Cardiovascular risk perception in women: true unawareness or risk miscalculation?

BMC Medicine

Michael J Blaha¹  Miguel Cainzos-Achirica¹ 

[1] Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

关键词: Women;    Risk communication;    Risk assessment;    Risk;    Cardiovascular disease;    Awareness;   

Others  :  1203886
DOI  :  10.1186/s12916-015-0351-2

 received in 2015-03-24, accepted in 2015-04-21,  发布年份 2015

【 摘 要 】

Assessing the ‘accuracy’ of cardiovascular risk perception is a worthy scientific goal that may lead to targeted interventions aimed at improving risk communication and health outcomes. Current cardiovascular risk scores, however, have shown poor calibration when used in populations that differ temporally and/or geographically from the derivation sample, limiting their reliability as the reference standard for absolute risk. In addition, accurately assessing risk awareness is challenging, with few available validated tools for effectively accounting for the outcomes assessed (coronary heart disease vs. cardiovascular disease), the time span of prediction (10-year vs. lifetime risk), and concepts of absolute versus relative risk. In this context, assessing patient awareness of the role of age as the key, non-modifiable driver of absolute risk can be particularly challenging. This commentary will examine each of these issues, providing context for the interpretation of studies on ‘discordance’ between calculated and perceived cardiovascular risk, such as the one recently published by Oertelt-Prigione et al. Moreover, we explore alternative approaches aimed at overcoming those limitations, enhancing understanding of the factors and true magnitude associated with such discordance.

Please see related article: http://www.biomedcentral.com/1741-7015/13/52 webcite.

【 授权许可】

   
2015 Cainzos-Achirica and Blaha; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Katz M, Laurinavicius AG, Franco FG, Conceicao R, Carvalho JA, Pesaro AE, et al. Calculated and perceived cardiovascular risk in asymptomatic subjects submitted to a routine medical evaluation: The perception gap*. Eur J Prev Cardiol. 2014. Ahead of print.
• [2]McDonnell LA, Pipe AL, Westcott C, Perron S, Younger-Lewis D, Elias N et al.. Perceived vs actual knowledge and risk of heart disease in women: findings from a Canadian survey on heart health awareness, attitudes, and lifestyle. Can J Cardiol. 2014; 30:827-34.
• [3]Altman R. Nunez de Ybarra J, Villablanca AC. Community-based cardiovascular disease prevention to reduce cardiometabolic risk in Latina women: a pilot program. J Womens Health (Larchmt). 2014; 23:350-7.
• [4]Oertelt-Prigione S, Seeland U, Kendel F, Rücke M, Flöel A, Gaissmaier W et al.. Cardiovascular risk factor distribution and subjective risk estimation in urban women; The BEFRI Study: a randomized cross-sectional study. BMC Medicine. 2015; 13:52. BioMed Central Full Text
• [5]McEvoy JW, Diamond GA, Detrano RC, Kaul S, Blaha MJ, Blumenthal RS et al.. Risk and the physics of clinical prediction. Am J Cardiol. 2014; 113:1429-35.
• [6]DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS et al.. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015; 162:266-75.
• [7]Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013; 382:1762-5.
• [8]Hense HW, Schulte H, Löwel H, Assmann G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany–results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J. 2003; 24:937-45.
• [9]Kavousi M, Leening MJ, Nanchen D, Greenland P, Graham IM, Steyerberg EW et al.. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines for cardiovascular disease prevention in a European cohort. JAMA. 2014; 311:1416-23.
• [10]Karmali KN, Goff DC, Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014; 64:959-68.
• [11]Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M et al.. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33:1635-701.