Lots of Poor Heart-Health Habits? Many See No Need to Change: INTERHEART

Marlene Busko

May 10, 2017

OTTAWA, ON — A large study based on self-replies to a questionnaire found that for each additional modifiable cardiovascular risk factor, people were more likely to report that they needed to make changes such as exercise more, or stop smoking, or watch what they ate[1].

However, one in five individuals who had the highest risk of having a cardiovascular event (since they had five or more modifiable risk factors) did not think that they needed to improve their health habits.

Thus "a substantial proportion of individuals at risk for cardiovascular events do not feel a need to improve their physical health," Dr F Daniel Ramirez (University of Ottawa Heart Institute, ON) and colleagues report, in their study that was published online May 3, 2017 in the Journal of the American Heart Association.

These findings show there is "an urgent need to identify means to modify public health perceptions and behaviors . . . [to improve] cardiovascular preventive efforts," according to the authors.

Awareness of Shortcomings, Plans to Improve Health Habits

Decreases in cardiovascular risk factors account for roughly half to two-thirds of the recent improvement in heart disease in developed countries, according to the authors. But an increasing prevalence of risk factors, especially obesity, type 2 diabetes, and hypertension, is threatening to quell or even reverse these health gains.

The INTERHEART study identified nine potentially modifiable risk factors that account for >90% of the population-attributable risk for MI.

However, it was not clear if people are generally aware that they have potentially modifiable cardiovascular risk factors and if they plan to take steps to address this.

The researchers aimed to study health perceptions using data from the 2011–2012 Canadian Community Health Survey. They hypothesized that modifiable risk factors would be positively associated with a perceived need to improve physical health.

They identified 47,269 adult survey respondents from Alberta, Manitoba, Quebec, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador.

The survey asked people "Do you think there is anything you should do to improve your physical health?" and "Is there anything stopping you from making this improvement? What?"

The researchers examined data for eight of the nine modifiable risk factors in INTERHEART: less than 4 hours a week of moderate exercise; obesity (BMI >30 kg/m2, a surrogate for abdominal obesity); eating less than five fruits and vegetables a day; smoking within the past 12 months; high stress; more than four alcoholic drinks/week or abstinent; type 2 diabetes; and hypertension. They did not have data for apolipoprotein B (apoB) or apoA.

Close to three-quarters of the survey respondents (74%) reported that they needed to change some health behaviors, and 81% planned to do so in the coming year.

The most common intention was to exercise more, followed by plans to lose weight, improve their diet, and quit or reduce smoking. Together these accounted for 91% of planned changes.

People who were younger than 60 or without a regular medical doctor or with at least a high school education or at least a moderate household income were more likely to plan to improve their health habits.  

After adjustment for these confounders, people who smoked or were obese or not very physically active were more likely to report that they needed to improve their physical health.

Low fruit and vegetable consumption and high stress were modestly associated with a need to improve health habits, but hypertension, alcohol consumption, and type 2 diabetes were not associated with this need.

For each additional modifiable cardiac risk factor, the adjusted prevalence of a perceived need to improve physical health increased slightly (adjusted ratio 1.08; 95% CI 1.07–1.09).

However only 83% of people with five or more modifiable risk factors thought they needed to make changes to improve their health.

Of those who saw a need to make lifestyle changes, 56% reported that they would be hindered, most notably by a lack of willpower, followed by a busy work schedule and family responsibilities.

"Though these associations may suggest a degree of public awareness of the health implications of [potentially modifiable risk factors] in general, our study suggests that it is modest and inconsistent," Ramirez et al write.

Moreover, whereas people must be aware that they need to improve their physical health, this alone may not be sufficient to bring about health behavior change, they note.

Thus, more research is needed to see how to change behaviors. "A greater understanding of factors underlying health perceptions and behaviors, including among these subgroups, may yield considerable benefits," according to the authors.

The authors report that they have no relevant financial relationships.

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