Background/Aims: Younger women underestimate personal cardiovascular disease (CVD) risk. The impact of individual risk factors, in particular hypercholesterolemia, on perceived CVD risk is unknown. Hypercholesterolemia represents a challenging risk factor for younger women as (1) unfavorable lipid profiles at younger ages are better predictors of future CVD risk than more contemporaneous profiles, (2) hypercholesterolemia in pregnancy places offspring at-risk for atherosclerotic plaque development, and (3) most lipid-lowering drugs are contraindicated during pregnancy. We evaluated perceived CVD risk by hypercholesterolemia status among women and we examined if this varies by age.
Methods: Women in this secondary data analysis were participants in the Making Effective Nutritional (MENU) Choices randomized controlled intervention trial aimed at increasing fruit and vegetable consumption through an online program. Participants were health plan members, ages 21 to 65 years, from five HMORN sites. All measures were self-reported from pre-intervention surveys. History of hypercholesterolemia was defined as previous diagnosis of high cholesterol or lipid-lowering treatment. Perceived risk of CVD was measured using an ordinal scale (5 choices ranging from not at all to extremely likely). The association of hypercholesterolemia with perceived risk of CVD was estimated using Bayesian proportional odds models. Women with pre-existing CVD were excluded.
Results: The analytic sample consisted of 1,614 women; 358 (22.2%) with hypercholesterolemia. Women with hypercholesterolemia were older, had larger BMI, were more likely to be African-American and to currently smoke (all P<0.01). Among hypercholesterolemic women, 137 (38.3%) ranked themselves as having no to little risk of CVD. After adjustment for race, age and BMI, women with hypercholesterolemia had a mean increase in perceived CVD risk of 1.2 (95% CI posterior mean = 0.6, 1.7; P=0.001) compared to women without hypercholesterolemia. There was no evidence that age moderated the effect of hypercholesterolemia on perceived CVD risk (interaction P=0.69).
Conclusions: In general, women with hypercholesterolemia rated their overall risk of CVD higher than women without this history, suggesting that women recognize hypercholesterolemia as a CVD risk factor. However, our findings reveal an important knowledge gap in nearly 40% of women with hypercholesterolemia did not perceive themselves at risk of CVD.