Self-Rated Cardiovascular Risk and 15-Year Cardiovascular Mortality

Abstract

PURPOSE Many individuals perceive their cardiovascular disease (CVD) risk to be lower than established clinical tools would estimate, yet little is known about the long-term consequences of holding such optimistic beliefs. We evaluated whether lower self-ratings of CVD risk are associated with lower rates of CVD death after addressing potential confounding by an extensive set of social and biologic CVD risk factors. METHODSWe conducted a 15-year mortality surveillance study of adults aged 35 to 75 years from southeastern New England (n = 2,816) who had no history of myocardial infarction. Baseline evaluation in 1990-1992 included household interview, anthropomorphic measures, and laboratory analyses. Outcomes were obtained using the National Death Index records through December 2005.RESULTS Rating oneself to be at lower-than-average risk for one's age and sex was associated with lower rates of CVD mortality among men (hazard ratio [HR] = 0.3; 95% confi dence interval [CI], 0.2-0.7) but not among women (HR = 0.9; 95% CI, 0.5-1.7). None of the following weakened the fi ndings among men: adjustment for baseline Framingham Risk Score, propensity score adjustment for both social and biologic factors, and censoring the fi rst 2 years of surveillance.CONCLUSIONS Lower self-ratings of CVD risk are independently associated with lower rates of CVD death among men. INTRODUCTIONR isk perception affects health behavior and emotional well-being among individuals facing a health threat. [1][2][3] When the behavior required to ameliorate the threat is a single event (eg, vaccination), 4 heightened perceptions of risk appear to motivate preventive action. In turn, successful completion of the preventive action facilitates reduction in risk perception. 4 Thus, holding higher risk perceptions can be benefi cial in some health contexts.The threat of cardiovascular disease (CVD), however, requires preventive actions that are not single events; they are multidimensional, ongoing, and effort-intensive. The preventive value of harboring higher perceptions of CVD risk is therefore less clear. An individual's failure to engage and sustain CVD preventive action can exacerbate negative emotions arising from threat perception, thereby leading to dysfunctional coping behaviors. In fact, holding optimistic perceptions of risk, whether through lack of awareness or denial, may protect against fear-related coping behaviors and the physiologic effects of stress that, in turn, can hasten the onset of CVD events. [5][6][7] These benefi ts might explain why so many adults tend to underestimate their personal risk of experiencing a CVD event. [8][9][10][11][12] Given the rapid emergence of genetic technologies that are likely to shape risk perceptions, 13 it is both timely and essential to investigate the long-term health impact of self-rated risk. We conducted a 15-year morRobert Gramling, MD 303SEL F -R AT ED C A R DIOVA SCUL A R RISK AND 15 -Y E A R MORTA LIT Y tality surveillance study of adults who rated their own CVD risk in the early...

Comparative optimism about healthy eating

“…Moreover, in line with findings showing that optimistic beliefs are grounded in reality (Gramling et al, 2008), we found that comparative optimism increased relative to healthier actual food intake and to lower BMI. However, people still rated their own eating behavior to be healthier than their peers' eating when actual healthy eating was unfavorable and BMI was high.…”

“…First, with increasing actual healthy eating, people might increasingly perceive their eating as healthier than their peers' eating. In this case, people who actually eat healthily would have a greater optimistic view, grounded in reality (de Ridder, Fournier, & Bensing, 2004;Gramling et al, 2008;. Second, people might hold a constant optimistic view of their own compared to their peers' healthy eating regardless of actual healthy eating.…”

Shared decision making: using health information technology to integrate patient choice into primary care

“…One explanation may be that our sample size was too small to detect a difference. However, it is also possible that unmeasured factors such as a patient's level of activation or their perceived level of risk, which may impact a patient's behavioral choices [14], are more important determinants of choice than age, education, or mFRS-derived risk.…”

In This Issue: Community Care, Healing, and Excellence in Research

“…Gramling and colleagues 13 found that men who rated their 5-year risk of having a stroke or heart attack as "low" went on to have lower-than-expected mortality from cardiovascular disease (CVD) in the subsequent 15 years (controlling for Framingham risk score and other CVD risk factors). Does the men's perception of low risk stem from insider knowledge of their own health, or does optimism protect against cardiovascular events?…”