Good general health and lack of family history influence the underestimation of cardiovascular risk: A cross-sectional study

Aims
Underestimation of cardiovascular risk may interfere with prevention of cardiovascular diseases (CVDs). We investigate whether general health and family history of myocardial infarction (MI) are associated with underestimation of perceived cardiovascular risk, and if the participants’ calculated risk modifies that association.

Methods and results
The analysis sample consisted of 526 individuals, 50–64 years old, from a population-based cohort study. Information on general health (poor/fairly good, good, and very good/excellent), family history of MI, and self-perceived risk relative to others of similar age and sex were collected though a web-based survey. Participants were categorized into underestimation (n = 162, 31%), accurate estimation (n = 222, 42%), and overestimation (n = 142, 27%) of cardiovascular risk by comparing calculated Systematic Coronary Risk Estimation (SCORE) with self-perceived risk. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for underestimation vs. accurate estimation of cardiovascular risk were computed using logistic regression (n = 384). Very good general health (OR 2.60, 95% CI 1.10–6.16) and lack of family history (OR 2.27, 95% CI 1.24–4.18) were associated with underestimation of cardiovascular risk. The associations were modified by the participants’ calculated risk level; the association was stronger for high-risk individuals; without family history OR 22.57 (95% CI 6.17–82.54); with very good/excellent health OR 15.78 (95% CI 3.73–66.87).

Conclusion
A good general health and the lack of family CVD history can obscure the presence of other risk factors and lead to underestimation of cardiovascular risk, especially for high-risk individuals. It is, therefore, crucial to address the fact that the development of CV disease may be silent and multifactorial.