Julio César Cadena-Estrada1
1Instituto Nacional de Cardiología Ignacio Chávez, Departamento de Investigación en Enfermería, Ciudad de México, México
Project approved by the Nursing Research Committee: DIE/CE/06/2015
Correspondence: Julio César Cadena-Estrada
Email: email@example.com; firstname.lastname@example.org
Received: March 31st 2016
Judged: July 8th 2016
Accepted: October 14th 2016
Introduction: Coronary artery disease (CAD) has an impact on the quality of life of patients and their family, given that after undergoing cardiac catheterization, patients must modify their practices and lifestyle beliefs in order to prevent the relapse of this disease.
Objective: To describe the dimensions of quality of life, practices and lifestyle beliefs of patients with CAD after cardiac catheterization.
Methods: Cross-sectional study with a non-probability sampling that included 32 adult patients (male and female) undergoing cardiac catheterization. Data were collected with scales for assessing quality of life, behaviour and lifestyle beliefs. The analysis was performed using parametric and non-parametric statistics. There was statistical significance with a p value of < 0.05.
Results: 78.1% were men with 58 ± 10 years, 75% had basic education, 59.4% had more than two affected vessels, 21.9% showed higher cardiovascular risk; 65.5% presented regular quality of life, and 96.9% had a low-level concerning practices and beliefs. Practices and beliefs were associated with schooling (rs = 0.585, p = 0.000); patients from outside Mexico City and its municipal openings have better quality of life than those who live in that area (Z = 2.031, p = 0.042); however, practices and beliefs are equal in both (Z = −0.536, p = 0.592).
Conclusions: Male and female patients with CAD undergoing a first cardiac catheterization have regular life quality. People with higher levels of education have better practices and lifestyle beliefs.
Keywords: Quality of life; Cardiovascular nursing; Chronic disease; Secondary prevention
The international panorama of health observed through the behavior of several indicators has shown, in the last decade of the 20th century and in the years since, chronic degenerative diseases to be the main cause of general morbidity and mortality, as well as resurgence of once-controlled diseases and the appearance of new ones. Such is the case of cardiovascular disease, which, according to the World Health Organization (WHO), represents one of the leading causes of death in the world.1,2
Latin American countries are not exempt from this health problem. For example, Mexico faces chronic conditions that are characteristic of industrialized countries, such as ischemic heart disease. According to Instituto Nacional de Estadística y Geografía (INEGI) statistics from 2014, ischemic heart diseases have been responsible for 82,334 deaths, placing them as the leading cause of death in both men and women.3
An ischemic heart disease, the disease produced by atherosclerosis, has its origin in both modifiable and non-modifiable cardiovascular risk factors, which are closely related to unhealthy lifestyles. Therefore, the combination of an unhealthy diet, lack of physical activity, smoking, and alcohol consumption have a synergistic effect that leads to a higher incidence of chronic diseases.
In the same line of reasoning, lifestyle is understood as the set of patterns and daily behavioral habits of a person or as those individual patterns of behavior that demonstrate a certain consistency in time, under more or less constant conditions, that can be constituted in dimensions of risk or safety, depending on their nature. Therefore, this includes lifestyle practices and beliefs.
When coronary heart disease first emerges, it brings emotions such as uncertainty about prognosis and risk of death with it, however, thanks to scientific and technological health advances, patients can undergo invasive procedures such as cardiac catheterization for diagnostic or therapeutic purposes. However, coronary heart disease has been shown to have a deleterious effect on quality of life of the individual suffering from it, as it causes deterioration of social, physical, and psychological function of the affected patients and of the family as a whole. Due to advances in the health sciences, in recent decades there has been a considerable increase in the diagnosis and timely treatment of coronary heart disease. However, this only increases the number of years that people live, which sometimes neglects and skews the quality of the years lived, that is, the quality of life of patients.
The term quality of life began to be used in Western countries from the 1950s onwards and acquired a semantic connotation from the 1970s. Currently the WHO defines it as:
The individual's perceptions of their position in life in the context of the culture and value system in which they live and related to their goals, expectations, standards, and concerns, so that the objective state of health, functionality, and interaction of the individual with their environment must be evaluated as well as the more subjective aspects that encompass the general sense of satisfaction of the individual and the perception of their own health.4
On the other hand, health-related quality of life has been defined as "the value assigned to the duration of life modified by deficiency, functional status, health perception, and social opportunity due to illness, accident, determined treatment or policy."5 That is, it recognizes the subjective appreciation of the individual in relation to their own health and not just how much they have left to live. Therefore, for this study the health-related quality of life constitutes an important subjective measure of the impact that the disease and its treatment have on the life of the person, taking into consideration, in addition, that quality of life related to health is a multidimensional concept, from the patient's perception, which changes with time.6
In the Instituto Nacional de Cardiología Ignacio Chávez (INCar), it has been observed that patients with coronary disease are younger, of productive and reproductive age, that besides playing a role of patient, also have the role of father, son, and brother. In most cases they are heads of families, so that,when the disease occurs, their quality of life, lifestyle and social role are affected.
On the other hand, when they have undergone therapeutic cardiac catheterization, many of the patients will have to be reincorporated to their daily life and work, so they consider in the majority of cases, that after receiving treatment, they will return to a normal life. However, this is not the case, since intervention alone does not cure coronary disease and all patients must modify their work, diet, physical activity, and cardiovascular risk factors, in order to reduce the risk of relapse of the disease and to improve their quality of life.
Studies by Li,7 Kahyaolu,8 and Kim9 have described the quality of life of people who first present with coronary heart disease is not good at the baseline and may decline with age, but that older cardiac catheter patients' physical condition improves six months after intervention. In Mexico, Martínez10 described that patients with heart disease have a high-moderate cardiovascular risk level and men have a higher quality of life, which is considered good for those living in the central region of the Mexico, followed by those living in the greater Mexico City area, and finally by those living in the southern region of the country. Also, people with higher income and higher education were identified as having a better quality of life, but the participants who were unemployed perceive it more deteriorated.
Given this panorama, the present study aims to describe the quality of life and lifestyles (practices and beliefs) in patients with coronary artery disease that first undergo cardiac catheterization. The importance of this work lies in the fact that nursing professionals have done few studies in our environment and with recognition of this group of people’s quality of life and lifestyles (both their practices and their beliefs), evidence-based interventions can be proposed and established as part of secondary prevention through health education, awareness of the importance of modifying unhealthy behaviors, adherence to pharmacological and non-pharmacological treatment, and patient care at home. Therefore, it is intended that based on the results, the distance education program be strengthened and expanded, and different strategies of specialized care and community nursing will be established to ensure and contribute to improving lifestyles and indirectly to quality of life.
A non-experimental, observational, and cross-sectional study was conducted on quality of life and lifestyles (practices and beliefs) of adult patients who are diagnosed and treated for the first time with coronary disease. For the purposes of this study, quality of life has been defined as the value assigned to the duration of life modified by deficiency, functional status, health perception, and social opportunity due to illness, accident, and determined treatment or policy. It is also defined as the lifestyles related to a person's set of patterns and daily behavioral habits, or as individual behavior patterns that demonstrate a certain consistency in time, under more or less constant conditions and that can be constituted in dimensions of risk or safety, depending on their nature. These lifestyles include health behaviors, behavioral patterns, beliefs, knowledge, habits, and practices of people to maintain, restore, or improve their health. Such styles are determined by beliefs and practices. Both are constituted by indicators of health condition, physical activity and sport; recreation and leisure time management; self-care and medical care; eating habits; consumption of alcohol, tobacco, and other drugs; and sleeping habits
From a population of 878 patients treated in the hemodynamics unit, 309 underwent diagnostic or therapeutic cardiac catheterization, and 70 received percutaneous transluminal coronary angioplasty (PTCA). Of these, a non-probabilistic sample selected for convenience (n=32) was obtained, which included adult patients of both sexes who underwent coronary catheterization with PTCA for the first time due to coronary artery disease without aggregate diseases such as valvulopathy or rhythm disorders. These patients were from Mexico City and the conurbated area (Estado de México, Hidalgo, and Puebla) and were attended to by the hemodynamics service unit through the external consultation of the INCar. All were oriented and agreed to participate freely and voluntarily in the study. Instruments unanswered at 100% or incomplete biochemical and anthropometric data were eliminated.
The data were collected by the researcher through an instrument organized in four sections, the first for sociodemographic data: sex, schooling, residence, social support network, and occupation. The second contains the Escala de Calidad de Vida para Pacientes con Cardiopatía elaborated by Martínez10 and validated in this study with a Cronbach's alpha index of 0.850, constituted by six dimensions: status of physical health; emotional and social well-being; personal control and employment status; sexual activity and autonomy; quality of interpersonal relationships and mood; and psychological health, with a dichotomous response scale where no=0 and yes=1, as well as a Likert scale, where 1 corresponded to "much less than before" and 4 to "no or better than before." The total score is 0-80 and the cut-off points for quality of life are: 66-80=very good; 49-65=good; 33-48=regular; 17-32=poor; and 0-16=very bad.
The Cuestionario de Prácticas y Creencias sobre Estilos de Vida, elaborated by Arrivillaga et al.11 and validated in this study with a Cronbach's alpha of 0.865, is located in the third section. This questionnaire contains the dimensions of practices and beliefs and both are constituted by indicators of condition; physical activity and sport; recreation and leisure time management; self-care and medical care; eating habits; consumption of alcohol, tobacco, and other drugs; and sleeping habits. Likewise, the questionnaire includes a Likert-type response scale, where 0 corresponds to never and 3 to completely agrees. The total score is 0-348 with the following cut-off points: very low=0-87; low=88-174; high=175-261; and very high=262-348 points. Finally, based on official Mexican norms, the fourth section is composed of data related to the characteristics of coronary disease and cardiovascular risk factors suffered by the patient, such as pain, through the Visual Analog Scale (VAS );12 signs and symptoms, New York Heart Association (NYHA) Functional Classification;13 number of stents; presence of diabetes mellitus (DM);14 systemic hypertension;15 dyslipidemia;16 and overweight or obese condition.17
In order to limit bias in data collection, the procedure was standardized:
Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 17, using frequencies and percentages for qualitative, and central tendency variables for quantitative variables. Likewise, association was determined between the number of cardiovascular risk factors, the quality of life, and the lifestyles of patients undergoing cardiac catheterization with parametric or non-parametric tests, according to the distribution of data. Statistically significant data had value of p<0.05.
In accordance with article 17 of the Reglamento de la Ley General en Materia de Investigación para la Salud,18 this study is classified as risk-free research. The principles of autonomy, beneficence, and non-maleficence to research participants were respected, since they were given the freedom to express their acceptance or refusal to participate and that data obtained were collected once the participant patient read and understood the scope of the research, with the capacity of free choice and without coercion, signing an informed consent. The principal investigator was responsible for keeping collected data under guard and confidentiality, since it adhered to what is established in legal ethical regulations.19,20
According to the sociodemographic characteristics of the total study population, the male gender predominated (78.1%). Age ranged from 23 to 77 years old with average 58.03±10.47 years old. 75% had a basic schooling level; 68.8% lived in the conurbation area; 68.8% had a partner; 81.2% lived with their children; 34.4% were workers, technicians or artisans, and 78.1% received a salary of less than 5000 pesos.
Coronary heart disease manifested with precordial pain (62.5%), during exertion (46.9%), or rest (12.5%). It should be mentioned that a level 6 was above the quartile 75 was according to the EVA. Likewise, dyspnea presented in 43.8% and fatigue 21.9%. Time the patient took from the start of symptomatology to disease diagnosis and treatment by cardiac catheterization was 21.7±18.3 months (12-60 months). 50% of the population had two coronary arteries affected and those that were above the quartile 75 required more than two stents.
Upon admission, 87.6% had a 1 NYHA functional classification and a high (21.9%) or medium (62.5%) level of cardiovascular risk. Regarding cardiovascular risk factors, 46.9% reported having type 2 DM and systemic arterial hypertension and 21.9% only DM. However, after cardiovascular assessment, and based on Mexican official standards, 21.9% were overweight and 12.5% were obese; 34.4% had optimal systolic blood pressure; 46.9% had borderline pressure 1 and 2; 18.7% had stage 1 and 3 hypertension; 20% had optimal diastolic blood pressure; 25% had borderline 1 and 2; 12.5% hypertension stages 1 and 3; 31.3% had prediabetes, and 25% had DM type 2.
Regarding the quality of life of the total population, 65.6% perceived it as regular and 28.1% as good but 3.1% said it was bad. However, quality of life is not correlated with lifestyle practices and beliefs (r=0.114; p=0.533); age (r=0.030; p=0.873); length of time with the disease (r=-0.108; p=0.557); number of coronary vessels affected (r=-0.109; p=0.552); schooling (rs=0.123; p=0.502); income level (rs=-0.118; p=0.519); functional classification according to AHA (rs=-0.012; p=0.947); or cardiovascular risk level (rs=0.322; p=0.072).
The quality of life of men and women was similar (Z=-1.006; p=0.314). However, by dimensions, it was observed that women have a better perception regarding sexual activity and autonomy (Z=-2.158; p=0.031). In relation to place of origin, those who live in the province perceive a better quality of life than those who live in the conurban area (Z=-2.031; p=0.042) and they have better psychological health (Z=-2.028; p=0.043). On the other hand, those with a basic schooling level and those with preparatory level to higher education level have the same perception about their quality of life (Z=-1.004; p=0.315) (Table I).
|Table I. Quality of life of patients undergoing cardiac catheterization according to three demographic variables (n=32)|
|Female||Male||Mexico City and conurbanation||Province||Basic||Prepatory and higher education levels|
|General quality of life||48.71±11.01||44.56±8.42||41.27±5.66||47.67±9.76*||44.63±9.60||48±6.89|
|Physical heath, emotional and social well-being||6.43±2.30||5.92±1.47||5.73±1.49||6.19±1.75||6±1.72||6.13±1.55|
|Personal control and employment status||6.14±1.57||6.40±1.63||6.09±1.45||6.48±1.69||6.17±1.71||6.88±1.13|
|Sexual activity and autonomy||3.86±1.35*||2.72±0.89||2.64±1.03||3.14±1.11||2.92±1.10||3.13±1.13|
|Quality of interpersonal relationships and mood||5.43±0.53||4.76±1.13||4.82±1.08||4.95±1.07||4.92±1.02||4.88±1.25|
|Mann-Whitney U test, * p<0.05|
Regarding lifestyle practices and beliefs, about physical condition, activity, and sport, it is important to mention that patients with coronary heart disease believe that physical activity improves their health (68.8%) and mood and prevents some diseases (50%). However, in practice they do not exercise or do it only a few times (81.2%) and they do not participate in supervised exercise programs (96.9%).
In recreation and leisure time management, they consider it important to share recreation activities with family and friends (84.4%) but only 12.5% walk, swim, or ride a bicycle. 15.2% includes moments of rest in their daily routine and 56.3% never allocate their free time to academic or work activities.
In self-care and medical care, it is important to emphasize that patients often or always consider rest to be important for health (93.8%), believe that each person is responsible for their health (100%), and that prevention is better than cure (87.5%). Health status is a consequence of behavioral habits and they consider it difficult to change unhealthy behaviors (65.6%). This perception is not reflected in their practices, since most patients only check their blood pressure (78.2%) and perform tests of cholesterol, triglycerides, and glycemia once a year (71.9%). That is, they do not take care of their health.
In the dimension of eating habits, the majority of patients sometimes or frequently consider that the greasier the food, the tastier it is, (71.9%). Patients report that water is important for health (93.8%); sometimes fast food lets us take better advantage of time (50%); diets are the best way to lose weight (28.1%); and eating pork is harmful to health (46.9%). They report drinking between four and eight glasses of water (65.6%); adding salt and sugar to their food at the time of consumption (56.3%); ingesting more than four sodas per week (18.8%); 50% sometimes include vegetables, fruits, whole grains, and sources of protein in their diet and only 40.6% consume fish and chicken more than red meats.
It was found that 62.5% of the study population believed they had healthy lifestyles, but 96.9% had a low to very low level in healthy lifestyle practices. In general, when practices and beliefs were combined, they were of a low level (96.9%) and this correlated with schooling level (rs=0.585; p=0.000). Practices were stronger (rs=0.616;p=0.000) than beliefs (rs=0.367; p=0.039). Nevertheless, it is noticeable that no relationship exists between income (rs=0.020; p=0.914) and cardiovascular risk (rs=-0.099; p=0.588).
Healthy lifestyle beliefs are similar between men and women, as well as between those living in the province and in the Mexico City conurbation (p>0.05). However, it was observed that people who had preparatory or higher education levels believed more frequently that physical activity and sport have health benefits (Z=-3.407; p=0.000), but the rest of the dimensions are similar in both groups (Table II).
|Table II. Beliefs about healthy lifestyles of patients undergoing cardiac catheterization according to three sociodemographic variables
|Female||Male||Mexico City and conurbanation||Province||Basic||Prepatory and higher education levels|
|General beliefs about healthy lifestyle||63.14±6.87||68.52±12.22||64.64±8.99||68.76±12.44||65.67±11.81||72.38±8.88|
|Beliefs about condition, physical activity, and sport||8.29±3.55||8.48±3.11||9.55±3.39||7.86±2.94||7.38±2.73||11.63±2*|
|Beliefs about recreation and leisure time management||6±1.83||6.52±1.12||6.45±0.82||6.38±1.50||6.38±1.24||6.50±1.51|
|Beliefs about self-care and medical care||20.71±4.42||22.12±3.24||21.27±3.10||22.10±3.74||21.58±3.35||22.50±4.11|
|Beliefs about dietary habits||9.29±2.63||9.72±2.76||8.73±2.24||10.10±2.84||9.42±2.72||10.25±2.71|
|Beliefs about consumption of alcohol, tobacco, and other drugs||11.43±5.74||13.28±6.04||11.09±4.83||13.81±6.35||13.33±5.79||11.50±6.55|
|Beliefs about sleeping habits||7.43±3.78||8.40±3.55||7.55±3.62||8.52±3.57||7.58±3.53||10±3.21|
|Mann-Whitney U test, * p<0.05|
According to sex, men and women were found to have very similar healthy lifestyle practices (Z=-0.616; p=0.538), both overall and by each dimension (p>0.05). People living in the Mexico City and the conurbated area have more practices related to physical activity and sport (Z=-2.248; p=0.025) and recreation and leisure time management practices (Z=-2.272; p=0.023) than those living in the province. Regarding the schooling level, people who studied at the preparatory or higher education level have more healthy lifestyle practices both in general (Z=-2.744; p=0.006) and in the dimensions of condition, physical activity, and sport (Z=-2.246; p=0.025); self-care and medical care (Z=-2.094; p=0.037); and eating habits (Z=-2.404; p=0.016) (Table III).
|Table III. Healthy lifestyle practices of patients undergoing cardiac catheterization according to three demographic variables (n=32)|
|Female||Male||Mexico City and conurbanation||Province||Basic||Prepatory and higher education levels|
|General healthy lifestyle practices||66.71±11.87||64.52±18.67||71.55±19.66||61.57±15.25||59.71±13.64||80.88±18.01|
|Condition, physical activity, and sport||2.43±1.72||4.04±3.31||5.55±3.96||2.71±2.00||3.21±3.24||5.13±2.10|
|Recreation and leisure time management||5.43±2.23||5.40±4.16||7.82±4.56||4.14±2.65||4.79±3.61||7.25±3.96|
|Self-care and medical care||23.14±9.04||18.44±7.97||21.27±8.32||18.52±8.33||17.67±8.04||24.88±6.94|
|Eating habits and diet||19.43±4.58||18.16±5.02||18.55±5.52||18.38±4.66||17.00±3.87||22.75±5.31|
|Practices of consumption of alcohol, tobacco, and other drugs||6.29±3.86||7.80±3.76||7.27±4.82||7.57±3.23||6.96±3.74||9.00±3.70|
According to Martínez10 and Alonso,21 at the time of presenting coronary disease for the first time, the majority of patients perceive their quality of life from regular to good, a figure that is similar to that reported in our study. However, this perception does not correlate with demographic data, such as schooling level, length of time with the disease, and number of affected vessels. These results suggest that people who have emerging coronary disease do not yet show a deterioration in quality of life because their social role, physical function, and psychological health are not affected, and it is expected that people living in large urban areas are subject to greater stress, as well as to environmental and social factors that may affect their quality of life.
The data of the present study show that both men and women with coronary heart disease perceive a very similar quality of life, data that differ from that reported by Veenstra,22 Kim,9 and Martínez,10 for whom men apparently maintain a better quality of life. Even so, it is noteworthy that women participating in this study reported having better sexual activity and autonomy. This difference is possibly due to the moment of data collection, because participants in this study are mature, productive adults with a functional classification of I and a partner as a social support network and can therefore still meet their human needs without problems, including sexual problems. However, the severity of the disease and the number of vessels affected sooner or later will influence the physical condition of the sick person, so it is essential that these patients, in the company of their partner or spouse, attend a cardiac rehabilitation program that allows them to condition their body to physical activity and make healthy lifestyle changes. In order for this to be successful, the health professional can rely on a patient who has also presented a cardiovascular event in the past and can now serve as a model for fostering vicarious learning, a social cognitive theory which has demonstrated its effectiveness in practice after being taken up by Pender.23-25
If in our study both men and women living in the province or in the big cities believed in having healthy lifestyles and the benefits they bring about, in practice it was just the opposite. These data are similar to those reported by Lizalde.26
Therefore, the results suggest that beliefs are the adjustment of a mental model and such is their importance that they affect preventive behavior, for example, beliefs about family history and cause of illness are linked to beliefs about the efficacy of preventive options. Even some studies.27,28 have shown that beliefs vary among diseases and genders, but little is known about cultural influence and ethnic diversity.
According to Nola J. Pender's health promotion model, risk factors depend on cognitive-perceptual factors that are modified by situational, personal and interpersonal characteristics, resulting in participation in health-promoting behaviors when there is a guideline for action. If you oberve people with coronary disease with beliefs about lifestyles and their benefit that favor the modification of unhealthy behaviors, since, according to Pender and Bandura, to the extent that the individual feels motivated and perceives that they have the ability to make changes in their lifestyle, you will observe and recognize benefits in the short term. Therefore, people can commit to adopting healthy behaviors.21,23,24,29-32
Our study draws attention to the fact that, despite the existence of similar practices of similar lifestyles in both genders, a higher score was observed in the dimensions of physical activity and sport, leisure time management, and self-care and eating habits in those living in Mexico City and the conurbated area and in those with a better schooling level. These data coincide with those reported by Lizalde;26 however, it is important to note the critical aspect of bad lifestyles, since, despite knowing the benefits of exercise; rest; recreation, heatlh care and disease prevention; consuming a healthy and balanced diet according to the requirements of each person; these activities are not carried out in the family or in the work environment.
Probably the lifestyle practices and beliefs held by patients with coronary disease are due to the interaction of multiple factors, one of which is related to previous behavior observed in the family, vicarious learning, or learning through modeling. These are the main means of learning unhealthy behaviors, since as a child a person is learning and modeling their behavior. Thus, seeing that foods rich in fat are consumed at home; sedentary behavior because of long hours spent sitting in front of the TV or doing activities that do not produce energy consumption; that the family does not invest in food as healthy and balanced as possible; that they do not visit the preventive health team, among other things, it becomes a pattern of behavior repeated in adolescence and adulthood. On the other hand, if few barriers and multiple short-term benefits associated with motivation and perceived self-efficacy have been observed, the person may have greater beliefs and healthy lifestyle practices. Therefore, biological, psychological, and sociocultural factors can predict behavior and are marked by the nature of the goal set, as reported by various authors.33-36
Although it is important to know that at the onset of coronary disease manifestation, people reported having a good quality of life and at least three or more cardiovascular risk factors, products of bad lifestyles, based on evidence, nursing care becomes more important since the nursing professional has the opportunity to participate and contribute to people’s health through secondary prevention, mainly if multidisciplinary and transdisciplinary educational interventions are developed based on theoretical assumptions and making use of information technology. Thus, several studies have described how an intervention program with printed and audiovisual materials, or individual or collective counseling, as a whole, reduce the risk of reinfarction and modifies unhealthy behaviors. However, these should last at least six to 12 months and take a theoretical and practical approach, with topics on healthy lifestyles; an exercise plan; psychological support; stress and smoking management; a nutritious and balanced diet (Mediterranean diet with reduced daily intake of salt-fats-alcohol-tobacco and greater intake of vegetables and fruits); periodic measurement of blood analytics and somatometry, and, most importantly, reinforcement and follow-up with telenursing (from 1 to 6 years). These types of programs are efficient and effective in modifying unhealthy behaviors and maintaining healthy habits, beliefs and practices that have been learned during the intervention phase.37-46
Based on the results, it can be concluded that patients with coronary disease who are first submitted to cardiac catheterization perceived a seemingly regular quality of life because they have not been deeply affected in their physical, social, emotional, laboral, sexual, and psychological states. Even when the disease emerges, there is no direct correlation with lifestyles (practices and beliefs) even though they are not healthy.
On the other hand, lifestyles of people with coronary heart disease are not healthy and their practices differ from their beliefs. This is reflected in their health and although they know the benefits of healthy and balanced eating; doing physical exercise; taking good care of their health; avoiding alcohol, tobacco, and drugs; they do not do these activies. Therefore, these practices need to be modified through multidisciplinary and interdisciplinary intervention; otherwise, there is a possibility of recurrence of the disease and the development of multiple complications that may endanger the patient's life, cause an overload for health institutions, or increase health care costs, among others.
A limitation of the study was convenience sampling that limits the generalization of the results. For future studies, it is recommended to carry out intervention studies based on the most prevalent risk factors, aimed at behavioral changes, and contributing to adopting a healthy lifestyle as a secondary prevention strategy.