The cardiovascular disease risk knowledge questionnaire (cvd-rkq) highlights various aspects of awareness regarding key risk factors for cardiovascular disease (cvd) among the participants. A significant majority (57.8%) recognized that smoking increases the risk of cvd, while 42.2% incorrectly believed it does not. There was a notable gap in understanding the impact of high blood pressure, as 60% correctly identified it as a risk factor, but 40% did not. Similarly, while only 30% knew that high cholesterol increases the risk of heart disease, a substantial 70% were unaware of this critical fact. Concerning physical inactivity, 60% acknowledged its role in heart disease, whereas 40% did not. Moreover, 31.2% identified obesity as a cvd risk factor, leaving 68.8% unaware. Over half of the participants (54.6%) knew that men are more likely to develop heart disease than women and a considerable 80% recognized diabetes as a risk factor. Encouragingly, a vast majority (90%) understood that a diet rich in fruits and vegetables could reduce cvd risk and 60% were aware of the protective effects of high hdl cholesterol. However, only 34.3% believed moderate alcohol consumption could lower cvd risk, while 65.7% disagreed. A significant proportion (80%) understood the link between stress and cvd and 67.8% recognized the importance of family history in determining risk. Most participants (86%) acknowledged age as a risk factor and 72.1% understood that daily physical activity reduces heart disease risk (table 5). Knowledge of the harmful effects of saturated fats and the benefits of lowering blood pressure was strong, with 70.3% and 79.6% agreeing, respectively. While 60% knew that excessive abdominal fat increases cvd risk, only 62.5% were aware that blood pressure control medications can help prevent heart disease. A slight majority (54.6%) identified high triglycerides as a risk factor and 53.1% recognized the benefit of quitting smoking in lowering cvd risk. These findings reveal substantial knowledge gaps in critical areas of cardiovascular health, indicating the need for targeted educational interventions.

Discussion
A study conducted among african americans revealed important insights into perceptions of the leading causes of death. When asked in an open-ended format, 27% of respondents believed obesity was the leading cause of death, followed by heart disease (16%), poor diet/unhealthy lifestyle (16%), hiv/aids (13%), cancer (11%) and diabetes (6%). However, when presented with a closed-ended question, the responses shifted, with heart disease being the most frequently cited cause (34%), followed by cancer (21%) and hiv/aids (12%). Awareness of heart disease as the leading cause of death was notably higher among college-educated respondents (p = 0.003) and older individuals (p = 0.012). Furthermore, 51% of participants reported feeling moderately well informed about heart disease, while 24% felt they were not informed at all. Similarly, 47% reported being moderately informed about stroke, but 33% stated they had no information on the subject⁸. In comparison, the findings of my study on young adults in peshawar also underscore a gap in knowledge about cardiovascular risk factors. In my study, only 30% of participants had high knowledge of cardiovascular risk factors, while 50% had low knowledge. This reflects a broader lack of awareness about heart disease, much like the african american study. Additionally, educational level in my study was also a significant factor, with participants holding undergraduate degrees demonstrating a higher level of knowledge about cardiovascular risk factors (52%, p = 0.001), similar to the higher awareness among college-educated respondents in the african american study. Both studies highlight the importance of education and targeted awareness campaigns to address gaps in cardiovascular health knowledge.

In the dublin study, it was observed that females had a significantly higher level of knowledge about cardiovascular disease (cvd) compared to males (p = 0.022). Participants demonstrated increased knowledge of cvd when they reported higher educational attainment (p = 0.036), a daily healthy diet (p < 0.02) and a family history of cvd (p < 0.02)⁹. In contrast, our study on young adults in peshawar revealed a different pattern. Although males showed a higher percentage of high knowledge about cvd (40%) compared to females (20%), this finding diverges from the dublin results. Regarding education, while our study also indicated that individuals with higher education levels were more knowledgeable, the results showed that postgraduate participants had 37.5% high knowledge and the uneducated group had none. This similarity emphasizes the crucial role of education in enhancing awareness of cvd, similar to the dublin findings. Additionally, our results indicate that dietary habits and family history also play a significant role; however, they were not explicitly assessed in our analysis. This suggests that there may be potential gaps in dietary awareness and family history recognition among the participants, highlighting the need for targeted interventions in peshawar to improve overall cardiovascular health knowledge. Overall, while both studies demonstrate the importance of gender, education and lifestyle factors in cvd knowledge, the differing outcomes underscore the necessity of contextualizing findings within specific populations.

In a comparative study, 35% of patients recognized that being overweight contributes to heart disease, 22% identified age as an important risk factor and only 16% considered smoking a significant contributor. These findings suggest that many young individuals either lack understanding of cardiovascular risk factors or believe they are not personally at risk, given the disproportionate emphasis on age as the primary concern¹⁰. When comparing these results to our study, a larger percentage of participants in our research demonstrated greater awareness of certain risk factors. In our study, 31.2% identified obesity as a cardiovascular disease risk factor, which aligns closely with the 35% reported in the other study. However, our participants showed significantly better awareness regarding smoking, with 57.8% correctly identifying it as a major risk factor, compared to only 16% in the previous study. Additionally, 86% of our participants recognized age as a risk factor, a much higher proportion than the 22% seen in the other study. This comparison highlights the need for further educational efforts, particularly to address gaps in understanding among younger individuals, as well as the influence of other modifiable risk factors beyond age.

Another study done in ethiopia, the majority of patients displayed strong awareness of key cardiovascular risk factors, with 79.4% acknowledging age, 97.6% recognizing smoking, 91.3% identifying being overweight and 81.9% understanding the role of high blood pressure. However, knowledge gaps were evident concerning the significance of family history and diabetes as risk factors, with only 86.8% and 64.1% aware of these, respectively. Additionally, 19.2% of patients did not realize that controlling blood pressure helps reduce cardiovascular disease risk, 18.1% failed to recognize that consuming fatty foods impacts cholesterol levels and 40.1% mistakenly believed that only gym or structured exercise could lower the risk of heart disease¹¹. When comparing these findings to our study, there are some notable similarities and differences. In our study, 86% of participants identified age as a risk factor, closely mirroring the 79.4% in the other study. Our participants also had substantial awareness of smoking as a risk factor (57.8%), though this was lower compared to the 97.6% reported in the previous study. Interestingly, fewer of our participants (31.2%) recognized being overweight as a risk factor, significantly less than the 91.3% reported in the other study. Regarding high blood pressure, our study showed 60% awareness, which was notably lower than the 81.9% in the comparison group. Our study also highlighted gaps in knowledge regarding family history (67.8%) and diabetes (80%), though our participants were more aware of diabetes as a risk factor compared to the other study (64.1%). Similar knowledge deficits were seen in understanding the importance of blood pressure control, as 20.4% of our participants were unaware of its significance, aligning closely with the 19.2% in the previous study. However, our participants showed stronger knowledge of the role of saturated fats (70.3%) compared to the 18.1% in the other study and fewer (72.1%) held the misconception that only structured exercise lowers cardiovascular risk, compared to 40.1% in the other study. These comparisons emphasize the variability in public knowledge of cardiovascular risk factors and the need for targeted health education to address specific gaps.

Limitations
This study was limited by its reliance on self-reported data, which may be subject to recall bias. Additionally, the cross-sectional design prevents the establishment of causality between knowledge levels and actual lifestyle behaviors. The study was conducted in a single region, limiting the generalizability of the findings to other populations.

Conclusion
The findings from this study indicate that young adults in peshawar possess a moderate level of awareness regarding cardiovascular risk factors. A significant proportion of participants demonstrated an understanding of well-known risk factors such as smoking, high blood pressure and high cholesterol, which suggests that existing health education initiatives may be effectively communicating the importance of these factors. However, this study also identified critical gaps in knowledge concerning less commonly recognized risk factors, including family history, diabetes and stress, which are vital for comprehensive cardiovascular health management. The awareness levels observed in this study point to an urgent need for tailored public health initiatives aimed specifically at young adults. Educational programs should not only focus on the conventional risk factors but also address the broader spectrum of cardiovascular risks, emphasizing the role of genetic predisposition, lifestyle choices and psychological well-being. Integrating these components into health promotion strategies could empower young adults to adopt healthier lifestyles and engage in proactive health management. Moreover, the significant association between educational attainment and knowledge of cvd risk factors suggests that increasing access to health education in academic settings may further enhance awareness. Collaborations between educational institutions and health authorities could facilitate the implementation of comprehensive cardiovascular health curricula that encompass both traditional and less recognized risk factors. In summary, while young adults in peshawar demonstrate a satisfactory understanding of key cardiovascular risk factors, addressing the identified knowledge gaps is essential for reducing future cvd incidence. Enhancing awareness through targeted health education and prevention strategies will be crucial in promoting long-term cardiovascular health within this demographic.   

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