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 Table of Contents  
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 23-29

General health of under and over 45-year-old patients with coronary artery diseases

1 Student Research Committee and Faculty of Nursing and Midwifery, Department of Nursing Tabriz University of Medical Sciences, Tabriz, Iran
2 Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
5 Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute and Department of Community Health Nursing, Tabriz University of Medical Sciences, Tabriz, Iran

Date of Submission26-Sep-2020
Date of Decision15-Jan-2021
Date of Acceptance20-Jan-2021
Date of Web Publication9-Feb-2021

Correspondence Address:
Mohammad Hasan Sahebihagh
Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute and Department of Community Health Nursing, Tabriz University of Medical Sciences, Tabriz
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/shb.shb_65_20

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Introduction: As a major cause of mortality, coronary artery diseases (CAD) have become an important health priority in recent years. They can affect physical, mental, and social aspects of health and one's perception of wellness and general health. The present study is aimed at determining and comparing the general health status of coronary artery patients in two age groups: Under 45 and 45 and older. Methods: This descriptive–analytical study was conducted with 368 participants. The subjects were selected from March to June 2018 using convenience sampling from Tabriz's Madani Heart Center and Shohada Hospital and then divided equally into four groups: Under 45 CAD patients; under 45 non-CAD patients; 45 and older CAD patients; and 45 and older non-CAD patients. The non-CAD patients were matched to the CAD patients regarding age (±3 years) and sex. The data collection instrument was a 28-item General Health Questionnaire that was administered in interviews with the participants. The data were analyzed using descriptive and analytical statistics. Results: The general health mean scores of the participants were as follows: under 45 CAD patients (41.75 ± 8.80) and their counterpart control group (61.35 ± 7.65); 45 and older CAD patients (40.02 ± 11.22) and their counterpart control group (65.40 ± 6.45). There was a significant difference between the scores of the case and control groups in both age groups (P < 0.001). Conclusion: The results showed that disruption of general health is one of the influential factors in the incidence of CAD. To prevent such diseases, special attention should be given to the instruction of the factors that affect general health and its improvement.

Keywords: Age groups, coronary heart diseases, general health

How to cite this article:
Parizad R, Mohammadpoorasl A, Hosseinzadeh M, Javanshir E, Sahebihagh MH. General health of under and over 45-year-old patients with coronary artery diseases. Asian J Soc Health Behav 2021;4:23-9

How to cite this URL:
Parizad R, Mohammadpoorasl A, Hosseinzadeh M, Javanshir E, Sahebihagh MH. General health of under and over 45-year-old patients with coronary artery diseases. Asian J Soc Health Behav [serial online] 2021 [cited 2023 Dec 2];4:23-9. Available from: http://www.healthandbehavior.com/text.asp?2021/4/1/23/308814

  Introduction Top

Health is a human right and a necessity as a goal to meet the needs and raise the quality of life of human beings.[1] The World Health Organization (WHO) defines health as: complete physical, mental, and social well-being and not the absence of disease or disability, emphasizing the fact that none of these dimensions is preferred to others.[2] Over the past years and because of industrialization and migration, half the population worldwide lives in cities and suburbs and this has made changes to the health status.[3]

Meanwhile, general health plays an important role in assuring the mobility and efficacy of each society. It refers to one's physical and mental health and encompasses a cluster of physical symptoms, anxiety, insomnia, social functioning disorders, and depression.[4]

According to the WHO reports, there will be transformations over the next two decades in epidemic diseases and people's health needs such that noncontagious diseases like mental diseases will rapidly replace infections and contagious ones and turn into important factors of premature disabilities and deaths. At the moment, 450 million people around the world suffer from mental, neurological, and behavioral complications with mental disorders being responsible for over one percent of the deaths. It is expected that by 2020, the rate of mental and neurological disorders will increase by nearly 50% and account for 15% of all diseases. This rise will be even higher than cardiovascular diseases (CVD).[2] Results of the studies conducted in Iran also indicate a significant increase in these noncontagious diseases 5 with a 21% rise in adults and 17.6% in the youth aged 15–24 years.[3],[4],[5],[6]

One of the important problems faced by families, organizations, and human communities is mental health and general health issues. The risk of developing mental disorders exists for all people and it is a serious threat to the existing and future generations; that is why many studies have recommended due attention of mental disorder prevention programs to adolescents and the youth as highly vulnerable populations.[7],[8],[9]

General health is an attribute of life, which is related to one's overall emotional, mental, and spiritual state and biological fitness, and adapts her to the surrounding environment and enables her to have adequate physical, mental, and social activities.[10] In people with chronic diseases where the purpose of treatments is to improve their functioning, control the symptoms and progression of the disease, attention to general health is of great importance. One instance of chronic diseases is coronary artery diseases (CAD), which is an important health priority and the main cause of mortality. CAD is of psychosomatic types[11] that, besides biological factors, are also influenced by mental-social factors.[12]

As the WHO (2012) has reported, around 1.6 million of the mortalities in the US (30% of all deaths) were because of CAD and they account for 54% of all the mortalities from noncontagious diseases in the East Mediterranean region.[13] Numerous epidemiological studies report a high prevalence for CAD in Iran[14],[15] such that they are the most common cause of mortality, being responsible for nearly 64% of the mortalities.[16]

More importantly, the onset age of developing CAD has had a worrying decline over the past years such that a significant number of the victims are the youth and the middle aged.[17],[18] The incidence of CAD at young ages is also increasing in Iran;[19],20],[21] not only is this troublesome for the families but it also imposes a heavy burden on the economics of society. The American Heart Association's report states that because of poor general health, around half the survivors go out of the job or impose high treatment costs on society.[22]

It is vital to examine the general health state of CAD patients considering the increasing rise of CADs and their impact on the overall lifestyle of patients and their families. A CAD patient may experience extensive changes in her family relations, work, values, physical and social abilities as well as the ability to take care of herself and as result, her general health may be undermined.[10] It is noteworthy that many of mental diseases such as depression and anxiety can affect physical health and that there is a mutual relationship between mental and physical diseases.[23] Given the disabling and progressive nature of CAD, achieving a definitive cure is practically impossible, but disease control and health outcome improvement should be among the basic goals of healthcare programs.[24] It should also be remembered that in addition to important physical symptoms of CAD, components of mental health including stress, anxiety, and depression are very common and may accelerate the progress of atherosclerosis, coronary artery thrombosis, arrhythmia, cardiovascular events, and mortality in patients.[25],[26],[27] These complications can have negative impacts on the patient's adaptability to the disease and participation in treatment programs as well as on controlling the disease progress. They also can increase the burden of existing problems and physical symptoms and lead to defects in personal functioning, general health, and increased medical costs.[28]

Due to the high prevalence of CVD and also the increase in these diseases in young people, several studies have been conducted on how to prevent and treat these diseases. In most of these studies, only the physical aspects of the diseases have been addressed. Studies on the mental health of these patients have shown that various factors such as stress, anxiety, and depression have affected the incidence of these diseases.[29],30],[31] Therefore, along with other components such as lifestyle modification in the prevention of CAD diseases, it is necessary to pay attention to aspects of mental health.[32]

Although many studies have been conducted on the mental health of patients with CVD, in comparison and differences between the two age groups of young and old with the control group has not been done, at least in Iran. Therefore, in the management and treatment of cardiovascular patients, especially at a young age, all its dimensions, including quality of life, general health, and life satisfaction, should be considered to improve these patients, which requires further investigation and obtaining information on mental health.

All things considered, the given explanations and the prevalence of mental disorders in patients with CVD and their complications and consequences, the present study was conducted to compare the general health status of CAD patients in two age groups under 45 and over 45 years and their control groups.

  Methods Top

This study is part of a descriptive, cross-sectional study. The research population was comprised of four groups: Under 45 CAD patients (case Group I); under 45 non-CAD patients (control Group I); 45 and older CAD patients (case Group II); and 45 and older non-CAD patients (control Group II). The CAD participants were selected from patients hospitalized in Shahid Madani Heart Center and the non-CAD patients were selected randomly (with a ± 3-year interval and matched to the CAD patients in terms of age and sex) from those patients who had been hospitalized in Tabriz's Shohada Hospital for accidents and had no history of CVD.

Sample size estimation and sampling

According to the results of the pilot study (20 people in each group) which is obtained as follows, in Stata software, considering the first line of the type equal to 0.05 and 80% test power using the following formula, 83 people in each The group obtained that with respect to 10% lost, 92 people in each group were studied.

The case groups were selected from those patients who had been in their first 24 h of hospitalization. The control groups were not selected from relatives of CAD patients due to living in the same environment. So, it was possible that their mental state and general health were similar which could distort the results.

The subjects were selected using convenience sampling from March to June. Data collection then began by reviewing the clinical files of patients. Those patients who were interested to participate in the study completed the questionnaire through interviews in their rooms in nonvisiting and noncare hours.


The data collection tool was a two-part questionnaire. The first part included demographic information and risk factors for CVD; the second part was the standard 28-item General Health Questionnaire (GHQ) adapted for the Iranian context. Four-point Likert scale was used for GHQ scoring (0 = never; 1 = usually; 2 = more than usual; and 3 = much more than usual).

The questionnaire consists of four subscales, each of which contains seven questions as follows:

Questions 1–7 are about the subtest of physical symptoms. The scores of questions 2, 3, 4, 5, 6, and 7 were inverse.

Questions 8–14 relate to the Anxiety and Sleep Disorder subtest.[8],[9],[10],[11],[12],[13],[14] The scores of questions 8, 9, 10, 11, 12, 13, 14 were inverse.

Questions 15–21 relate to the social dysfunction subtest.[15],[16],[17],[18],[19],[20],[21] Questions 22–28 relate to the depression subtest.[22],[23],[24],[25],[26],[27],[28] The scores of questions 22, 23, 24, 25, 26, 27, and 28 were inverse.

The total general health score for the entire questionnaire was between 0 and 84. The sum of the scores of the >4 subscales indicated the general health status of the individual. Higher scores indicate better general health.

This questionnaire is the best and easiest tool to measure general health.[33] Goldberg reported both the sensitivity and specificity at 84% when evaluating the questionnaire.[34] It has also been translated into Persian in different studies; in Nourbala et al.,(2009) the questionnaire had an 84.2% sensitivity and a 7.8% error rate.[35] Maghsoodi et al. reported a 91% sensitivity.[36]

The content validity method was used to check the validity of the questionnaire. A pilot questionnaire was completed for 20 patients in each group. Then, 15 professors of the School of Nursing and cardiologists were seen and their corrective opinions were used content validity method was used to check the validity of the questionnaire. A pilot questionnaire was completed for 20 patients in each group. Then, 15 professors of the School of Nursing and cardiologists were seen and their corrective opinions were used. Reliability was calculated at 0.88 Cronbach's alpha for the whole questionnaire.

Ethical consideration

The research proposal was approved by the Research Council of the faculty of nursing and midwifery and the Regional Committee of Ethics in Research at Tabriz University of Medical Sciences (Ethics Code IR. TBZMED. REC.1397.007).

Statistical analysis

Kolmogorov–Smirnov test was used to evaluate the normality of the distribution of general health variables and the results showed that P = 0.200 distribution of this variable is normal.

The collected data were statistically analyzed by SPSS version 14.0 (SPSS, Chicago, IL, USA) was used for statistical analysis. Descriptive statistics to compare demographic characteristics and risk factors in case and control groups, Chi-Square test to analyze the relationship between mean general health scores between groups, also paired sample t-test and to determine the relationship between mean general health scores and demographic variables of the test One-way analysis of variance, independent t-test, and Pearson correlation coefficient were used.

  Results Top

In the under 45 age group, there was no significant difference between the case and control groups in the variables sex, marital status, education, residence, and history of alcohol and drug use, but the two groups had significant differences in the history of hypertension and high blood sugar (P < 0.001) [Table 1]. The most frequent CAD was unstable angina (n = 54, 58.7%) in this age group.
Table 1: Comparison of the demographic information and risk factors in the coronary patients and their counterpart control groups

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In the 45 and older age group, the case and control groups were not significantly different in the variables sex, education, residence, history of alcohol use and hyperlipidemia, age, and BMI, but they had significant differences in marital status (P = 0.023), history of drug use (P = 0.003), hypertension (P < 0.001), and high blood sugar (P = 0.001) [Table 1]. The most frequent CAD was related to unstable angina (n = 48, 52.2%) in this age group.

The difference between the mean scores of each subscale and the total mean score of general health was significant in the case and control groups of both age groups (P < 0.001) [Table 2]. Comparison of the difference between general health mean scores of the two age case groups revealed that the two groups had no significant differences in any of the subscales [Table 2].
Table 2: Comparison of the general health mean scores of the coronary patients and their counterpart control groups

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The difference between the mean scores of general health in the case groups of both age groups indicated that the two groups had significant differences in the subscales somatization (P = 0.006), social functioning disorders (P < 0.001), and in general health (P < 0.001) as a whole and the 45 and older group obtained better scores [Table 2].

There was a significant relationship between the general health mean score and marital status (P = 0.004) and age (r = −0.026) in case Group I and between the general health mean score and age (r = −0.039) in the control Group II [Table 3].
Table 3: The relationship between the demographic variables and the general health questionnaire mean scores of the coronary patients and their counterpart control groups

Click here to view

  Discussion Top

In our study, there was a significant difference between the mean score of each subscale and the total general health score in both groups under 45 years and over 45 years with the control group (P < 0.001). In both control groups, the score of each of the subscales and overall general health score was high. Similar studies have also found that people's state of general health is correlated with disease.[37],[38],[39],[40],[41] Momeninejad et al. in their study on patients with myocardial infarction and their control group achieved a significant difference (P = 0.012) which is consistent with our study and the possible reason may be the research community which is present in both heart patients.[42]

Furthermore, in the study of Noorbala et al. who compared the general health of young and old people with the control group, there was a significant difference between the general health scores of the case and control groups (P < 0.001), which is consistent with our study.[43] One possible reason could be the same age of the study population. It seems that to prevent diseases, depending on the type of vulnerability and epidemiological conditions, life skills training and special behaviors should be provided for people, especially at a young age.

The results of the study showed that no significant difference was found between the general health mean scores of the CAD patients in both age groups. No related study was found in the literature to compare the results.

Parizad et al. reported in their study on the causes and risk factors for CAD among 15–45-year-old women that 22.6% of the patients used mental health medications.[44] Considering the increasing number of CAD in recent years among the youth, it seems that in addition to attention to the physical health of this population, their mental and general health also needs due attention.

In their study on hypertensive patients, Moodi et al. found that 53% of the subjects had general health disorders.[45] Nourdini et al.(2016) studied CAD elderly patients and reported that their general health had been disrupted and was near to illness.[46] The significant increase of the elderly population in recent years and the increased possibility of CDA and other chronic diseases in the elderly show that besides physical health, attention to mental, familial, social, economic, and functional issues is necessary for assessing the general health of this group of people. It may be argued that disruption of general health in any age group can lead to CVD and that it might be a risk factor for CVD.

Comparison of the general health, mean scores of the two control groups showed a significant difference between them with lower scores in the younger age group. No related study was found to compare the findings. This difference can probably be due to changing lifestyle patterns and the vulnerability of young people and the need to pay attention to the general health of this age group.


Our study has some limitations; Results are based on the answers provided by the research units and may not reflect the actual views of the participants. Moreover, postillness and hospitalization stress and anxiety, as well as personal, social, cultural differences, and psychological traits might influence how the participants would respond to the questions, so recall bias was more probable.

  Conclusion Top

To sum up, the results of the present study showed that there is a significant difference between the general health score in each subscale and also the total score of CAD patients in both age groups with their control group. Due to the vulnerability of young people, on the one hand, and the possibility of developing chronic diseases associated with aging, especially CAD, proper attention to supportive factors and other basic variables to empower and ultimately improve the general health of both age groups seems necessary. Therefore, community health care planning in both age groups should be planned in both primary and secondary prevention. At the level of primary prevention, health officials should pay more attention to public health planning based on vulnerability before accidents due to epidemiological conditions and teaching life skills and specific behaviors to families for prevention purposes. At the second level of prevention, psychological interventions and the inclusion of psychological care in nursing practice to provide comprehensive care for patients with CAD. Physicians should also seek psychiatric counseling to identify and resolve mental health issues affecting the physical health of these patients to facilitate the recovery process.

Financial support

This study was approved and funded by Tabriz University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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