Cardiovascular diseases (CVDs) continue to dominate the global health landscape as the leading cause of mortality and morbidity, accounting for nearly one-third of all deaths worldwide. Despite remarkable advances in diagnostic techniques, therapeutic interventions and public health initiatives, the burden of heart disease persists-particularly in low- and middle-income countries like India, where socio-economic transitions, urbanization and lifestyle changes have dramatically shifted disease patterns. No longer confined to urban populations or the elderly, CVDs now increasingly affect middle-aged adults, imposing a substantial burden on families, healthcare systems and national economies [1-4].

India, currently witnessing a dual burden of communicable and non-communicable diseases, has seen an alarming rise in cardiovascular risk among younger populations. Sedentary lifestyles, unhealthy dietary habits, tobacco use, increasing prevalence of hypertension, diabetes, dyslipidemia, obesity and chronic stress are major modifiable risk factors fueling this epidemic. However, public awareness about these risk factors, early warning signs and the importance of preventive behaviors remains critically low, particularly among middle-aged adults who are at a crucial juncture for intervention. Timely identification of risk perception gaps and preventive behavior patterns is essential to curb the rising tide of heart disease [5-8].

The Solan district of Himachal Pradesh, with its combination of rural, semi-urban and growing urban populations, offers a unique microcosm to study cardiovascular health awareness. Lifestyle transitions, dietary shifts and reduced physical activity, even in traditionally active rural communities, have begun to mirror national trends. Yet, despite the growing burden, localized data on the community’s knowledge of cardiovascular risk factors, their perception of personal risk and the adoption of preventive health behaviors remain scarce.

This study aims to assess the level of awareness regarding cardiovascular disease risk factors, examine risk perception and evaluate preventive behavior practices among middle-aged adults in Solan district. By identifying key knowledge gaps, misconceptions and behavioral patterns, the study seeks to inform the development of culturally tailored public health interventions and risk-reduction strategies to promote heart-healthy lifestyles and ultimately reduce the burden of cardiovascular diseases in this vulnerable segment of the population.

Study Design

This research adopted a descriptive, cross-sectional survey design to assess the awareness of cardiovascular disease (CVD) risk factors, risk perception and preventive behaviors among middle-aged adults in Solan district, Himachal Pradesh. The cross-sectional approach enabled the capture of real-time information regarding the community’s knowledge and practices within a specific timeframe.

Study Area and Population

The study was conducted across multiple rural, semi-urban and urban localities of Solan district to ensure diverse socio-demographic representation. The target population consisted of adults aged 35 to 55 years, an age group considered critical for early intervention in cardiovascular risk prevention. Healthcare professionals, medical students and individuals with previously diagnosed heart diseases were excluded to focus on the general community's primary prevention awareness.

Study Duration

Data collection was undertaken over a three-month period from January to March 2025, offering ample time to engage participants from different geographic, occupational and socio-economic backgrounds across the district.

Sample Size and Sampling Technique

A minimum sample size of 400 participants was calculated based on an anticipated 50% awareness prevalence, a 95% confidence level and a 5% margin of error. Purposive and snowball sampling strategies were employed. Initial participants were recruited through local community centers, public events, healthcare camps and digital community groups (e.g., WhatsApp and Facebook groups), with participants encouraged to further disseminate the survey link within their networks to expand reach.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Adults aged between 35 and 55 years residing in Solan district.

• Ability to understand and respond to the questionnaire in Hindi or English.

• Access to an internet-enabled device (smartphone, tablet, or computer)

• Willingness to provide informed consent before participation.

Exclusion Criteria:

• Practicing healthcare professionals (doctors, nurses, dietitians, physiotherapists)

• Medical and allied health students

• Individuals with a history of diagnosed cardiovascular diseases

• Incomplete or partially submitted survey responses

Data Collection Tool

A structured, pre-validated bilingual (Hindi and English) questionnaire was developed in consultation with cardiologists, public health experts and epidemiologists. Hosted on Google Forms for ease of access, the survey comprised four major sections:

• Demographic Information: Age, gender, education level, occupation, residential setting

• Knowledge Assessment: Awareness of major CVD risk factors (e.g., hypertension, smoking, obesity, diabetes, dyslipidemia, stress)

• Risk Perception Assessment: Participants' perceived susceptibility to CVDs based on lifestyle habits and family history

• Preventive Behavior Assessment: Evaluation of lifestyle practices including physical activity, dietary habits, smoking and alcohol use, blood pressure and cholesterol monitoring and engagement with health services

Data Collection Procedure

Participants were invited to complete the online survey link accompanied by a study information sheet detailing objectives, confidentiality assurances and informed consent requirements. The survey was voluntary and participants were allowed to withdraw at any time. Only fully completed responses were included in the final analysis to ensure data integrity.

Scoring and Data Classification

Knowledge questions were scored by awarding one point for each correct answer and zero for incorrect or “don’t know” responses. Risk perception and preventive behaviors were assessed using a combination of multiple-choice and Likert-scale questions. Participants’ knowledge levels were categorized as:

• Very Good Knowledge (≥80% correct responses)

• Good Knowledge (60%–79% correct responses)

• Fair Knowledge (41%–59% correct responses)

• Poor Knowledge (<40% correct responses)

Preventive behaviors were classified into favorable or unfavorable patterns based on adherence to internationally recognized heart-healthy guidelines.

Data Analysis

Data were extracted from Google Forms, cleaned and coded using Microsoft Excel and subsequently analyzed with SPSS version 26.0. Descriptive statistics, including frequencies, percentages, means and standard deviations, were calculated for demographic variables, knowledge scores, risk perception and preventive behavior patterns.

Table 1 presents the socio-demographic profile of the 400 participants surveyed in Solan district. The majority of respondents (38.8%) fell within the 35–40 years age group, followed by 31.5% aged 41–45 years, highlighting a predominance of younger middle-aged adults, who are at a critical window for CVD prevention. Female participants slightly outnumbered males (52.0% vs. 48.0%), consistent with trends in community-based health surveys where women often show greater participation. Regarding educational status, 37.5% had completed secondary education, 28.8% held an undergraduate degree and 7.8% had completed postgraduate studies, while 7.5% reported no formal education, reflecting a range of literacy levels important for tailoring health communication. Occupation-wise, homemakers represented the largest group (35.8%), followed by self-employed individuals (21.5%) and a notable 20.3% were unemployed, indicating socio-economic diversity. Rural residents comprised a significant 67.0% of the sample compared to 33.0% from urban settings, underscoring the importance of addressing rural-urban differences in heart health awareness and access to preventive services.

Table 2 outlines participants’ awareness and knowledge about cardiovascular disease (CVD) risk factors, showing a generally encouraging but still improvable landscape. High levels of correct knowledge were observed for major risk factors: 81.5% identified high blood pressure as a primary CVD risk, 84.8% recognized smoking as harmful and 79.5% linked obesity to heart disease. Awareness was similarly strong regarding diabetes (77.8%), high cholesterol (76.3%) and physical inactivity (82.5%) as contributors to CVD. Stress (74.3%) and family history (72.0%) were also fairly well-recognized. Importantly, 85.0% of participants correctly indicated that a cardiologist or doctor should guide CVD risk assessment. However, areas needing improvement were identified, particularly regarding asymptomatic early stages of CVD (66.5%) and misperceptions about regular exercise being incorrectly classified as a risk factor by 35% of participants. Overall, while basic awareness of key cardiovascular risks was strong, more nuanced aspects of disease progression and symptom recognition warrant targeted educational reinforcement.

Table 3 categorizes participants based on their overall knowledge scores about cardiovascular disease risk factors. A commendable 32.0% of respondents achieved "Very Good" knowledge (≥80% correct responses) and the majority (42.5%) were classified as having "Good" knowledge (60–79%), reflecting a reasonably strong foundation of CVD-related awareness.

Table 1: Socio-Demographic Characteristics of Participants

Table 2: Awareness and Knowledge of Cardiovascular Disease Risk Factors Among Participants

Table 3: Knowledge Score Classification

However, 18.8% fell into the "Fair" category (41–59%) and 6.8% exhibited "Poor" knowledge (<40%), highlighting that roughly one-quarter of participants have limited understanding, leaving them vulnerable to preventable heart disease risks. These findings underscore the need for continuous, targeted public health interventions to uplift awareness, particularly among those with only moderate or poor knowledge, to effectively strengthen heart disease prevention efforts within the Solan middle-aged population.

This study offers critical insights into the level of awareness, risk perception and preventive behavior regarding cardiovascular diseases (CVDs) among middle-aged residents of Solan district, Himachal Pradesh. Given the mounting global and national burden of heart diseases and the increasing vulnerability of middle-aged adults, these findings are timely and provide a valuable foundation for developing localized and culturally relevant public health strategies aimed at mitigating cardiovascular risk.

The socio-demographic profile of the participants (Table 1) reveals that the majority (70.3%) were aged between 35 and 45 years, reflecting a younger middle-aged group that represents a prime target for preventive health interventions. The slight female predominance (52%) highlights the critical role women could play not only in safeguarding their own cardiovascular health but also in influencing health behaviors within their families. The educational distribution-where 66.3% had attained at least secondary education or higher-suggests a moderately educated population, which theoretically should facilitate the dissemination and uptake of health information. However, the rural predominance (67%) underscores potential challenges related to health service accessibility, health literacy variations and cultural factors that could impede effective CVD prevention and management efforts in these communities.

Knowledge regarding key cardiovascular risk factors (Table 2) was found to be generally encouraging but still leaves room for significant improvement. Most participants were well aware of traditional modifiable risk factors such as high blood pressure (81.5%), smoking (84.8%), obesity (79.5%), diabetes (77.8%) and high cholesterol (76.3%). Furthermore, strong awareness was demonstrated regarding physical inactivity (82.5%) and the protective role of regular exercise (82.0%) and healthy diets (80.3%). This promising level of foundational knowledge aligns with findings from other regional studies that emphasize growing general awareness, likely influenced by widespread health campaigns, media outreach and COVID-19-induced health consciousness. However, nuanced knowledge areas were less satisfactory: only 66.5% recognized that CVDs could be asymptomatic in early stages-a critical knowledge gap that could delay timely risk assessment and intervention. Furthermore, misconceptions were evident, with 35% of participants incorrectly viewing regular exercise as a risk factor, indicating confusion between preventive behaviors and risk contributors. Awareness regarding the importance of monitoring blood sugar and salt intake, although relatively high (70.3% and 78.5% respectively), also points to lingering knowledge gaps that must be addressed to ensure comprehensive risk management.

The knowledge classification (Table 3) revealed that while a substantial proportion of participants demonstrated "Very Good" (32%) and "Good" (42.5%) knowledge, a concerning 25.6% (combined "Fair" and "Poor") exhibited limited understanding. These participants represent a vulnerable segment of the population that could benefit most from focused educational interventions. Similar patterns have been observed in national and international studies, where baseline awareness exists but is insufficiently deep or actionable, particularly when it comes to understanding asymptomatic disease progression, non-traditional risk factors and the critical need for proactive health monitoring.

Lifestyle transitions in Solan, as mirrored across rural India, are likely contributing significantly to rising CVD risk. Traditional protective factors-such as higher physical activity due to agrarian lifestyles-are being eroded by increased mechanization, indoor occupations, dietary shifts toward processed foods and persistent tobacco and alcohol use. Compounded by socio-cultural barriers, low-risk perception among asymptomatic individuals and limited routine engagement with preventive health services, the conditions are ripe for a looming cardiovascular epidemic even in semi-rural settings.

From a public health perspective, these findings emphasize the urgent need for a multi-pronged approach. First, health education campaigns should move beyond basic awareness and focus on deepening the public’s understanding of silent risk factors, early warning signs and the asymptomatic nature of early-stage CVDs. Messaging must be clear, relatable and delivered through trusted local sources including Accredited Social Health Activists (ASHAs), school teachers, community leaders and healthcare providers. Second, interventions must actively address behavioral translation-turning awareness into preventive action. Campaigns promoting routine blood pressure, cholesterol and glucose monitoring, along with sustainable lifestyle changes such as daily exercise, salt restriction, smoking cessation and balanced diets, should be prioritized. Third, addressing rural-urban disparities by enhancing access to primary preventive services in rural Solan-through mobile health units, periodic screening camps and integration of CVD risk assessments into existing health programs-will be crucial. Fourth, considering the 20.3% unemployment rate among participants, economic barriers to accessing health-promoting resources such as medical check-ups, medications and fortified foods must also be factored into policy planning [7-9].

Additionally, the strong trust indicated in healthcare providers (85% preferring cardiologists or doctors for risk assessment) provides an opportunity: empowering primary care physicians and community health workers to offer early cardiovascular screening and counseling can bridge existing gaps cost-effectively. Simultaneously, the low awareness regarding asymptomatic CVD and misinterpretations about preventive behaviors highlight the need to incorporate targeted myth-busting and culturally sensitive narratives into communication strategies.

In summary, while the awareness of classical cardiovascular risk factors among middle-aged adults in Solan district is relatively robust, significant gaps persist in nuanced knowledge and preventive behaviors. Bridging these gaps through sustained education, community empowerment, accessible preventive services and culturally tailored interventions will be essential to reducing the future burden of cardiovascular diseases in this critical demographic group. Left unaddressed, the silent progression of CVD risk factors will continue to translate into a rising tide of preventable morbidity and mortality, straining families, healthcare systems and society at large.

This study highlights that while middle-aged adults in Solan district possess a reasonably strong foundational awareness of Classical Cardiovascular Disease (CVD) risk factors, critical gaps in nuanced knowledge, risk perception and preventive health behaviors persist, leaving a substantial portion of the population vulnerable to preventable heart diseases. Although encouraging levels of awareness regarding hypertension, smoking, obesity and physical inactivity were observed, misconceptions surrounding asymptomatic disease progression and the protective role of exercise underline the need for deeper, actionable education. The findings emphasize the urgent necessity for culturally tailored, community-driven public health strategies that not only enhance awareness but also translate knowledge into sustainable preventive practices, particularly in rural and socio-economically diverse populations. Strengthening access to preventive services, empowering healthcare providers for proactive risk counseling and addressing behavioral barriers are pivotal to reducing the rising burden of cardiovascular diseases in this critical demographic segment, ultimately fostering a healthier, heart-conscious society across Solan district.

Ethical Approval

Ethical approval was secured from the Institutional Ethics Committee prior to study commencement. All participants provided informed online consent before participation. Confidentiality and anonymity of participants were strictly maintained and no personally identifiable information was collected. The study adhered to the ethical standards outlined in the Declaration of Helsinki for research involving human subjects.

1. Krishnan, M.N. "Coronary heart disease and risk factors in India: On the brink of an epidemic?" Indian Heart Journal, vol. 64, no. 4, 2012, pp. 364–367.

2. George, G.M., et al. "A Study of Cardiovascular Risk Factors and Its Knowledge Among School Children of Delhi." Indian Heart Journal, vol. 66, no. 3, 2014, pp. 263–271.

3. Kundu, J., and S. Kundu. "Cardiovascular Disease (CVD) and its associated risk factors among older adults in India: Evidence from LASI Wave 1." Clinical Epidemiology and Global Health, vol. 13, 2022, Article ID 100937.

4. Singh, K., et al. "Community-level knowledge, attitudes, and practices regarding cardiovascular diseases and modifiable risk factors in India." Indian Heart Journal, vol. 76, no. 6, 2024, pp. 376–384.

5. Thomas, J., et al. "Knowledge About Cardiovascular Disease and Its Risk Factors Among College-Going Students in Peri-Urban Bengaluru, South India." International Journal of Noncommunicable Diseases, vol. 6, no. 1, 2021, pp. 29–33.

6. Jan, B., et al. "Cardiovascular diseases among indian older adults: A comprehensive review." Cardiovascular Therapeutics, vol. 2024, Article ID 6894693.

7. George, C. and G. Andhuvan. "A population-based study on awareness of cardiovascular disease risk factors." Indian Journal of Pharmacy Practice, vol. 7, no. 2, 2014, pp. 23–25.

8. Bischops, A.C., et al. "A cross-sectional study of cardiovascular disease risk clustering at different socio-geographic levels in India." Nature Communications, vol. 11, 2020, Article ID 5891.

9. Ghamri, R.A.M. "Knowledge of cardiovascular diseases and associated risk factors in the general adult population of Jeddah, Saudi Arabia: A Cross-Sectional Study Examining Gender Disparities." Medicine (Baltimore), vol. 103, no. 24, 2024.