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Navar AM, Wang TY, Li S, Mi X, Li Z, Robinson JG, Virani SS, Peterson ED. Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy. Circulation. Cardiovascular quality and outcomes. 2021 Jan 1; 14(1):e006548.
BACKGROUND: Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy. METHODS: We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy. RESULTS: Overall, there was no correlation between patients'' estimates of their 10-year CVD risk and calculated 10-year risk (? = -0.01, = 0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%, < 0.01). Patients'' perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (? = 0.19, < 0.01), although most had overly optimistic views of how risk compared with their peers. Increasing perceived risk was not associated with current statin use ( = 0.18) but was associated with willingness to consider future prevention therapy ( < 0.01). Perceived risk relative-to-peers was associated with increased prevalent statin use (risk ratio 1.04 per category increase [95% CI, 1.02-1.06]) and reported willingness for prevention therapy (risk ratio 1.11 [95% CI, 1.07-1.16]). CONCLUSIONS: When asked, most patients overestimate their 10-year risk but hold an optimistic bias of their risk relative to age-, race-, and sex-matched peers. Providing accurate absolute risk assessments to patients without proper context may paradoxically decrease many patients'' perceived risk of CVD, thereby disincentivizing initiation of CVD risk reduction therapy.