Gap between estimated cardiovascular risk and individual risk perception: a survey from a cardiovascular prevention center.
Authors: Ziveri V , Lazzeroni D , Coppa D , Rastelli S , Guazzi E , Moderato L , Geroldi S , Cacciola G , Camaiora U , Brambilla L , Brambilla V , Gurgoglione F , Bini M , Ardissino D , Niccoli G 
Published: October 2024

Abstract

Background
Cardiovascular risk scores represent a great achievement of preventive cardiology, since they allow to stratify individual risk. The recently updated European Society of Cardiology Scores offer an accurate cardiovascular risk estimation. However, a gap between perceived and calculated risk may strongly interfere in healthy lifestyle changes as well as in cardioprotective drugs adherence.
Purpose: The aim of the present study was to evaluate and quantify the above-mentioned gap.

Methods
A cohort of subjects referred to our Cardiovascular Prevention Center were included in the present study. Cardiologists assessed each tradional and emerging risk factor in terms of presence or absence, severity, distance from target, and the cardiovascular risk was calculated using appropriate ESC scores. Each subject filled out a questionnaire in which they were asked to declare their perceived cardiovascular risk and to report, among all the traditional and emerging cardiovascular risk factors, which ones they believed to have greater impact on their individual risk.

Results
366 consecutive subject were included, 70% in primary prevention and 30% with atherosclerotic cardiovascular disease, mean age was 65 years, male gender was prevalent (57%), arterial hypertension (AHT) was found in 78,7% (43,4% uncontrolled), dyslipidaemia in 91,5% (87,5% not at target), diabetes in 18,6%, smokers were 12,9% and 24,4% had obesity. Among emerging risk factors, sedentary lifestyle was found in 63%, while 18% reported regular aerobic physical activity, mediterranean diet adherence was found in 26% and moderate-to-severe perceived anxiety in 23%, depression in 17% and stress in 66%. 6,6% had low risk cardiovascular risk, 16,1% intermediate, 38,0% high and 39,3% very high. A concordance between estimated and perceived risk was found in 18,9% while a discordance in 81,1%; 93,3% underestimate their risk, while 6,7% only overestimate it (figure 1A). A significant higher rate of discordance was found with the progressive increase of the risk (p&lt;0.0001). Different perceived cardiovascular risk among each estimated classes of risk was shown in figure 1B and figure 2; of note only 11% of high risk and 8% of very high risk were concordant in their risk perception. In particular, elderly (p&lt;0.001), male (p&lt;0.001), subjects with AHT (p=0.001) and dyslipidaemia (p=0.02) showed higher rate of underestimation while younger (p&lt;0.001), female (p&lt;0.001) as well as anxiety (p=0.047) and depressed (p=0.010) had higher rate of overestimation.

Conclusions
A high rate of subject underestimate its cardiovascular risk; the higher the risk, the higher the gap between perceived and estimated risk. This risk gap represents a "risk within the risk". for these reasons it is necessary to increase all efforts towards a more effective health education in the field of cardiovascular prevention in order to reinforce patients awareness and physician-patient alliance.Figure 1Figure 2