Smoking and Blood Sugar level: An important cause of cardiovascular diseases

among Australians.

Abstract

In the present era, cardiovascular diseases are the major life threating concerns being
addressed worldwide. Researches have been carried out with the aim of identification
of factors related to the coronary heart diseases and evaluation of risk associated with
those factors in order to provide timely treatment to the patients. However, with the
increased advancement in the clinical research, there exist a paradigm shift in
identification of individual centric factors related to cardiovascular diseases and the
risk associated with such factors leading to long term diseases. The study aimed to
determine the role of smoking and blood glucose level on systolic blood pressure,
which can lead to cardiovascular diseases. A cross sectional survey was conducted at
the Australia health promotion fair, 2017 in NSW. All the people who attended the
Fair and visited the health promotion counter were asked to participate in the study.
Data corresponding to their Blood pressure, blood glucose, and waist circumference
were calculated by health professional present there. While as history of diabetes,
smoking habits and demographic profile were obtained through self-reporting
instrument. Data were analysed for 161 participants in the survey. The results
indicated that there exists an insignificant relationship between male and females with
respect to the blood glucose level and history of blood pressure. Also, it has been
found that irrespective of age, there is high level of risk associated with smoking
habits resulting in high mortality rate. Thus, making it necessary for the government
and health departments to create awareness among nurses and other health
professionals about the risk associated with such fatal conditions.

Keywords: Cardiovascular diseases, Smoking, Personal factors, Diabetes, Blood

pressure.
Introduction

Good health is an important aspect of everyone life. Good health is vivacious as it

determines the well being of individuals in particular and society in large. A healthy
individual is the result of many factors like environmental, social, lifestyle, political,
genetic. The nation with population of more healthy people is more successful in
minimizing the diseases among its people. It is the duty of the people living in the
society in large to creative awareness about the factors and risks associated with
various healthy habits leading to healthy lifestyle. Among them nursing plays an
important role in determining and creating awareness about the good health. As
reported by world health organization cardiovascular disease are the prominent
factors for deteriorating health leading to high mortality worldwide. It has been found
that almost 17.7 million people died from cardiovascular diseases in 2015, which
represents 31% of all global deaths. Among these deaths, an estimated 7.4 million
were due to coronary heart disease and 6.7 million were due to stroke (WHO). Thus,
making it important for nursing and other health sectors to understand and analyse the
risk factors associated with cardiovascular diseases.

Review of Literature

Nursing has always been a major player in delivery healthy environment amongst
nationals of a country. The role of nurses has been globally recognized in public and
professional training to improve the conditions of fatal diseases causing factors by
creating awareness and providing apt treatment to the patients suffering from those
diseases. Cardiovascular diseases are one of the concerned diseases, which need to be
addressed in more organized manner so that the mortality rate can be reduced. Thus
making it important to understand the causes and risk factors for these diseases.
Researches have found that smoking and high sugar level are one of the prominent
factors leading to systolic blood pressure which leads to life threatening
cardiovascular diseases.

Various factors and conditions have been identified that plays an important role in the
development of systolic blood pressure which comprise of smoking, alcohol
consumption, too much salt and sugar intake, lack of physical activity, obesity, stress,
age, genetics, family history of high blood pressure, chronic kidney disorder and
adrenal thyroid disorders. (Asare, 2008; Pickup and Williams, 2003). Lack of physical
activity is another major factor causing insulin resistance and cardiovascular diseases.
It is likely that any type of physical activity likes sports, household chores, gardening
or work-related activities are always beneficial. Despite the fact that a certain amount
and duration of the physical activity is vital for good health, it has also been argued
that physical activity is necessary for prevention of metabolic and cardiovascular
diseases. Apart from this, genetic, behavioural, environmental and family history
elements also impact the health (Harrison, 2003). On the other hand, it has been found
that lifestyle of an individual especially those who are more into alcohol consumption,
smoking habits are meant to have increased risk for developing insulin resistance,
resulting in the condition, in which the body does not efficiently make use of the
insulin being produced. The insulin resistance predisposes an individual to high sugar
level and high blood pressure resulting in increased chances of a heart attack (Nesto,
2009). In clinical research the fluctuating clinical indicators such as blood
haemoglobin (Hb), blood pressure level (BP) and blood glucose level (BGL) may lead
to change in the health of an individual. These indicators determine the presence or
absence of a particular disease which does not mean that the effect of some other
factors like age, gender, height, or weight of a person should be ignored. These
factors may unearth people to acquisition of cardiovascular risk factors, which
comprise of diabetes, hypertension, heart attack and obesity. Many people may or
may not be aware of the fact that any factor could prepare a fertile ground for some
diseases to occur. This makes important for the health professionals and nurses in
particular to create a platform so that awareness could be created among large masses
and counselling and care should be provided those who are suffering from those
diseases.

Objective of the research

The study aimed to examine the role of smoking and blood glucose level on the
systolic blood pressure of people living in major city of Australia. The study also
aimed to identify that is there any significant difference in blood glucose level of
males and females. Is there any significant relationship between history of blood
pressure among males and females? Moreover, it also aimed to identify is there exist
any significant relationship between age of people and history of smoking?
Research Methods

Research methods forms an integral part of any research, which encompasses the
procedure, followed to complete the research in order to obtain pre-specified
objectives.

Research Design

A cross-sectional study has been conducted in order to gain information about the
cardiovascular profile of the respondents. Data has been collected from the people
who attended and visited the counter at Health promotional fair 2017 in New South
Wales. The data was collected using a convenience sampling method.

Sample and Setting

The sample size for the research comprise of 161 respondents who attended the health
promotional fair 2017 in NSW. Among 161 respondents, 69 were females and 92
were males. Questionnaire consisting of their demographic profile, health conditions
were self assessed by them while as information regarding their clinical health
condition was assessed by health professionals present at the counter.

Data collection method

Data was collected through self-administered questionnaire regarding health issues on

the same day at Health promotional fair, 2017 at NSW.

Data collection instrument

The questionnaire consisting of eight variables have been used to gather information
from the respondents. Data regarding the demographic profile of the respondents
which comprise of age, gender, highest educational level and the clinical history
comprising of five variables corresponding to history of blood pressure, diabetes,
smoking and the actual blood sugar and blood pressure has been measured.
Data Analysis

The data collected through the questionnaire has been logically arranged in the data
view and the variable view window of IBM SPSS Version 25.The data has been
subsequently subjected to various statistical tools like Descriptive analysis to get
mean, Standard deviation (SD) and frequencies of categorical and continuous data. t-
test and Chi square test been used to assess the difference between continuous
variables and categorical variables. Comparisons were made considering the p value,
significant at 0.05 (Mann-Whitney U Test).

Results

Many people visited the health promotional fair 2017 at NSW. Among them, data was
collected from people who visited the counter which comprise of 161 people. The age
group of respondents ranges from 18-81years with an average age of 43.81;
SD=13.48. Majority of respondents were males 57.1% with n=92 and rest of them
were females 42.9% with n=69. When asked about their highest educational level,
most of the respondents were bachelors (n=76; 47.2%), followed by master degree
(n=45; 28%), followed by HSC (n=29; 18%) and least number of people having
doctorate degree (n=2; 1.2%). The health professionals present there measured the
blood pressure level and blood sugar level of the respondents and the average blood
pressure found to be (127.14; SD=13.48) where as the mean average for blood sugar
level was found to be (6.19; SD=2.14).
While analysing the clinical history of the respondents it has been found that 37.3%
respondents have a history of high blood pressure (n=60) and 35.4% have a history of
high blood sugar level (n=57). Moreover, smoking habits of respondents depicts that
29% of respondents have history of smoking habits (n= 47). The detailed profile of
the respondents with their clinical history has been summarized in the following
table1.1.

Table 1.1 Descriptive analysis of profile of respondents

Description of Variables Mean Standard Deviation

Age 43.81 13.48
Blood Pressure level 127.14 17.26
Blood Sugar level 6.19 2.14
Waist Circumference 93.75 14.10

Frequency %age
Gender
Male 92 57.1
Female 69 42.9
Highest Education Level
HSC 29 18
Bachelors 76 47.2
Masters 45 28
Doctorate 2 1.2
History of high Blood 60 37.3
Pressure(yes)
History of high blood 57 35.4
sugar(yes)
History of smoking(yes) 47 29.2

Are there any significant gender differences in BGL?

In order to find the significance difference in the mean blood sugar level of males and
females, t-test has been applied. The mean blood sugar level for females is (6.12;
SD=2.628) while as for males the mean blood sugar level is (6.24;SD=1.706).
Moreover, the p value is (.722) significant at value greater than 0.005 indicating that
there exists an insignificant difference between blood sugar level of males and
females. The results of t-test have been summarized in the tables1.2.

Table 1.2 Independent t-test: Significance gender difference in Blood glucose level
Group Statistics
Gender N Mean Std. Std. P Significance
Deviation Error valu
Mean e
Blood Female 69 6.12 2.628 .316
Sugar .722 .752
Male 92 6.24 1.706 .178
Level

Is there any significant relationship between gender and history of BP?

Since gender and history of blood pressure both are classified as categorical variables,
chi square test has been applied in order to find the significant relationship between
them. The result of Chi Square indicates that out of 69 females, 20 have a history of
blood pressure. On the other hand, out of 92males, 40 have a history of blood
pressure. Moreover, the p value is .071 indicating that there exist an insignificant
relationship between gender and history of blood pressure, which are summarized in
table 1.3(a) and 1.3(b).
Table 1.3(a) Crosstabulation of Gender and history of blood pressure.

Crosstabulation of Gender and History of blood pressure

History of high Blood Total
Pressure
No Yes
Gender Female Count 49 20 69
% within Gender 71.0% 29.0% 100.0%
% within History 48.5% 33.3% 42.9%
of high Blood
Pressure
% of Total 30.4% 12.4% 42.9%
Male Count 52 40 92
% within Gender 56.5% 43.5% 100.0%
% within History 51.5% 66.7% 57.1%
of high Blood
Pressure
% of Total 32.3% 24.8% 57.1%
Total Count 101 60 161
% within Gender 62.7% 37.3% 100.0%
% within History 100.0% 100.0% 100.0%
of high Blood
Pressure
% of Total 62.7% 37.3% 100.0%

Table 1.3(b) Chi-square analysis of gender and history of blood pressure.

Chi-Square Tests
Value df Asymptotic Exact Exact
Significanc Sig. (2- Sig. (1-
e (2-sided) sided) sided)
a
Pearson Chi-Square 3.542 1 .060
Continuity Correction 2.950 1 .086
Likelihood Ratio 3.588 1 .058
Fisher's Exact Test .071 .042
Linear-by-Linear 3.520 1 .061
Association
N of Valid Cases 161
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is
25.71.
b. Computed only for a 2x2 table

Are there any significant relationship between age and history of Smoking?
The relationship between age and history has been analysed through t-test as age is
the continuous data while as history of smoking is a dichotomous data. The results
indicate that among 161 respondents only 47 individuals had a history of smoking
with SD= 12.337 while as 114 respondents doesn’t have history of smoking with
SD=13. 971.Moreover, the p value is (.841) which is greater than 0.05 indicating that
there exists an insignificant relationship between age and history of smoking which
has been summarized in table 1.4. This implies that age doesn’t have any relationship
with the history of smoking.

Table 1.4 Independent sample t-test. Relationship between age and history of smoking
Group Statistics
History N Mean Std. P value Significance
of Deviation level
Smoking
Age No 114 43.67 13.971 .841 .305
Yes 47 44.15 12.337

Discussion

Smoking and blood sugar level has an adverse effect on systolic blood pressure that
effects the health of an individual. It has found that the blood pressure and heart rate
of an individual increase during smoking but epidemiological studies have confirmed
that smokers tend to have low blood pressure level as compared to non-
smokers.(Basson et al,2015). Moreover, the lower body mass index (BMI), high level
of adiposity and lifestyle of an individual is also found to be associated with high
blood pressure, which is a major risk factor for cardiovascular diseases. The exact
relationship between smoking and systolic blood pressure is always
debatable. Benowitz and Sharp found in their study that there is a significant inverse
correlation between smoking and systolic, diastolic blood pressure wherein Charlton
conducted a longitudinal study on children and found that lower blood pressure
among children at the age 10 was related to the inception of smoking at very young
age of 16years. However, in our study it has been found that smoking is not
significantly associated with the age of respondents.
On the other hand, the people with high glucose level tend to have high blood
pressure, along with other coronary issues. High or low blood sugar level tend to
damage arteries and makes them harden leading to a condition known as
atherosclerosis which if not treated on time might leads to heart attack or stroke.

The clinical implications of smoking and high glucose level on the systolic blood
pressure are yet not clear. However, considering the well documented effects and risk
associated with smoking and blood sugar level on systolic blood pressure the finding
of the study might not have found direct effect of gender, age on blood pressure and
blood sugar level and smoking habits of the individuals, it may be speculated that
more attention needs to be paid to identify and create awareness about the risk factors
associated with such conditions when in the health professionals and nurses can play a
major role in minimizing such conditions leading to a healthy lifestyle.

The limitation of the study is that the questionnaire has been self-administered by the
individuals; therefore some of the risk factor data are self-reported, which may be
inaccurate.
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