 American Heart Association national survey. Circulation. 2013;127:1254–63.

Inter-Agency Information and Analysis Unit/ United Nations. Najaf governorate profile overview Iraq millennium development goals who does what where (3W); 2016:9–10.

KRSO. DEMOGRAPHIC. Kurdistan Region of Iraq; 2018.

Dean AG, Sullivan KM SM. OpenEpi: Open Source Epidemiologic Statistics for Public Health., updated 2013/04/06.(Accessed March 2, 2020, at

Khidr Y, Ismail S. Applications of geographical information system (GIS) in planning of health services in Erbil city, Kurdistan Region. Zanco J Med Sci. 2010;14(1):47–54.

Sarnecka A, Kopec G, Waśniowska A, Waligóra M, Knap K, Lenart-Migdalska A, et al. Prevalence and knowledge of modifiable cardiovascular risk factors among patients of primary health care. Małopolska Cardiovascular Preventive Intervention Study (M-CAPRI). Prz Lek. 2016;73:641–7.

Fahmya S, Nofald L, Shehatad S, El Kadyband H, Ibrahim H. Updating indicators for scaling the socioeconomic level of families for health research. J Egypt Public Health Assoc. 2015;90:1–7.

WHO. WHO-Body mass index. 2020. (Accessed March 1, 2020, at

Yusof A, Chia YC, Mohd Hasni Y. Awareness and prevalence of mammography screening and its predictors - A cross sectional study in a primary care clinic in Malaysia. Asian Pac J Cancer Prev. 2014;15:8095–9.

Khan S, Ali SA. Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study. BMC Womens Health. 2017;17:88.

Tedesco LMR, Di Giuseppe G, Napolitano F, Angelillo IF. Cardiovascular diseases and women: Knowledge, attitudes, and behavior in the general population in Italy. Bio Med Res Int. 2015;2015:324692.

Bairey Merz CN, Andersen H, Sprague E, Burns A, Keida M, Walsh MN, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women. J Am Coll Cardiol. 2017;70:123–32.

Awad A, Al-Nafisi H. Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey. BMC Public Health. 2014;14:1131.

Szoeke C, Dang C, Lehert P, Hickey M, Morris ME, Dennerstein L, et al. Unhealthy habits persist: The ongoing presence of modifiable risk factors for disease in women. PLoS ONE. 2017;12:e0173603.

Winham DM, Jones KM. Knowledge of young African American adults about heart disease: a cross-sectional survey. BMC Public Health. 2011;11(1):248.




How to Cite

Mala Ahmed, N. S., Dauod, A. S., & Sulaiman, K. H. (2022). Perception of cardiovascular diseases among women attending primary health care centers in Erbil city, Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 26(1), 1–12.



Original Articles