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The cardiovascular risk perception of first degree relatives of individuals with premature coronary heart disease : does gender matter? Burns, Susanne Lee


The presence of premature atherosclerosis or a clinical cardiac event in a first degree relative is a significant independent risk factor predisposing a person to the development of cardiovascular, peripheral vascular or cerebrovascular disease. First degree relatives (FDRs) of coronary heart disease patients have an increased risk of death from coronary disease compared to those without a family history. Appreciation or perception of one's personal risk for coronary heart disease may be integral to the adoption of a healthful lifestyle or the need for behaviour change. Knowledge of one's risk for heart disease does not always lead to the adoption of healthful lifestyle behaviour that may reduce one's risk. This may be due to a discrepancy between an individual's perception of his or her risk and the actual risk for developing disease. Inaccurate perceptions of personal risk, whether they are over or underestimated, may reduce the likelihood of incorporating healthful lifestyle changes. Applying a descriptive correlational design, 118 individuals participating in the Family Atherosclerosis Counseling and Testing Study, underwent a cardiovascular risk factor assessment including laboratory, anthropometric and behavioural measures. Participants also were asked to give their personal subjective risk estimates. Subjective risk perception estimates were then compared to an objective epidemiological risk estimate, the Framingham risk score, to determine the level of the participant's accuracy. Data analysis determined the relationship between level of accuracy (accurate, over-estimation, or under-estimation) and the influence of gender of the FDR (the participant), gender of the index patient, the kinship relationship to the index patient, and the variables of age and education. The results revealed that participants varied in their level of risk perception accuracy with 51.3% being accurate, 47.9% as over-estimating, and 0.9% under-estimating their risk. Education was not associated with risk perception accuracy but age was significantly associated. The average age of those with accurate risk perceptions was 36.7 years (s.d. = 13.4) compared with over-estimators who were 43.9 years of age (s.d. = 12.4), on average (p = .003). The gender of the FDR and of the index patient was not associated with risk perception accuracy. The kinship relationship of the FDR to the index patient was significant: 63.3% of siblings over-estimated their risk compared to 31.5% of children (p = .001). Further study of the metabolic status and anthropometric markers suggested that over-estimators may indeed be accurate in their perception of their risk; the Framingham risk score may not be a sensitive measure of this population's risk.

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