Abstract
Diabetes mellitus (DM) is known to be associated with cardiovascular disease. This study aims to determine the level of knowledge about cardiovascular diseases among DM patients in the Kingdom of Saudi Arabia. This online cross-sectional survey study was conducted between March 2024 and April 2025 in Saudi Arabia. The study population comprised patients diagnosed with DM and aged at least 18 years who were currently residents in Saudi Arabia. The questionnaire for this study was adopted from a previous study by Wagner et al, named the Heart Disease Fact Questionnaire. Logistic regression analysis was conducted to predict significant factors influencing the knowledge of heart disease. Most participants had good knowledge of heart disease risk factors. For example, 210 (94.2%) knew that smoking is a risk factor, and 202 (94.2%) agreed that quitting smoking reduces the risk. In addition, 199 (91.7%) recognized high blood pressure as a risk factor, and 204 (93.4%) knew that controlling it reduces heart disease risk. A total of 200 (94.8%) understood that high blood sugar over time increases cholesterol and heart disease risk, and 194 (92.4%) believed that good blood sugar control helps reduce this risk. Furthermore, some misconceptions were observed: 185 (78.4%) incorrectly believed a person always knows when they have heart disease, and 118 (57.3%) thought people with diabetes rarely have high cholesterol. Smokers had significantly lower odds of good knowledge compared with nonsmokers (odds ratio = 0.32, 95% confidence interval: 0.11–0.90, P = .031). Conversely, participants who adhered to their treatment were significantly more likely to have good knowledge (odds ratio = 4.63, 95% confidence interval: 1.09–19.67, P = .038). The majority of the participants had a high level of understanding of the risk factors for heart disease. There were significant misconceptions regarding diabetes-related cholesterol risk and the symptoms of heart disease. Compliant patients had a higher level of awareness, and smokers had a significantly lower level of knowledge. These findings point to the necessity for educational interventions that are specifically designed to address particular deficiencies.
Keywords: cardiovascular diseases, diabetes mellitus, heart diseases, knowledge
1. Introduction
Diabetes mellitus (DM) is a chronic disease that affects individuals when the body is unable to produce a sufficient amount of insulin or when there is insulin in the body, but there are difficulties and problems in using it. This disease is one of the most widespread diseases in the world, as the number of people infected with it is increasing over time.[1] DM exposes patients to several complications, which can be divided into microvascular and macrovascular complications. Concerning microvascular complications, they include complications related to retinopathy, nephropathy, and neuropathy.[2] On the other hand, macrovascular complications, which result from oxidative stress because of high elevation of glucose levels, include cerebrovascular disease (stroke), cardiovascular diseases (CVD), and diseases related to the limbs.[3] DM is known to be associated with CVD as CVD is the most common leading cause of death among DM patients, due to either coronary artery disease or peripheral artery disease. It is common, especially among patients with type 2 diabetes.[4,5] The incidence of CVDs is high in these patients, and this is related to several factors, including increased blood glucose levels, which are closely linked to the occurrence of a defect in the blood vessel linings, thus increasing the chance of developing heart disease.[6] Moreover, high levels of lipids and cholesterol, especially among patients with type 2 diabetes, are important leading causes of the accumulation of arterial plaque.[7] In addition, when blood glucose levels rise significantly, this leads to damage to the blood vessels. As a result, the patient will suffer from hardening and narrowing of the arteries, which leads to a reduction in blood flow to the heart and, thus, causes a myocardial infarction.[4] Diabetes is significantly linked to deaths caused by heart disease as it exposes the patient to heart failure. One of the complications of diabetes is neuropathy, which, in turn, increases the rate of cardiac neuropathy.[8–12] The knowledge and awareness about CVD among DM patients are important to encourage them to improve their self-management. In India, a study was conducted to find out how much DM patients knew about complications associated with their condition. The results revealed that those patients had a poor understanding of the complications that DM could cause.[13] Another study in Ethiopia found that patients who had DM were often unable to recognize the complications that are linked with DM.[14] In Ghana, >80% of participants in one study were unaware of the issues related to the heart that they could suffer from in the future.[15] Other studies in Pakistan, Nigeria, and Turkey have shown that most DM patients were unaware of the cardiac adverse events that they may face in the long term.[16,17] In Saudi Arabia, a study was conducted to assess how familiar the DM patients were with the events that may occur because of DM regarding cardiac events. This study suggested that patients needed more education related to this aspect because most of them knew little about the complications that can be caused by this chronic disease.[18,19] It is important to raise awareness of the risks related to CVDs that DM patients can be exposed to as greater education helps in avoiding complications that can occur.[20–23] Being aware of the factors that increase risks to the heart, especially in type 2 diabetes, reduces the chance of these diseases occurring and encourages patients to deal with their disease accordingly. Furthermore, the patient’s awareness of the proper lifestyle that must be followed, including diet, exercise, adherence to medication, and continuous testing of blood sugar and cholesterol profile, leads to a reduction of the risks related to CVDs.[9] Knowledge of heart risks among DM patients is very weak, leading to a lack of adherence to related activities that are associated with controlling blood glucose levels. There are limited studies concerning knowledge about CVDs among DM patients in Saudi Arabia. This study aims to determine the level of knowledge about CVDs among DM patients in the Kingdom of Saudi Arabia.
2. Method
2.1. Study design
An online cross-sectional survey study was conducted between March 2024 and April 2025 in Saudi Arabia.
2.2. Study population and sampling procedure
The population for this study comprised patients diagnosed with DM and aged at least 18 years who were currently residents in Saudi Arabia. The inclusion criteria for the study population included all DM patients, whether they are using oral medications, insulin, other injectable dosage forms, or combinations of them. We did not restrict the study inclusion criteria based on patients’ duration of disease, age, or gender.
The questionnaire link was disseminated across social media platforms, including Facebook, WhatsApp, and X. The sample for this research was selected using convenience sampling. The utilization of convenience sampling expedites the recruitment of study participants, requiring minimal time and effort. The current study included participants who met the established inclusion criteria and showed their willingness to participate in the research. To improve patients’ comprehension of the importance of their participation, the research aims were articulated in full. The invitation letter outlined the inclusion criteria.
2.3. Study instrument
The questionnaire for this study was adopted from a previous study by Wagner et al, named the Heart Disease Fact Questionnaire.[24] The questionnaire tool comprises 25 items in a yes/no format. The questionnaire items focused on major risk factors of CVDs. The original instrument was pre-tested in a pilot study on 66 patients with DM. Stability of the instrument was assessed with test–retest reliability (n = 13, R = 0.89). In addition, our questionnaire instrument gathered information related to patients’ sociodemographic characteristics (gender, marital status, education level, income in Saudi Arabian riyals, treatment type, smoking status, adherence level, and age), comorbidities history, and DM complications.
2.4. Data analysis
Descriptive statistics were used to summarize the characteristics of the study participants, such as gender, age group, and smoking status, including frequencies and percentages for categorical variables. The continuous data, such as the knowledge score, were expressed by mean and standard deviation. The Kolmogorov–Smirnov test was applied to assess the normality of the continuous variables. For group comparisons, independent-sample t tests and one-way analysis of variance were performed; the Tukey post hoc test was applied for multiple comparisons. In addition, a logistic regression analysis was conducted to predict significant factors influencing the knowledge of heart disease risk factors and prevention, after categorizing the scale into 2 groups, based on the median score of 21. Before analysis, items 1, 9, 10, and 20 were reverse-coded due to negative statements. All data analysis was conducted utilizing the Statistical Package for the Social Sciences software, version 29. A P value <.05 was considered to be significant.
3. Results
The study included 261 participants, with 157 (60.2%) males and 104 (39.8%) females. The majority were married (201, 77.0%), while 25 (9.6%) were single, 17 (6.5%) divorced, and 18 (6.9%) widowed. In terms of education, 130 (49.8%) had a high school education or lower, 37 (14.2%) had a diploma, 77 (29.5%) held a bachelor’s degree, and 17 (6.5%) had postgraduate education. Most participants were using tablets with insulin for controlling diabetes (73, 28.0%) or tablets only (67, 25.7%) as their treatment. A high percentage were nonsmokers (196, 75.4%) and had good adherence to their treatment regimen (238, 91.5%). The age distribution showed that 81 participants (31.0%) were 61 years or older, and the largest group was aged 41 to 50 years (75, 28.7%): see Table 1.
Table 1.
Demographic characteristics.
| Demographic characteristics | Frequency (%) | |
|---|---|---|
| Gender | Male | 157 (60.2%) |
| Marital status | Single | 25 (9.6%) |
| Married | 201 (77.0%) | |
| Divorced | 17 (6.5%) | |
| Widowed | 18 (6.9%) | |
| Education level | High school or less | 130 (49.8%) |
| Diploma | 37 (14.2%) | |
| Bachelor | 77 (29.5%) | |
| Postgraduate | 17 (6.5%) | |
| Income (SAR) | <6000 | 114 (43.7%) |
| 6000–10,000 | 66 (25.3%) | |
| 10,000–16,000 | 40 (15.3%) | |
| 16,000 and above | 41 (15.7%) | |
| Treatment type | Tablet only | 67 (25.7%) |
| Tablet and weekly injection | 43 (16.5%) | |
| Tablets and insulin | 73 (28.0%) | |
| Tablet, insulin, and weekly injection | 67 (25.7%) | |
| Insulin injection | 11 (4.2%) | |
| Smoking status | Nonsmoker | 196 (75.4%) |
| Smoker | 36 (13.8%) | |
| Smoker < 5 yr | 8 (3.1%) | |
| Smokers > 5 yr | 20 (7.7%) | |
| Adherence | Yes | 238 (91.5%) |
| Age (yr) | 18–23 | 2 (0.8%) |
| 24–30 | 7 (2.7%) | |
| 31–40 | 22 (8.4%) | |
| 41–50 | 75 (28.7%) | |
| 51–60 | 74 (28.4%) | |
| 61 and older | 81 (31.0%) | |
Table 2 shows the prevalence of various chronic diseases and diabetes-related complications among the participants. The majority of patients had hypertension (157, 60.2%) and high cholesterol or triglycerides (143, 54.8%). Other chronic conditions reported included thyroid disorders (30, 11.5%) and gout (16, 6.1%). In terms of diabetes complications, eye complications were reported by most of the patients (95, 36.4%), followed by neuropathy (87, 33.3%). Most participants had diabetes for >10 years (194, 74.3%), and 211 patients (80.8%) reported having a first-degree family member diagnosed with diabetes.
Table 2.
Chronic diseases and diabetes complications among the participants.
| Chronic diseases and diabetes complications | Frequency (%) | |
|---|---|---|
| Other chronic diseases the patient has* | Hypertension | 157 (60.2%) |
| High cholesterol or triglycerides | 143 (54.8%) | |
| Thyroid disorders | 30 (11.5%) | |
| Gout | 16 (6.1%) | |
| Bone diseases | 53 (20.3%) | |
| Other disease | 44 (16.9%) | |
| I do not suffer from any chronic diseases | 42 (16.1%) | |
| Are there any complications of diabetes that the patient is suffering from?* | Neuropathy | 87 (33.3%) |
| Eye complications | 95 (36.4%) | |
| Kidney complications | 19 (7.3%) | |
| Heart and vascular diseases | 28 (10.7%) | |
| Diabetic foot | 37 (14.2%) | |
| Stroke | 6 (2.3%) | |
| I do not suffer from any complications | 102 (39.1%) | |
| How long has the patient been suffering from diabetes? | <1 yr | 3 (1.1%) |
| 1–5 yr | 27 (10.3%) | |
| 6–9 yr | 37 (14.2%) | |
| 10 yr and more | 194 (74.3) | |
| Is any first-degree family member (father, mother, brother, sister) diagnosed with diabetes? | Yes | 211 (80.8) |
More than 1 answer can be selected, percentage summation ≠ 100.
The findings show that most participants had good knowledge about heart disease risk factors. For example, 210 (94.2%) knew that smoking is a risk factor, and 202 (94.2%) agreed that quitting smoking reduces the risk. In addition, 199 (91.7%) recognized high blood pressure as a risk factor, and 204 (93.4%) knew that controlling it reduces heart disease risk. Similarly, 200 (94.8%) understood that high blood sugar, over time, increases cholesterol and heart disease risk, and 194 (92.4%) believed that good blood sugar control helps reduce this risk. However, some misconceptions were observed: 185 (78.4%) incorrectly believed a person always knows when they have heart disease, and 118 (57.3%) thought people with diabetes rarely have high cholesterol: see Table 3.
Table 3.
Participants’ knowledge about risk factors and prevention of heart disease.
| Please answer the following questions regarding patients’ knowledge about heart disease | No | Yes |
|---|---|---|
| A person always knows when they have heart disease.* | 185 (78.4%) | 51 (21.6%) |
| If you have a family history of heart disease, you are at risk of developing heart disease. | 135 (58.2%) | 97 (41.8%) |
| The older a person is, the higher their risk of developing heart disease. | 39 (17.4%) | 185 (82.6%) |
| Smoking is a risk factor for heart disease. | 13 (5.8%) | 210 (94.2%) |
| A person who quits smoking reduces their risk of heart disease. | 20 (9.0%) | 202 (91.0%) |
| High blood pressure is a risk factor for heart disease. | 18 (8.3%) | 199 (91.7%) |
| Keeping blood pressure under control will reduce a person’s risk of heart disease. | 14 (6.4%) | 204 (93.6%) |
| High cholesterol is a risk factor for heart disease. | 22 (10.2%) | 193 (89.8%) |
| Eating fatty foods does not affect blood cholesterol levels.* | 149 (69.6%) | 65 (30.4%) |
| If the level of “good” cholesterol is high, you are at risk of heart disease.* | 124 (58.2%) | 89 (41.8%) |
| If the level of “bad” cholesterol is high, you are at risk of heart disease. | 14 (6.5%) | 201 (93.5%) |
| Being overweight increases a person’s risk of heart disease. | 12 (5.6%) | 202 (94.4%) |
| Regular physical activity reduces a person’s chance of heart disease. | 15 (7.1%) | 197 (92.9%) |
| Only exercising in the gym or in fitness classes reduces the chance of getting heart disease.* | 98 (46.2%) | 114 (53.8%) |
| Walking and gardening are forms of physical activity that help reduce a person’s chance of heart disease. | 14 (6.5%) | 200 (93.5%) |
| Diabetes is a risk factor for heart disease. | 27 (12.7%) | 186 (87.3%) |
| High blood sugar puts stress on the heart. | 17 (8.1%) | 194 (91.9%) |
| If blood sugar levels remain high for several months, it may lead to increased cholesterol levels and raise the risk of heart disease. | 11 (5.2%) | 200 (94.8%) |
| Any person with diabetes can reduce their risk of heart disease by maintaining good blood sugar control. | 16 (7.6%) | 194 (92.4%) |
| People with diabetes rarely have high cholesterol.* | 118 (57.3%) | 88 (42.7%) |
| If a person has diabetes, keeping cholesterol levels under control will help reduce their risk of heart disease. | 16 (7.6%) | 194 (92.4%) |
| People with diabetes often have low levels of good cholesterol. | 82 (39.8%) | 124 (60.2%) |
| If a person has diabetes, keeping blood pressure under control will help reduce their risk of heart disease. | 18 (8.7%) | 189 (91.3%) |
| If a person has diabetes, maintaining a healthy weight will help reduce their risk of heart disease. | 12 (5.8%) | 194 (94.2%) |
| Men with diabetes are more likely to develop heart disease than women with diabetes. | 79 (38.2%) | 128 (1.8%) |
The correct answer is false.
The knowledge score was significantly higher among nonsmokers (21.01 ± 2.38) compared with smokers (19.67 ± 2.56) and those who had smoked for <5 years (18.40 ± 2.70; P = .007). Participants who adhered to their treatment had significantly higher knowledge scores (20.76 ± 2.58) than those who did not (19.33 ± 1.97; P = .02). In addition, age showed a significant difference among the groups, where the highest knowledge scores were observed in the 31 to 40 and 61 + age groups (21.36 ± 1.69 and 21.59 ± 2.04, respectively), while the lowest was among those ages 24-30 (16.67 ± 8.39; P = .001): see Table 4.
Table 4.
Knowledge score of heart disease risk factors and prevention stratified by the demographic characteristics.
| Variables | Mean ± SD | P value | |
|---|---|---|---|
| Gender | Female | 20.67 ± 2.79 | .88 |
| Male | 20.61 ± 2.43 | ||
| Marital status | Single | 20.29 ± 2.46 | .68 |
| Married | 20.74 ± 2.48 | ||
| Divorced | 20.50 ± 1.69 | ||
| Widowed | 19.92 ± 3.86 | ||
| Education level | High school or less | 20.19 ± 2.74 | .13 |
| Diploma | 21.15 ± 1.79 | ||
| Bachelor | 20.77 ± 2.64 | ||
| Postgraduate | 21.73 ± 2.00 | ||
| Income (SAR) | <6000 | 20.42 ± 2.90 | .79 |
| 6000–10,000 | 20.75 ± 2.28 | ||
| 10,000–16,000 | 20.63 ± 2.08 | ||
| 16,000 and above | 20.94 ± 2.64 | ||
| Treatment type | Tablet only | 20.73 ± 2.47 | .42 |
| Tablet and weekly injection | 20.80 ± 2.28 | ||
| Tablets and insulin | 20.92 ± 2.26 | ||
| Tablet, insulin, and weekly injection | 20.29 ± 2.49 | ||
| Insulin injection | 19.25 ± 5.28 | ||
| Smoking status | Non smoker | 21.01 ± 2.38 | .007 |
| Smoker | 19.67 ± 2.56 | ||
| Smoker < 5 yr | 18.40 ± 2.70 | ||
| Smokers > 5 yr | 20.00 ± 3.10 | ||
| Adherence | No | 19.33 ± 1.97 | .02 |
| Yes | 20.76 ± 2.58 | ||
| Age (yr) | 24–30 | 16.67 ± 8.39 | .0001 |
| 31–40 | 21.36 ± 1.69 | ||
| 41–50 | 20.00 ± 2.43 | ||
| 51–60 | 20.24 ± 2.50 | ||
| 61 and older | 21.59 ± 2.04 | ||
SD = standard deviation.
In the multivariate analysis, the variables showed statistically significant associations with knowledge levels. Smokers had significantly lower odds of good knowledge compared with nonsmokers (odds ratio [OR] = 0.32, 95% confidence interval [CI]: 0.11–0.90, P = .031). Conversely, participants who adhered to their treatment were significantly more likely to have good knowledge (OR = 4.63, 95% CI: 1.09–19.67, P = .038): see Table 5.
Table 5.
Predictors of knowledge in multivariate logistic regression.
| Variables | OR (95% CI) | P value | |
|---|---|---|---|
| Gender | Female (reference category) | 1.00 | |
| Male | 0.73 (1.80–1.80) | .499 | |
| Marital status | Single (reference category) | 1.00 | |
| Married | 0.86 (0.19–3.85) | .840 | |
| Divorced | 2.48 (0.24–26.04) | .450 | |
| Widowed | 0.89 (0.12–6.49) | .911 | |
| Education level | High school or less (reference category) | 1.00 | |
| Diploma | 1.57 (0.51–4.83) | .429 | |
| Bachelor | 1.67 (0.63–4.43) | .307 | |
| Postgrad | 1.37 (0.22–8.54) | .733 | |
| Income (SAR) | <6000 (reference category) | 1.00 | |
| 6000–10,000 | 0.85 (0.32–2.31) | .755 | |
| 10,000–16,000 | 1.02 (0.31–3.36) | .977 | |
| 16,000 and more | 0.84 (0.22–3.23) | .800 | |
| Treatment type | Tablet only (reference category) | 1.00 | |
| Tablet and weekly injection | 0.71 (0.24–2.09) | .536 | |
| Tablets and insulin | 0.64 (0.25–1.66) | .358 | |
| Tablet, insulin, and weekly injection | 0.42 (0.15–1.16) | .095 | |
| Insulin injection | 1.25 (0.20–7.94) | .813 | |
| Smoking status | Nonsmoker (reference category) | 1.00 | |
| Smoker | 0.32 (0.11–0.90) | .031 | |
| Smoker < 5 yr | 0.00 (0.00–0.00) | .999 | |
| Smokers > 5 yr | 0.54 (0.16–1.83) | .321 | |
| Adherence | No (reference category) | 1.00 | |
| Yes | 4.63 (1.09–19.67) | .038 | |
| Age (yr) | 24–30 (reference category) | 1.00 | |
| 31–40 | 2.26 (0.11–44.93) | .592 | |
| 41–50 | 2.10 (0.12–38.01) | .615 | |
| 51–60 | 1.81 (0.10–33.39) | .690 | |
| 61 and older | 5.76 (0.30–109.40) | .243 | |
| Constant | 0.13 (0.00–0.00) | .207 | |
CI = confidence interval, OR = odds ratio.
4. Discussion
The current study aims to determine the level of knowledge and awareness among DM patients in the Kingdom of Saudi Arabia about CVDs. In our study, most participants had good knowledge about heart disease risk factors. For example, 210 (94.2%) knew that smoking is a risk factor, and 202 (94.2%) agreed that quitting smoking reduces the risk. In addition, 199 (91.7%) recognized high blood pressure as a risk factor, and 204 (93.4%) knew that controlling it reduces heart disease risk. This result was consistent with the study that was conducted in Ethiopia involving 318 diabetic patients, 152 of whom knew that smoking was one of the main causes of increased CVD.[25] In addition to that, in another study performed by Khanal et al on diabetes patients to examine the level of awareness of risk factors associated with heart disease, more than half of the sample knew that smoking and hypertension were linked to increased risk of CVD. These results were also consistent with the educational level among these patients.[9] In contrast, in a study conducted in Jeddah, Saudi Arabia, a small number of participants demonstrated little knowledge of the relationship between diabetes, smoking, high blood pressure, and CVD. This shows the importance of targeting this group to increase their awareness.[26]
The risk factors that can increase the likelihood of CVD can be modifiable or unmodifiable. The unmodifiable risk factors include age, sex, race, and any past medical history of CVD. The modifiable risk factors, which mean those that can change following good adherence to medical regimens and a healthy lifestyle, include high blood pressure, high cholesterol and lipids, diabetes, gaining weight, tobacco smoking, unhealthy diet, and exposure to stress and tension.[27,28] Smoking correlates with an increased incidence of mortality among CVD patients.[29,30] In addition to that, by inducing some processes that trigger inflammation cascades, oxidative stress, and induce formation of blood clots, smoking can cause substantial deterioration of the circulatory system, the result of which could affect cardiac outcomes.[31] Smoking can increase the risk of blood vessel and artery damage because it involves several substances, such as carbon monoxide, which increase the risk of blood vessel inflammation.[31,32] Moreover, smoking also links heart disease and diabetes as smoking increases insulin resistance and, thus, indirectly increases the risk of vascular disease.[33–35] Giving up smoking is considered a key factor in protecting patients from deterioration that may occur concurrently with heart disease. In this case, the laboratory test results regarding the inflammation would return to the normal range, the lipid profile would be enhanced, and the risk of developing new events related to the heart would decrease.[31] Regarding hypertension, smoking can damage the endothelium, which, as a result, can cause blood vessel blockage and inflammation. Thus, giving up smoking could reduce certain negative effects on the arteries of the heart.[36]
In our study, 200 (94.8%) participants understood that high blood sugar, over time, increases cholesterol and heart disease risk, and 194 (92.4%) believed that good blood sugar control helps reduce this risk. These results agree with the previous literature. Our result was consistent with a study that was conducted in Saudi Arabia to assess awareness among DM patients about the relationship between diabetes and CVD risk. A majority of the patients had adequate understanding of CVD complications associated with DM.[37] In contrast to our findings, Zehirlioglu et al, in their study on Turkish patients, found that patients with type 2 DM had insufficient knowledge regarding CVD complications.[17] Another study in Ghana was conducted to examine the awareness of complications that may be caused by DM among patients. The participants were able to identify some complications that may occur because of DM, but only 9.2% of them were able to identify CVD as a medical complication of DM, which reflected poor knowledge related to CVD.[15] Moreover, a study in Korea showed that 83.3% of their participants who were diagnosed with DM had hyperlipidemia, but their adherence to their lipid-lowering agents had been significantly low. This result was inconsistent with our results, and the findings indicated that patients were unaware of this complication.[38] DM plays a vital role in increasing the rate of developing CVDs. This disease is involved in many pathways that can weaken the cardiac function, one of which is an increase in the ability of fat disposition inside the arteries. As a result of this, they are attacking the inner parts of these arteries and causing them to narrow.[39] As a result of this process, further CVD complications can occur, such as cerebrovascular complications and cardiac infarction.[40] As many trials have shown, controlling blood glucose levels can help in reducing the risk of CVD by 40%, and diabetes has been linked to the development of lipid levels due to the changes that occur in lipoproteins.[41,42] If irregular blood sugar levels occur, especially in type 1 diabetes, then the level of triglycerides will increase,[43] and high-density lipoprotein (HDL) will decrease,[44] and thus, due to the accompanying complications that can be caused by high lipids in the body, patients will be more susceptible to heart disease.[45]
In the United Kingdom, a study with the same results as our study aimed to examine the effects of controlling the levels of blood glucose on heart disease. The participants were patients with type 2 diabetes who had been monitored for 20 years. It summarized that controlling blood glucose levels can reduce complications of the microvascular diseases in the short term. As for the long term, the continuation of monitoring the levels of blood glucose can reduce CVD and their complications that are associated with diabetes, such as macrovascular diseases.[46] As DM is considered one of the main risk factors that increases the chance of having heart diseases, the close monitoring of blood glucose to control its level in the blood is an essential factor for lowering the risk of this disease in patients. As many previous studies have suggested, this approach is effective in the management of CVD complications.[47]
Our study also uncovered some misconceptions: 185 (78.4%) participants incorrectly believed a person always knows when they have a heart disease, and 118 (57.3%) thought people with DM rarely had high cholesterol. This result was consistent with 2 studies conducted respectively on African American women and patients visiting emergency departments in Tanzania. Regarding African American women, the study aimed to evaluate the extent of these women’s awareness of symptoms associated with heart disease, as the level of general awareness was extremely low. The study showed that they were not aware of the symptoms of heart diseases, such as heart attacks or strokes. This percentage was found to be greater among women with low education and at a younger age.[48] Concerning the study conducted in Tanzania it aimed to assess the awareness of patients visiting the emergency department to measure their knowledge of heart diseases. The results showed a low level of awareness and knowledge among these patients, with most of them being unable to identify the risk factors that increase the occurrence of these diseases.[49] Concerning high cholesterol levels, in South Korea, in a study to measure awareness among diabetics about dyslipidemia, it was found that some patients did not have full knowledge of their symptoms, and only a few of them took lipid-lowering medication. The study revealed that many diabetic patients needed to increase their awareness to avoid the risks of high lipids in their bodies, and so prevent cardiovascular events.[38] According to the American Heart Association, diabetes, especially type 2, increases the body’s lipid levels due to an increase in insulin resistance, which, in turn, increases cholesterol levels and decreases HDL, thus raising the risk of CVD.[50] Furthermore, having DM can lead to the development of dyslipidemia, as the insulin deficiency causes some imbalance in lipoproteins, thus resulting in abnormal levels of low-density lipoprotein, cholesterol, and HDL.[51] Most of the patients who were diagnosed with DM had poor knowledge about the symptoms that can cause to put them at risk of developing CVDs. Because of this, many countries try to reduce these complications by increasing education about the importance of self-management and by campaigns that help patients recognize the symptoms.[52]
In our study, smokers were significantly less knowledgeable compared with nonsmokers (OR = 0.32: 95% CI: 0.11–0.90, P = .031). Conversely, participants who adhered to their treatment were significantly more likely to have good knowledge (OR = 4.63, 95% CI: 1.09–19.67, P = .038). This aligns with a study conducted in Iraq by Sulaiman and Andsoy, which confirmed that the level of knowledge about CVDs is linked to smoking status, where the level of awareness was higher among nonsmokers than smokers.[53] Furthermore, Raebel et al, in a study conducted on DM patients to evaluate the relationship between the adherence of medications among diabetic patients and knowledge about CVD, agreed with our findings regarding adherence by patients to the medications issued and knowledge about CVD. They found that if patients took their medications, such as blood pressure and lipid-lowering treatments, this would significantly contribute to controlling CVD.[54]
According to our findings, it appears that we must have an approach that helps diabetic patients manage their blood glucose levels and encourages self-management to prevent any complications related to CVDs. This study has highlighted the role of the medical team in determining the risk factors that patients suffer from regarding the distribution of educational material related to specific issues. The main role of the medical team is to enhance the patient’s life and decrease the mortality rate.[55] Strategies exist that can support this process, such as periodic follow-ups with the patients to assess any deterioration, choosing the most appropriate treatment according to the patient’s condition, and increasing the education concerning how to deal with CVD symptoms when they appear. Also, health care providers can support patients to control other risk factors, such as hypertension, hyperlipidemia, smoking, and hyperglycemia, to improve their health.[56]
This study has limitations. It is a cross-sectional survey study, so determining the specific cause of associated risk factors that may be linked to diabetes and increase CVDs is lacking. Moreover, it is not clear whether modifiable risk factors will change with time, and how much this can influence a patient’s health. The generalizability of the study findings might have been affected as the study population was restricted to online platform users. Thus, further longitudinal studies are needed to determine the changes in patients’ knowledge over time and the impact on clinical outcomes. Besides, future studies should aim to examine the effectiveness of educational interventions on improving patients’ awareness levels.
5. Conclusion
The majority of the participants had a high level of understanding of the risk factors for heart disease. There were significant misconceptions regarding diabetes-related cholesterol risk and the symptoms of heart disease. Compliant patients had a higher level of awareness, and smokers had a significantly lower level of knowledge. These findings point to the necessity for educational interventions that are specifically designed to address particular deficiencies. Educational campaigns are warranted to correct misconceptions concerning risk factors of CVDs.
Author contributions
Conceptualization: Kadejh Abdulrahman Bashekah.
Data curation: Kadejh Abdulrahman Bashekah.
Formal analysis: Kadejh Abdulrahman Bashekah.
Funding acquisition: Kadejh Abdulrahman Bashekah.
Investigation: Kadejh Abdulrahman Bashekah, Ibraheem Mahmoud Ghulman, Saeed Ali Alzahrani, Mashaer Omar Fallatah, Lowloh Abdullah Alotaibi, Salma Abdulkarim Alkhoutani, Ghofran Siraj A Khogeer, Faizah Omar Almahmudi, Reem Mohammed Alqahtani, Hind Mauafaq Aljifri, Sarah Mauafaq Aljifri, Rayan Abdulbasit Marzuqi, Moneerah Abdulmotheeb Alhemedi.
Methodology: Kadejh Abdulrahman Bashekah.
Project administration: Kadejh Abdulrahman Bashekah.
Resources: Kadejh Abdulrahman Bashekah, Ibraheem Mahmoud Ghulman, Saeed Ali Alzahrani, Mashaer Omar Fallatah, Lowloh Abdullah Alotaibi, Salma Abdulkarim Alkhoutani, Ghofran Siraj A Khogeer, Faizah Omar Almahmudi, Reem Mohammed Alqahtani, Hind Mauafaq Aljifri, Sarah Mauafaq Aljifri, Rayan Abdulbasit Marzuqi, Moneerah Abdulmotheeb Alhemedi.
Software: Kadejh Abdulrahman Bashekah.
Supervision: Kadejh Abdulrahman Bashekah.
Validation: Kadejh Abdulrahman Bashekah.
Visualization: Kadejh Abdulrahman Bashekah.
Writing – original draft: Kadejh Abdulrahman Bashekah.
Writing – review & editing: Kadejh Abdulrahman Bashekah, Ibraheem Mahmoud Ghulman, Saeed Ali Alzahrani, Mashaer Omar Fallatah, Lowloh Abdullah Alotaibi, Salma Abdulkarim Alkhoutani, Ghofran Siraj A Khogeer, Faizah Omar Almahmudi, Reem Mohammed Alqahtani, Hind Mauafaq Aljifri, Sarah Mauafaq Aljifri, Rayan Abdulbasit Marzuqi, Moneerah Abdulmotheeb Alhemedi.
Abbreviations:
- CI
- confidence interval
- CVD
- cardiovascular disease
- DM
- diabetes mellitus
- HDL
- high-density lipoprotein,
- OR
- odds ratio
Ethical approval for this study was obtained from the Saudi Ministry of Health (KSA: H-02-J-002). Informed consent was obtained from the study participants before study commencement.
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Bashekah KA, Ghulman IM, Alzahrani SA, Fallatah MO, Alotaibi LA, Alkhoutani SA, Siraj A Khogeer G, Almahmudi FO, Alqahtani RM, Aljifri HM, Aljifri SM, Marzuqi RA, Alhemedi MA. Knowledge of cardiovascular diseases among patients with diabetes mellitus in the Kingdom of Saudi Arabia: A cross-sectional study. Medicine 2026;105:18(e48492).
Contributor Information
Ibraheem Mahmoud Ghulman, Email: Ibraheem.ghulman@gmail.com.
Saeed Ali Alzahrani, Email: sam_az@hotmail.com.
Mashaer Omar Fallatah, Email: Mashaer_f@yahoo.com.
Lowloh Abdullah Alotaibi, Email: dr.lowloh@outlook.sa.
Salma Abdulkarim Alkhoutani, Email: Dr.s_khoutani@hotmail.com.
Ghofran Siraj A Khogeer, Email: ghofran.khogeer@gmail.com.
Faizah Omar Almahmudi, Email: Faizah.almahmudi@gmail.com.
Reem Mohammed Alqahtani, Email: rmalqahtani@kau.edu.sa.
Hind Mauafaq Aljifri, Email: Sarajifry1@gmail.com.
Sarah Mauafaq Aljifri, Email: Sarajifry1@gmail.com.
Rayan Abdulbasit Marzuqi, Email: rmarzuqi@moh.gov.sa.
Moneerah Abdulmotheeb Alhemedi, Email: dr_memy241@hotmail.com.
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