Cardiovascular Disease Risk Perception Research Articles

Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV

Background Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. Objective Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. Methods Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40–59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. Results Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. Conclusions Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.

Personalized feedback improves cardiovascular risk perception and physical activity levels in persons with HIV: results of a pilot randomized clinical trial

ABSTRACT People with HIV (PWH) have an elevated risk for cardiovascular disease (CVD) compared with the general population. This study examined the feasibility, acceptability and preliminary efficacy of a tailored intervention aimed at increasing CVD risk perception and the adoption of heart-healthy behaviors in PWH. Forty adults were randomized to receive personalized feedback on CVD risk and discussion of risk reduction or health education. Participants were issued pedometers and seen for two treatment sessions. Participants were 60% male and had a mean age of 51.5 years. Ninety percent of participants completed all study sessions indicating good feasibility and acceptability. A medium effect size for the difference between treatment and control groups was found on both the Perceived Risk for Heart Disease (d = .38) and the Rapid Eating and Activity for Patients scales (d = .56) at 12 weeks. Atherosclerotic cardiovascular disease (ASCVD) risk score moderated the effect of treatment, such that at high (but not low) ASCVD risk, active intervention, compared to control, was associated with a greater increase in steps between baseline and both 8 (d = .38) and 12 weeks (d = .55). Findings provide preliminary evidence that tailored interventions delivered by nurses may be effective for primary prevention of CVD in PWH.

Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy.

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. 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. Overall, there was no correlation between patients' estimates of their 10-year CVD risk and calculated 10-year risk (ρ=-0.01, Pcorrelation=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%, Pdifference<0.01). Patients' perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (ρ=0.19, P<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 (P=0.18) but was associated with willingness to consider future prevention therapy (P<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]). 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.

Diabetes and Cardiovascular Disease Risk Perception and Risk Indicators: a 5-Year Follow-up

BackgroundPerceived disease risk may reflect actual risk indicators and/or motivation to change lifestyle. Yet, few longitudinal studies have assessed how perceived risk relates to risk indicators among different disease risk groups. We examined in a 5-year follow-up, whether perceived risks of diabetes and cardiovascular disease predicted physical activity, body mass index (BMI kg/m2), and blood glucose level, or the reverse. We examined further whether perceived risk, self-efficacy, and outcome beliefs together predicted changes in these risk indicators.MethodParticipants were high diabetes risk participants (N = 432) and low/moderate-risk participants (N = 477) from the national FINRISK 2002 study who were followed up in 2007. Both study phases included questionnaires and health examinations with individual feedback letters. Data were analyzed using gender- and age-adjusted structural equation models.ResultsIn cross-lagged autoregressive models, perceived risks were not found to predict 5-year changes in physical activity, BMI, or 2-h glucose. In contrast, higher BMI and 2-h glucose predicted 5-year increases in perceived risks (β-values 0.07–0.15, P-values < 0.001–0.138). These associations were similar among high- and low/moderate-risk samples. In further structural equation models, higher self-efficacy predicted increased physical activity among both samples (β-values 0.10–0.16, P-values 0.005–0.034). Higher outcome beliefs predicted lower BMI among the low/moderate-risk sample (β-values − 0.04 to − 0.05, P-values 0.008–0.011).ConclusionPerceived risk of chronic disease rather follows risk indicators than predicts long-term lifestyle changes. To promote sustained lifestyle changes, future intervention studies need to examine the best ways to combine risk feedback with efficient behavior change techniques.

Cardiovascular disease risk perception in a Hungarian community sample: psychometric evaluation of the ABCD Risk Perception Questionnaire

ObjectivesReliable and valid assessment of subjective risk perception is a crucial part of cardiovascular disease (CVD) prevention and rehabilitation. Since the recently developed Attitudes and Beliefs about Cardiovascular Disease (ABCD)...

Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry.

BackgroundAfter achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression.MethodsQualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory.ResultsFifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers’ recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors.ConclusionFindings suggest that future research should focus on developing interventions to enhance patient–provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.

Primary Prevention of Cardiovascular Risk in Lithuania-Results from EUROASPIRE V Survey.

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

Perception of diabetes management and cardiovascular disease risk among men with type 2 diabetes: A qualitative study.

AimThe aim of this study was to explore the perception and understanding of men with type 2 diabetes about their illness control, risk for CVD and their adherence to healthcare management plans in Jordan.DesignA qualitative descriptive design was used, recruiting a purposive sample of 13 men diagnosed with type 2 diabetes.MethodsData were collected between February and April 2019 through in‐depth semi‐structured interviews and analysed using content analysis.ResultsData analysis revealed four themes: (a) Perception of diabetes control; (b) Perception of cardiovascular disease risk; (c) Coping with disease‐imposed limitations; and (d) Information validation.ConclusionThe study concludes that the perception of disease control does not necessarily coincide with actual disease control. Examining patients with diabetes perception and knowledge of their healthcare management and increased CVD risks is essential. An individualized culture and gender‐sensitive health education and counselling involving spouses are recommended. Social media to disseminate scientific valid health instructions can enhance adherence.

Perceived versus Actual Risk of Cardiovascular Disease in College Students

ABSTRACTBackground: College wellness interventions have potential to reduce the growing burden of cardiovascular disease (CVD) by guiding students to establish behaviors for lifetime CVD risk reduction. Yet, some students may not see CVD prevention as a relevant issue during young adulthood. Purpose: We examined perceived risk of CVD amongst 148 college students and compared perceived risk to demographic characteristics and traditional risk markers. Methods: Survey data on perceived CVD risk and student characteristics were linked to biochemical lab values from a cholesterol screening program. Results: Only 39.2% of students had been previously screened for dyslipidemia. Mean perceived CVD risk was highest amongst students with age ≥21 years, BMI ≥30, a family history of CVD, and a fair or poor rating of overall health. Perceived risk was not higher amongst students with total cholesterol values outside of the normal range. Discussion: While some students were aware they may possess an elevated CVD risk, we identified others who were unaware of a potential risk. Translation to Health Education Practice: These variations in perceived risk indicate that individualized intervention approaches may be necessary to engage college students in behaviors for lifelong CVD prevention.

Comparison of Cardiovascular Disease Risks of Actual and Perceptions of Men’s that 40-65 Years Old

Abstract Background Turkey is among the top countries in Europe in coronary mortality in the 45-74 age range. The highest death due to disorders of the circulatory system (50.8%) that is Amasya province. Objective Determine related factors and to compare with actual and perceived cardiovascular disease (CVD) risks of men aged 40-65 living in Amasya. Methods The sample size of cross-sectional and analytical study consisted of 400 people who met the inclusion criteria. Actual CVD risks of men were calculated using HeartScore. Age, systolic blood pressure, total cholesterol measured by blood taken from the capillary and smoking status were used to calculate CVD risk. Actual CVD risk in next decade has been calculated as low, medium, high or very high. Perceived CVD risk in next decade were identified by participants as low, medium, high and very high responses. They also questioned why evaluation of perceived risk. Results It was determined whereas 8.3% of the males had high, 52.5% had a very high level of CVD risk. The main variables affecting actual CVD risk; diastolic blood pressure, BMI and physical activity. 13.3% of males perceived CVD risks at high and 8% at very high. The main variables affecting perceived CVD risk; age and DM. It was found that 48% and 23.8% of males perceived CVD risks lower and higher than actual CVD risk while 28.2% were accurate. Those who perceived CVD risk at a moderate, high and very high think that this is caused by diseases that increase the risk of CVD and smoking. Conclusions Approximately 1/2 men has very high risk of CVD. It was determined that 1/2 men perceived risks are lower with false optimism and couldn’t accurately identify risks of people older and with diabetes. Key messages It can be ensured that develop risk reducing behaviors and individuals with high risk of CVD can raise their awareness. The risk perceptions of males in the very high-risk group from the past to the present are important because they affect their actual risks and risk-reducing behaviors.

"Always on the go": A qualitative study of the perceptions of cardiovascular disease risk among Latino cab drivers.

The taxicab industry is a burgeoning occupation that predominantly employs immigrant males from low socioeconomic backgrounds. Factors such as sedentary nature, environmental factors, high stress coupled with socioeconomic factors may increase cardiovascular disease risk among taxicab drivers. Latinos, a growing immigrant population make up approximately 20% of this industry. However, few studies focus on their experiences as cab drivers or on the factors that may increase their cardiovascular risks. This was an ethnographic qualitative study. Data was collected via individual interviews combined with Go-Alongs. The Go-Along is an observational qualitative method whereby researchers accompany participants during routine activities and make observations. Interviews and observations were transcribed and coded to identify emerging themes. Thirty-two Latino male cab drivers participated; their mean age was 45 + 12 years; 47% did not finish high school; and 63% earned $30 000 or less. Time and stress emerged as dominant themes. Time constraints posed a barrier to healthy eating and physical activity. Drivers reported stress from constantly worrying about their finances and personal safety. Drivers also described stress from the physical toll of driving on the body. Go-Alongs supported these themes and identified social interactions and environmental factors that could be leveraged for health promotion. This study provided an opportunity for cab drivers to describe their perspectives on reasons why their occupation was associated with a high risk for cardiovascular disease. The Go-Alongs contributed to the understanding of the social and environmental context that characterized cardiovascular risks in this occupation.

Abstract P169: The Impact of Perceived Cardiovascular Risk on Cardiovascular Prevention Behaviors in People Living With HIV

Objective: To examine whether HIV status influences knowledge, beliefs and perception of risk for cardiovascular disease (CVD) and how this influences CVD prevention behaviors (exercise, diet, and adherence to preventative CVD drug therapy). Methods: We conducted a cross-sectional study of HIV infected and demographically similar uninfected adults ≥ 30 years of age. Participants completed a self-reported survey on CVD risk perceptions, a self-reported CVD medication adherence survey, and three dietary intake interviews to assess overall diet quality. All wore an ActiGraph accelerometer for 7-10 days to measure physical activity. Wilcoxon rank-sum and t -tests were used to analyze the differences between groups and multiple linear regression was used to analyze the extent to which perceptions were associated with CVD prevention behaviors. Findings: Overall, 191 (105 HIV-infected and 86 HIV-uninfected) persons participated. Participants were on average 54 years old, 58% male, and 81% African American without difference by group (all p &gt;0.05). People living with HIV (PLHIV) engaged in significantly less moderate-to-vigorous physical activity (median 0 vs 34 minutes per week, p =0.006). However, participants had similar, but poor, overall diet quality (overall Healthy Eating Index score 45.14), and similar smoking rates (56.5%), statin use (51%) and blood pressure medication use (50%; p for all comparison &gt;0.05). PLHIV reported significantly better adherence to CVD prevention medications (94 vs 68%, p &lt;0.001). There were no differences in perceived CVD risk between the two groups ( p &gt;0.05). In age and sex-adjusted models, HIV status was positively associated with medication adherence ( p &lt;0.001), and the interaction of HIV status and perceived severity of CVD were inversely associated with physical activity ( p &lt;0.05). Conclusion: Overall, PLHIV were more likely to adhere to CVD prevention medications than well-matched HIV-uninfected adults and less likely to engage in moderate-to-vigorous physical activity in this study. However, this difference in physical activity is attenuated among those who perceive higher risk from CVD. Interventions targeting perceived CVD susceptibility and severity may help to increase physical activity in this population.

Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: results of a systematic literature review

BackgroundIndividuals with rheumatoid arthritis (RA) are at risk of developing cardiovascular disease (CVD), but patient perceptions of CVD are not routinely assessed. We performed a systematic literature review to evaluate awareness of the association between RA and CVD, and perceived risk of CVD among individuals with RA.MethodsThree electronic databases (MEDLINE, EMBASE, and PubMed) were searched for English language articles between the years of 1990–2018. Search terms pertained to RA, CVD, knowledge, awareness, or perceptions of CVD risk. s were screened for inclusion/exclusion by two independent reviewers.ResultsA total of 33 abstracts were screened and 6 underwent full review. The overall sample size was 478 subjects and included patients with established RA who were predominantly female with a mean age range of 53 to 64 years. RA disease characteristics relevant to CVD were not uniformly reported, including the use of DMARDs, corticosteroids, or NSAIDs. A high proportion of subjects (range 73 to 97%) were unaware of an increased risk of developing CVD in relation to their RA, and this frequently occurred in those with a greater number of traditional CVD risk factors. Misperceptions about CVD were common, and the majority of subjects misestimated their actual CVD risk.ConclusionIndividuals with RA at highest risk for CVD report low awareness and perceived risk of this comorbidity. This represents a knowledge gap in need of intervention but must be tailored to patients’ needs. An understanding of the system- and individual-level barriers preventing CVD awareness is needed. Only then will approaches to improve CVD screening and management in RA be successful.

A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study

BackgroundNHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40–74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients’ responses.MethodsRIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12–18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources).DiscussionThis study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed.Trial registrationISRCTN ISRCTN10443908. Registered 7th February 2017.

Perceptions related to cardiovascular disease and physical activity behavior in Arab men: A qualitative study

ObjectivesTo describe the daily physical activity of Arab men living in the United States and to understand how perceptions of cardiovascular disease (CVD) risk influence their inclusion of physical activity into their daily routine. MethodsA qualitative descriptive method using a semi-structured face-to-face interview with each participant was conducted. Twenty young college males (age 26 ± 4 years) were recruited from Arab American community centers. ResultsThe qualitative inductive content analysis revealed three main themes: impact of perceived CVD risk on physical activity behavior and perceived barriers and motivators to be physically active. Arab men primarily perceived gaining weight as the most important CVD risk factor that could promote their physical activity behavior. ConclusionsThese findings demonstrate that unawareness about CVD risk and barriers to regular physical activity must be considered in any intervention to engage Arab men in regular physical activity.

Cardiovascular Risk Reduction in Persons Living With HIV: Treatment Development, Feasibility, and Preliminary Results

Persons living with HIV (PLWH) have elevated risks for cardiovascular disease (CVD). Our goal was to develop and pilot test a tailored intervention to improve CVD risk perception and the adoption of heart-healthy behaviors. In-depth qualitative interviews were conducted with 30 PLWH participants to examine learning needs and preferences. An intervention manual was developed and tested in an open pilot with eight participants. Participants were stable on antiretroviral therapy and were recruited from two urban HIV clinics in the northeastern United States. Thematic analysis identified five major themes: (a) tailored structure and design for PLWH, (b) learning needs (specific to HIV), (c) desire for prompts/reminders (to exercise), (d) importance of participant resources, and (e) need for personal evaluation and goal setting. Feasibility and acceptability of the intervention were demonstrated with high session attendance and treatment satisfaction. Further testing is warranted.

Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis.

Patients with rheumatoid arthritis are at increased risk for cardiovascular disease. The prerequisites for reducing the risk of cardiovascular disease are adequate levels of knowledge and being aware of the risk. In this study, the levels of knowledge about cardiovascular disease among patients with rheumatoid arthritis and the perception were evaluated in relation to their actual 10-year risk of cardiovascular disease. This cross-sectional study of 200 patients with rheumatoid arthritis was conducted in a university-affiliated hospital in South Korea. The patients’ actual risk of cardiovascular disease was estimated using the Framingham Risk Score. The most common risk factor was physical inactivity, with 77% of the patients not engaging in regular exercise. The patients lacked knowledge about the effects of physical inactivity and anti-inflammatory medication on the development of cardiovascular disease. Misperceptions about the risk of cardiovascular disease were common, i.e., 19.5% of the patients underestimated their risk and 41% overestimated. Hypertension, diabetes, obesity, and smoking were the most prevalent among the patients who underestimated their risk, and these same patients had the lowest level of knowledge about cardiovascular disease. This study demonstrated the rheumatoid arthritis patients’ lack of knowledge about the effects of physical inactivity and anti-inflammatory medications on the development of cardiovascular disease, and their misperception of cardiovascular risk was common. As a preventive measure, educational programs about cardiovascular disease should be tailored specifically for patients with rheumatoid arthritis, and behavioral interventions, including routine exercise, should be made available at the time of diagnosis.

Abstract P334: Primary Prevention Aspirin Use in an African American Population: The Impact of Health Beliefs and Social Norms

Background: Cardiovascular disease (CVD) is a leading cause of death that disproportionately impacts African Americans. Aspirin (ASA) is a simple, low-cost medication that lowers the risk of a first heart attack or stroke by 12-22%. This study investigates the prevalence of primary prevention ASA use among a metropolitan, predominantly African American population. It examines the association between primary prevention ASA use and measures of health beliefs, social norms, and perceptions of CVD risk hypothesized to influence ASA use. Methods: Between April and August 2015, trained community health workers administered 10 minute, in-person surveys to a convenience sample of adults ages 45-79 years within the Minneapolis-St. Paul metro area. The survey defined demographics, CVD history, atherosclerosis risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4 point Likert scale. Logistic regression with adjustment for age and number of risk factors was used to examine the association of demographics and health beliefs with ASA use. Results: Of the 797 survey participants, 590 had no CVD history. Of these, 460 (78%) were between the ages of 50-69, the range recently defined in the 2016 United States Preventive Services Task Force (USPSTF) recommendation. Overall primary prevention ASA use was 38% and increased as the number of CVD risk factors (RF) increased, from 21% (0 RF) to 62% (≥ 3 RF). After adjusting for age and risk factors, ASA use was associated with diabetes (OR 2.6, 95% CI: 1.6-4.2) and current smoking (OR 0.4, 95% CI: 0.2-0.6). If a participant discussed ASA use with a doctor, they were much more likely to use ASA (OR 5.5, 95% CI: 3.7-8.1). Participants who believed ASA could prevent a heart attack or stroke were also more likely to use it (OR 4.6, 95% CI: 1.9-11.4). ASA use was higher among participants who perceived that their peers were using ASA (OR 3.7, 95% CI: 2.0-6.6), and among participants who believed those close to them thought they should use ASA (OR 6.6, 95% CI: 4.1-10.5). Perceived safety and ease of use were also positively associated with ASA use, (OR 9.8, 95% CI: 5.0-19.3 and OR 23.2, 95% CI: 8.2-65.5 respectively). Conclusion: Increased primary prevention aspirin use was associated with positive beliefs regarding the expectations and behaviors of participants’ social network, and about perceived effectiveness, safety and convenience of the medication. Novel interventions to increase primary prevention ASA use could focus on promoting conversations with physicians about appropriate ASA use, and normalizing ASA for at-risk individuals within communities.

Exercise for prevention of cardiovascular disease: Evidence-based recommendations

Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD). In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD) and the patient-specific factors (the patient's physical activity level and the perceived CVD risk). The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.

한국 생산직 근로자들의 심혈관질환 관련 지식, 인식, 신념 및 예방행위: 내용분석을 통한 심혈관질환 위험 감소 중재 프로그램 개발을 위한 요구사정

Purpose: This study intended to grasp real context of Cardiovascular disease (CVD)-related factors of Korean blue-collar workers, especially CVD-related knowledge, perception, beliefs, benefits and barriers of behaviors according to the health belief model. Methods: We interviewed twenty two workers working in two small-sized companies and performed two series of focus group interviews. Data were analyzed by deductive content analysis approach based on Elo & Kyngas. Results: Excepting participants who have CVD risk factors, most participants had lower level of CVD risk perception. The level of CVD knowledge was low but there was difference by gender. CVD-related beliefs were 'fatal disease', 'caused by lifestyle' and 'difficult to prevent by themselves'. The risk reduction behaviors were motivated by current or family history of hypertension. But there were barriers to interfere practice of preventive behaviors such as poor quality of food provided by cafeteria in the workplace, frequent overtime, victim mentality as one of vulnerable social group, housework and financial burden, lack of facilities for rest and physical activity in the workplace. Conclusion: To develop intervention for reducing CVD risks in Korean blue-collar workers, we need to focus on improving CVD knowledge and perception and modifying work-related environments such as low quality of food and lack of facilities for rest and physical activity in the workplace.