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Annals of Family Medicine 6:302-306 (2008)
© 2008 Annals of Family Medicine, Inc.
doi: 10.1370/afm.859
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Self-Rated Cardiovascular Risk and 15-Year Cardiovascular Mortality

Robert Gramling, MD, DSc1,2,3, William Klein, PhD4, Mary Roberts, MS1, Molly E. Waring, MS1,3, David Gramling, PhD5 and Charles B. Eaton, MD, MS1,2

1 Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket
2 Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
3 Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
4 Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
5 Department of German, University of California, Berkeley

CORRESPONDING AUTHOR: Robert Gramling, MD, Rochester Center to Improve Communication in Healthcare, 1381 South Ave, Rochester, NY 14620, Robert_Gramling{at}URMC.Rochester.edu

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.

METHODS We 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% confidence 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 findings among men: adjustment for baseline Framingham Risk Score, propensity score adjustment for both social and biologic factors, and censoring the first 2 years of surveillance.

CONCLUSIONS Lower self-ratings of CVD risk are independently associated with lower rates of CVD death among men.

Key Words: Fear • health knowledge, attitudes, practice • denial • risk reduction behavior • cardiovascular diseases • social psychology




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TRACK Comments:

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Great research in the twilight zone between existence and endothelia
Linn Getz, MD, PhD
Annals of Family Medicine, 16 Jul 2008 [Full text]
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