Accuracy of self-perception of cardiovascular risk in the community

Background: Assessment of individual risk is an important part of the primary prevention of coronary disease and stroke. The accuracy by which individuals perceive their risk is unclear. We aimed to explore the accuracy of self-perceived cardiovascular risk in the community, and the value of one-to-one interview, using a risk assessment tool, in increasing the accuracy.

Methods: Participants in 2 community health fair events in 2006 were asked to assign their 5-year cardiovascular risk to one of 3 categories (high, moderate and low), before and after being counseled about their risk using a Framingham-based risk calculator. Agreement between perceived risk and calculated risk was studied using kappa analysis. Change in perception was the indicator of response to the study intervention. Predictors of accuracy, underestimation, and responsiveness to the study intervention were identified using logistic regression.

Results: There were 146 participants that were included in the analysis (mean age±SD, 47±15; 64% women). Rate of inaccuracy was 66% (mainly due to underestimation of risk n=86 participants). Agreement between perceived and objective risk was poor (kappa±standard error [SE] 09.0±4.3%). After the study intervention, the rate of accuracy significantly increased to 74% (n=108, p<0.0001). Post intervention kappa±SE 60.9±5.7%. Age >45 years predicted inaccuracy. Age > 45 years, non-African-American race, and alcohol use predicted underestimation. Family history of cardiovascular diseases or risk factors predicted responsiveness.

Conclusion: Self perception of the 5-year risk of cardiovascular events is inaccurate, mainly due to underestimation. A targeted educational session using a risk assessment tool improved the accuracy.