This study showed that perception and knowledge of some CVD risk factors was significantly better among graduating students than among freshmen but was still not sufficient. Freshmen’s knowledge and attitudes did not differ much from those of other young people of their age (6
). It was better than, for example, the knowledge of students of Michigan high schools, who although rated accidents as the greatest perceived lifetime health risk, identified CVD as the greatest cause of death (6
). However, it was about the same as the Croatian general population’s knowledge about causes of death (4
Although the knowledge on CVD risk factors in our students, as expected, was significantly better at the end of university medical education, the results of this survey suggest insufficient awareness of CVD risk factors and indicate an urgent need for an improved promotion of CVD prevention during medical education. This might be a problem of the curriculum, which comprises mandatory courses in family medicine, epidemiology, and public medicine as well as internal medicine, during which students have only about 4 hours of lectures, 6 hours of seminars, and 12 hours of practicals and clinical audits on CVD risk factors and prevention. However, they discuss CVD risk factors in a number of other clinical audits. Despite the fact that most of graduating students believed they were familiar with last Joint European guidelines on CVD prevention (2
), too many of them did not know the target values for TC, HDL-cholesterol, and BP, and only 64.5% reported that they would prescribe lipid-lowering therapy to high-risk subjects. Therefore, if medical education is like this, it is not surprising that several recent studies have shown a failure to achieve the recommended risk factor targets in patients with CVD and those without CVD but with CVD risk factors not only in Croatia but in many other European countries (7
A very disturbing fact is that many students were smoking at the end of their medical education in spite of sufficient knowledge about harmful effects of smoking (14% vs 30.4%). This is in accordance with the data from two Spanish surveys. One of them showed that 27% of final year medical students were smokers and 32.54% of them had started smoking during their medical studies (13
). The other showed that the prevalence of smokers among Spanish medical students increased between the first study year and the beginning of the third year from 20% to 31% (14
). A survey performed in 2010 on students of four Italian medical schools showed that they had limited knowledge about tobacco dependence, how to treat it, and the critical role of the physician in promoting smoking cessation (15
Similarly disappointing is graduating students’ low awareness of obesity as an important CVD risk factor. Namely, recent data show that the prevalence of obesity is increasing and reaching epidemic proportions, particularly in the high-risk group of patients with CVD all over Europe and that management of excessive body weight, which is at the moment inadequate, should be given the highest priority (16
It is encouraging that graduating students had relatively good knowledge on metabolic syndrome and atherogenic dyslipidaemia characterized by low HDL-cholesterol and elevated triglycerides. These are typically encountered in high-risk patients with metabolic disorders like diabetes and/or obesity, which have an increasing prevalence but are largely under-diagnosed and under-treated (17
). In fact, their knowledge of HDL-cholesterol was not much worse than the knowledge of Croatian general practitioners and/or family doctors, although this was also not satisfactory (20
). However, students’ knowledge on increasing low HDL-cholesterol was clearly not sufficient. Another encouraging finding is graduating students’ quite positive attitude toward combined lipid-lowering treatment consisting of two or more different lipid-lowering drugs, which was feared by many physicians until very recently, mainly because of adverse effects (21
The major limitation of the study is that it compared two different generations of students, so no clear conclusion about the success of medical education can be made. For this purpose, the same population of medical students should be evaluated at the beginning and at the end of their education.
Based on the results presented, it could be concluded that university medical education on CVD prevention, at least in Croatia, must be substantially improved and should include strategies to increase not only knowledge but also perception of modifiable risk factors for CVD and strategies to reduce or eliminate them. Particular attention has to be paid to increase students’ knowledge about obesity and low physical activity as important CVD risk factors, but also to the methods for increasing low HDL-cholesterol and smoking cessation. To achieve this, the core curriculum should be modified to include more information about these issues.