Many People at Risk of Heart Attack See No Need to Improve Their Health

Broadly speaking, Canadians at risk for a heart attack know they need to improve their physical health. But not all do. In a recent study of residents of six Canadian provinces, almost one in five people with the highest cardiac risk did not think they needed to make any lifestyle changes to improve their health.

“Perceiving a need to do something about a health problem is a precursor to actually doing something about it,” said F. Daniel Ramirez, MD, a cardiology resident at the Ottawa Heart Institute and lead author of the study published in the Journal of the American Heart Association. “A large proportion of the population has known risk factors for heart attack that can be modified, but a lot of them don’t even sense a need to change [those risk factors]. The numbers surprised us.”

For their study, Dr. Ramirez and his colleagues combed through data from the Canadian Community Health Survey conducted in 2011 and 2012. This cross-sectional survey sampled over 45,000 Canadians aged 12 and older.

The survey data included the presence of eight major, potentially modifiable risk factors for heart attack: smoking, high blood pressure, diabetes, obesity, low fruit and vegetable consumption, alcohol intake and low physical activity. Participants were also asked about their perceived need to improve their physical health and about barriers to making lifestyle changes.

Overall, survey participants had an average of two potentially modifiable risk factors for heart attack, and almost three-quarters reported a perceived need to change their health behaviours. And as a broad trend, patients with more risk factors were more likely to report a perceived need to change. But this was not universal: almost 20% of participants with five or more risk factors said their health was fine as-is.

In addition, some risk factors brought with them more concern than others—not always in line with their importance, explained Dr. Ramirez. Smoking, obesity and low levels of physical activity were strongly associated with a perceived need to change health behaviours. But high blood pressure and diabetes were not, even though they also raise the risk of a heart attack substantially.

The survey did not collect information on whether participants were taking medications for these conditions, said Dr. Ramirez. “Patients with high blood pressure or diabetes are often on some form of therapy,” he explained. “So it’s very possible that people who are on medication may feel like it’s not something they need to do anything else about.”

“It’s important to note, though, especially for diabetes: even if it’s under control, it’s still a risk factor for cardiac complications. These are individuals who still need to be very cautious with other aspects of their health,” he added.

Another unexpected finding was the nature of the barriers to change most often cited by patients. “We assumed we’d see environmental or resource issues. But when you look at the leading ones, they’re all individual factors,” said Dr. Ramirez. The most commonly mentioned barriers to changing health habits were lack of will power or self-discipline, work schedule and family responsibilities. “There are a lot of motivational issues and a lot of day-to-day inconveniences or difficulties in actually getting themselves to do it,” he explained.

“There’s very little data on what the effective ways are to really effect change in patients’ behaviours,” added Dr. Ramirez. “I think we as doctors assume that if we tell them often enough—if we tell them smoking is bad, or that their risk of a heart attack is higher because they don’t eat healthy or they are obese—that this will somehow translate into change. And I think this data suggests that that’s not very effective.”

Dr. Ramirez hopes to see studies done in the future to identify what methods actually help motivate patients to perceive and undertake health changes. “We would like to see if there are approaches or strategies that are more effective in getting buy-in from patients, and to get some guidance for doctors as to how to be more effective in doing this,” he said. “At a population level, finding ways to prevent heart disease in the first place is a much more sustainable long-term strategy than tacking it after the fact.”