Correlation of heart healthy lifestyle parameters to blood pressure and obesity: A cross sectional study in medical students
Authors: Winfred Gnanaraj J P , Hariharan R , Raghunanthan S , Nalini Kumaravelu K , Anusuya M , Shanthi T S , Samuel Dinesh A , Umadevi T B , Malarvizhi P , Paraimala Sundari S , Rajendran V , Bala Manikandan P , Sandeep S , Sudharshini S , Gnanaraj J P 
Published: November 2023

Abstract

Background
Incidence of premature cardiovascular (CV) deaths in medical practitioners is increasing. Stress and emotional status have the potential to initiate premature CV disease. Rigors of medical course can worsen the stress and emotional wellbeing of medical students(MS), particularly as they move from preclinical to clinical years.

Purpose
To evaluate the heart healthy lifestyle (HHL) of MS and identify their correlation with two CV risk factors- obesity and high blood pressure (BP). To compare the differences between pre/para clinical students (PCS) and clinical students (CS) in HHL.

Methods
All undergraduate MS of a medical college from low-and middle-income country in south Asia during 2017-2018 were eligible for inclusion. The study had Institutional ethics committee approval and participation was voluntary. Height, weight, waist and hip circumference and blood pressure were measured using standard methods. Lifestyle habits, psychological status, stress levels and attitude towards CV health were collected using a specially designed questionnaire. Each participant was assigned pre-defined scores on five areas- physical activity, dietary habits, emotional status, psychological status and attitude towards lifestyle counselling all of whom sum up to give a total heart healthy lifestyle score(HHLS).

Results
824 MS (394[47.8%] CS and 430[52.2%] PCS) participated in the study. The HHLS had significant negative correlation with body mass index (BMI) and systolic blood pressure (BP). (Figure-1 and 2a). Physical activity, emotional status, social media screen time and sleep had significant negative correlation with BMI (Figure 2a). The proportion of CS and PCS with abnormal BMI, waist hip ratio (WHR) and BP were similar. The attitude towards HHL counselling and willingness to implement when needed (57.3% vs 47.7%; P&lt;0.001) was better in CS compared to PCS. However higher proportion of CS had low self-esteem (78.5% vs 68.9%; P=0.002) and suicidal thoughts (18.7% vs 12.4%; P=0.03) compared to PCS. Further the scores for emotional and psychological health were lower in CS (Figure-2b) 29.4% of MS recorded high levels of stress in daily life, which however was similar between CS and PCS. Academic performance (41.2%) was the most common reason cited for stress followed by health(19.2%), relationships (17.4%) and finances (14.8%). Teachers (4.5%) and parents (5.9%) were less likely to be causes of stress.

Conclusion
The unhealthy lifestyle habits in MS, significantly correlated with BMI and SBP. Higher proportion of CS experience lack of self-worth and suicidal thoughts. One third of MS experience high levels of stress in daily life. Cardiovascular health education and training and emotional support to MS have to be started early in medical students, in order to have healthy medical practitioners serving the society.