Cardiovascular diseases (CVDs) represent a formidable challenge to global health, posing significant burdens on individuals, communities, and healthcare systems worldwide. These diseases, which affect the heart and blood vessels, encompass a diverse array of conditions, ranging from coronary artery disease and heart failure to stroke and peripheral vascular disease. ^[1] Despite advances in medical science and public health initiatives, CVDs remain the leading cause of morbidity and mortality globally. ^[2]

The prevalence of cardiovascular diseases is influenced by a myriad of factors, including demographic shifts, urbanization, changes in lifestyle behaviors, and evolving patterns of risk factors such as obesity, diabetes, hypertension, and dyslipidemia. ^[3] While these diseases affect individuals of all ages, they tend to disproportionately impact older adults and those from socioeconomically disadvantaged backgrounds. Understanding the complex interplay of genetic, environmental, and behavioral determinants underlying cardiovascular diseases is essential for effective prevention, diagnosis, and management. ^[4] Lifestyle modifications, including smoking cessation, adoption of a healthy diet, regular physical activity, and weight management, constitute cornerstone strategies for reducing the risk of CVDs. ^[5]

Additionally, early detection through screening programs, coupled with evidence-based medical interventions and surgical procedures, can significantly improve outcomes for individuals with established cardiovascular conditions. The economic burden of cardiovascular diseases is staggering, encompassing direct healthcare costs, indirect productivity losses, and intangible impacts on quality of life. ^[6] Addressing this burden requires a multifaceted approach, integrating clinical care, public health initiatives, policy interventions, and community engagement efforts. ^[7] Moreover, ongoing research endeavors aimed at unraveling the underlying mechanisms of CVDs, identifying novel therapeutic targets, and optimizing healthcare delivery are crucial for advancing cardiovascular medicine and improving patient outcomes in the 21st century. ^[8]

Cardiovascular diseases (CVDs) among healthcare physicians represent a multifaceted challenge influenced by both occupational and personal factors. Physicians often face long working hours, irregular schedules, and high-pressure environments, which can contribute to chronic stress, disrupted sleep patterns, and unhealthy lifestyle behaviors. ^[9] The demanding nature of patient care, coupled with administrative responsibilities and documentation requirements, may lead to sedentary behavior and limited opportunities for physical activity. Moreover, occupational exposures to infectious agents, occupational hazards, and psychological stressors further compound the risk of CVDs among physicians. ^[10]

Evidence suggests that physicians may be at increased risk of cardiovascular events compared to the general population, highlighting the importance of targeted interventions to mitigate these risks. Implementing comprehensive wellness programs within healthcare institutions, including initiatives focused on stress management, physical activity promotion, nutrition education, and access to mental health resources, can support physicians in adopting healthier lifestyles and reducing their cardiovascular risk. ^[11] Furthermore, fostering a culture of peer support, open communication, and work- life balance is crucial for addressing the unique challenges faced by physicians and promoting overall well-being in the medical profession.

This cross-sectional study was conducted to estimate the prevalence of risk factors of cardiovascular diseases (CVD’s) among healthcare workers in tertiary care hospitals in Hyderabad. The city was divided into five zones: North, South, East, West, Central and one hospital was selected from each zone based on feasibility criteria. The feasibility criteria included the hospital’s willingness to participate, ease of access and the availability of a sufficient number of healthcare workers.

Study Population

The study was done in tertiary care hospitals in different zones in the Hyderabad. The hospitals that were chosen as employ different types of health care professionals. The study included healthcare workers from these hospitals, such as doctors, nurses, lab technicians, and support staff. This group represented various ages, educational backgrounds and job roles which gave a broad view of cardiovascular risk factors among healthcare professionals.

Inclusion criteria:

1. Aged between 30 and 64
2. Currently employed at one of the selected tertiary care hospitals in
3. Working at the hospital during the study period (January 2023 to December 2023).
4. Willing to provide informed consent and participate in the

Healthcare workers who did not fall within the specified age range or were unwilling to participate were excluded from the study.

Sampling Procedure:

A total of five hospitals were included in the study. Although the ideal sample size was 176, we collected extra data in case of errors in data collection and to avoid a shortfall of data. The data collected turned out to be N=412, of which 200 were not considered due to exclusion criteria. This brought the final sample size to n=212.To ensure a comprehensive and representative evaluation across Hyderabad, the city was meticulously divided into five zones: North, East, West, South, and Central. Each zone represented a distinct geographic and demographic section of the city. A tertiary hospital from each zone was then selected for the study. This zoning ensured a balanced representation and facilitated a detailed analysis of healthcare services across different parts of the city.

North Zone: Regions Covered: Secunderabad, Bolarum, Malkajgiri Selected Hospital: KIMS Hospital.

East Zone: Regions Covered: Uppal, Kothapet, LB Nagar Selected Hospital: Kamineni Hospitals.

West Zone: Regions Covered: Gachibowli, HITEC City, Madhapur Selected Hospital: Continental Hospitals.

South Zone: Regions Covered: Charminar, Falaknuma, Chandrayangutta Selected Hospital: GHI Hospital (Chavan Hospitals).

Central Zone: Regions Covered: Banjara Hills, Jubilee Hills, Punjagutta Selected Hospital: Gleneagles Hospital.

A multi -stage sampling method was carried out in selecting the tertiary hospitals. It has been performed in multiple stages in which stage 1 includes listing out different hospitals in respective five zones in the Hyderabad. After that the selection process involved approaching hospitals sequentially: if a hospital agreed to participate, it was included in the study. If the hospital declined, another hospital in the same zone was approached. This process was repeated until one hospital from each zone was successfully included in the study. Thus, a total of five hospitals from, one from each zone were selected for the study. Then the sample data of healthcare workers has been collected.

Data Collection Method:

A questionnaire was used, following the World Health Organization (WHO) guidelines for the Stepwise approach to surveillance (STEPS) of Non-Communicable Disease (NCD) risk factors. This included: [72]

1. Questionnaire: Collecting demographic and behavioral data through a structured
2. Physical Measurements: Recording physical measurements such as blood pressure, height, weight, and waist circumference.
3. Biochemical Measurements: Instructing the 212 individuals to obtain readings for random glucose.

The evaluation methodology was carefully planned and carried out to ensure reliable and valid findings.

Data Collection:

After obtaining written informed consent, data collection was conducted adhering to ethical standards in administering the questionnaire. The data collection involved various methods, including face-to-face interviews, online surveys, and telephone interviews, to

accommodate the preferences and availability of participants. We closely monitored the data collection process to maintain quality control and ensure data integrity.

Statistical Analysis:

All the data were entered into MS Excel. Rigorous data cleaning was performed to address any errors or inconsistencies. Analysis was conducted using SPSS software. Chi-square tests were used to find associations between categorical variables. Multivariate analysis was performed using logistic regression.

Ethical Considerations:

Throughout the study, we adhered to strict ethical guidelines to protect the rights and welfare of participants. Informed written consent was obtained from all participants. We maintained strict confidentiality and anonymity of the participants’ responses. Ethical approval was obtained from institutional review boards or ethics committees before the study commenced, underscoring our commitment to ethical research practices.

Table 1: Demographic characteristics of the study subjects: n= 212

MBBS: Bachelor of Medicine, Bachelor of Surgery | MD : Doctor of Medicine | DM : Doctor of Medicine | MCh : Master of Chirurgiae | GNM : General Nursing and Midwifery | Msc : Master of Science in Nursing | Bsc : Bachelor of Science in Nursing | MS : Master of Surgery

The mean age distribution shows that the majority are aged 30-39 years (41.5%, 88 participants), followed by 40- 49 years (29.7%, 63 participants), 50-59 years (24%, 51 participants), and 60 years and above (4.71%, 10 participants). Gender distribution indicates that 53.7% are male (114 participants) and 46.2% are female (98 participants). In terms of marital status, 77.3% are married (164 participants) while 22.6% are unmarried or divorced (48 participants). Regarding educational qualifications, the participants have diverse backgrounds: 30.1% hold an MBBS degree (64 participants), 10.8% have an MD (23 participants), 10.38% have an MS ( 22 participants)3.77% possess a DM (8 participants), 2.35% hold an MCh (5 participants), 15.5% have a GNM (33 participants), 12.7% possess a BSc (27 participants), and 14.1% have an MSc (30 participants) in table 1.

Table 2: Distribution according to past history and family history (n=212)

*P<=0.005 represents that result is statistically significant.

CAD : Coronary Artery disease

In the table above (table 2) A significant portion of individuals have a family history of Diabetes (32%) and Hypertension (28.77%). CAD (Coronary Artery Disease ) in family history is reported by (17.4%). A smaller percentage of individuals have a past history of CAD (3.8%) . Stroke has not been reported in past history. Cardiac Surgery is reported at a very low percentage (0.4%).

Table 3: Prevalence of Major Cardiovascular risk factors (n=212)

Above table 3 lists various risk factors along with their corresponding percentages and frequencies (number of cases). Current smoking (12.8%) of the population, which corresponding to 27 individuals , are current smokers. Tibacco Cnsumption 5.7% of the population , which corresponds to 12 individuals , cnsume tobacco, physical activity (inactive) 39.7% of the population, which corresponds to 84 individuals, consume tobacco. Hypertension (≥140/≥90 mmHg) 20.7% of the population, which corresponds to 44 individuals , have hypertension. Overweight WHO standards (BMI ≥30) 43% of the population , which corresponds to 91 individuals , are obese according to WHO standards. Waist Cirmcumference (Male) (WC≥102cm) 21.5 of males , which corresponding to 46 individuals have waist circumference greater than 102cm. Waist Circumference (WC≥88cm) 49.5% frmales , which corresponds to 105 individuals, have a waist circumference greater than 88 cm. Fruit and Vegetable Consumption (Inadequate)81.7% of the population, which corresponds to 173 individuals, have inadequate fruit and vegetable consumption. Alcohol Consumption (Socially) ,5.1% of the population, which corresponds to 11 individuals, consume alcohol socially, Alcohol Consumption (Moderate) 2.8% of the population, which corresponds to 6 individuals, consume alcohol moderately, Alcohol Consumption (Heavily) 1% of the population, which corresponds to 2 individuals, consume alcohol heavily.

Table 3: The Range and mean of various biophysiological parameters

The above table (3) illustrates Weight (kg): This parameter indicates the body weight of individuals. Males have a weig ht range from 50 to 119 kg, while females have a range from 40 to 96 kg.Height (cm): This parameter shows the height of individuals. Males are generally taller, with a range from 1.5 to 1.9 meters, compared to females who have a range from 1.4 to 1.7 meters.

Table 4: Association of Gender with various Cardiovascular Risk factors (p value <= 0.05 statistically significant)

*P<=0.005 represents that result is statistically significant.

The above table 4 illustrates cardiovascular risk factors associated with gender i.e males and females, highlighting several statistically significant disparities. Current Smoker: A significantly higher proportion of males (23.1%) are current smokers compared to females (0%). The p-value of 0.001 indicates this difference is statistically significant.

Table 5: Association of Age with various Cardiovascular Risk Factors (p value

<= 0.05 statistically significant)

*P<=0.005 represents that result is statistically significant.

The table 5 above presents data on various risk factors across different age groups (30-39 years, 40-49 years, 50-59 years, and >60 years) with corresponding p-values indicating the statistical significance of differences across these age groups. Regular physical exercise and the absence of overweight/obesity have statistically significant differences across age groups. Other risk factors such as smoking, tobacco consumption, and fruit/vegetable intake do not show significant differences across age groups as indicated by their p-values.

Table 6: Significant Table

*P<=0.005 represents that result is statistically significant.

Study findings among 212 healthcare workers, revealed significant health concerns: 42.9% were obese, 20.8% had hypertension, and 39.6% were physically inactive. The age distribution included 30-39 years (N=88), 40-49 years (N=63), 50-59 years (N=51), and >60 years (N=10). Obesity prevalence ranged from 70% to 81% across age groups, and diabetes was present in 2.7% to 17.6% of participants. Adequate fruit and vegetable intake was noted in 83% to 100% of participants. In comparison, Monir Nabahar et al. (2015) ^[12] studied 108 healthcare workers, predominantly female (68.5%), with a mean age of 36.30 years. They found that 39.8% were overweight or obese, 1.8% were smokers, and only 19.4% exercised more than twice a week. Dietary habits included 17.6% consuming vegetables and 51.9% consuming fruit more than once a day. The prevalence of diabetes was 1.9%, hypertension 2.8%, and a history of cardiovascular disease in 20.4%. Both studies highlighted a high prevalence of obesity and associated health risks among healthcare workers, with my study reporting higher rates of obesity and physical inactivity. This comparison underscored the urgent need for targeted health interventions to improve lifestyle habits and reduce health risks among healthcare professionals.

The findings of this study underscored the critical need for comprehensive wellness programs within healthcare institutions. Such programs should focus on promoting physical activity, healthy dietary habits, regular health screenings, smoking cessation, and stress management to mitigate the risk of CVDs. Implementing these measures was essential to protect the health of healthcare workers, ensuring they remained capable of delivering high-quality care to their patients. ^[13]

Workplace wellness programs encouraged physical activity through facilities like on-site gyms, fitness classes, and organized group exercises. Research showed that workplace physical activity programs significantly improved cardiovascular health outcomes Incorporating regular breaks during shifts for physical activity and creating a supportive environment promoted walking or cycling to work. ^[14] Studies demonstrated that workplace policies promoting physical activity led to significant reductions in sedentary behavior and improvements in cardiovascular health. ^[15]

Healthy Food Options: Access to healthy food options in hospital cafeterias and vending machines. A study by Lassen et al. (2014) found that improving the nutritional quality of food offered in workplace settings led to healthier dietary choices among employees. ^[16]

Workshops and seminars on the importance of a balanced diet and practical ways to incorporate fruits and vegetables into daily meals. Nutrition education programs significantly improved dietary habits and reduced the risk of CVDs. ^[17]

Smoking Cessation Programs: Support groups and counseling services helped healthcare workers quit smoking. Evidence from randomized controlled trials indicated that support groups and counseling significantly increased the likelihood of smoking cessation. Offering incentives for participation in smoking cessation programs and successful quitting. Financial and social incentives enhanced the effectiveness of smoking cessation interventions. ^[18]

Regular Health Screenings:Regular health screening camps monitored blood pressure, BMI, and other vital parameters. Regular screenings helped in the early detection and management of CVD risk factors, reducing the overall burden of disease (Mancia et al., 2013). ^[19] Personalized health interventions based on screening results, especially for those with a family history of CVD risk factors. Personalized interventions were more effective in managing CVD risk factors compared to generic advice (Artinian et al., 2010). ^[20]

Mental Health Support: Mental health support services, including counseling and stress management workshops. Research showed that stress management interventions significantly reduced stress levels and improved cardiovascular health (Goyal et al, 2014).

The study emphasized that addressing these risk factors is crucial for ensuring the well-being of healthcare workers, who are essential for delivering high-quality care to patients. In conclusion, the high prevalence of cardiovascular risk factors among healthcare workers in Hyderabad highlights the need for comprehensive wellness programs within healthcare institutions. Such programs should aim to promote physical activity, healthy dietary habits, and regular health screenings. Implementing these measures is essential to protect the health of healthcare workers, enabling them to remain effective in their professional roles and maintain their overall well-being. Future research should explore specific interventions tailored to this population and evaluate their effectiveness over time.

1. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) N Engl J Med. 2001;344(1):3-10.
2. Barbagallo M, Dominguez Magnesium and blood pressure: The interaction of magnesium and renin-angiotensin-aldosterone system. J Am Coll Cardiol. 2010; 56(4):402-409.
3. Bazzano LA, Serdula MK, Liu Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep. 2003; 5(6):492-499. https://academic.oup.com/ajcn/article/76/1/93/4689477
4. Kaplan GA, Keil Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993; 1):1973-1998., 88(4 Pt
5. Braveman PA, Cubbin C, Egerter S, et Socioeconomic status in health research: one size does not fit all. JAMA. 2005; 294(22):2879-2888.
6. Wang Y, Wang The prevalence of prehypertension and hypertension among US adults according to the new Joint National Committee guidelines: new challenges of the old problem. Arch Intern Med. 2004; 164(19):2126-2134.
7. Diez Roux AV, Mair Neighborhoods and health. Ann N Y Acad Sci. 2010;
8. 1186:125-
9. Vita JA, Keaney JF Endothelial function: a barometer for cardiovascular risk?.
10. ; 106(6):640-642. https://www.ahajournals.org/doi/10.1161/01.CIR.106.6.640
11. Deanfield JE, Halcox JP, Rabelink Endothelial function and dysfunction: testing and clinical relevance. Circulation. ; 115(10):1285-1295.
12. Hall The kidney, hypertension, and obesity. Hypertension. ; 2):625-633., 41(3 Pt
13. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018; 71(6):e13-e115.
14. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA.; 289(19):2560-2572.
15. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial Eur Heart J. 2013; 34(28):2159-2219.
16. Oparil, , Zaman, M. A., & Calhoun, D. A. Pathogenesis of Hypertension. Annals of Internal Medicine, 139(9), 761-776:
17. Lifton, P., Gharavi, A. G., & Geller, D. SMolecular Mechanisms of Human Hypertension. Cell, 104(4), 545-556:
18. Padmanabhan, S., Melander, O., Johnson, T., et al. Genome-wide association study of blood pressure extremes identifies variants near UMOD and Nature Genetics, 42(2), 183-190.
19. Newton-Cheh, , Johnson, T., Gateva, V., et al.Genome-wide association study identifies eight loci associated with blood pressure. Nature Genetics, 41(6), 666- 676:
20. Zhang, H., & Gelernter, J. (2019). Review: DNA methylation and alcohol use disorders: Progress and American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 180(2), 103-116: