Abstract 1814: Perceived Cardiac Risk Underestimated Among Urban Diabetics
Cardiovascular disease (CVD) is the leading cause of death in diabetics; however, understanding among diabetics of the importance of CVD as a major health threat is unknown. We studied perceived and actual risk of developing CVD and the factors associated with perceptions of CVD risk in a sample of 82 type II diabetic patients without diagnosed CVD. Data were collected during baseline evaluation for a randomized trial to reduce total CVD risk in urban community clinics. Perceived risk was determined by the patients’ estimation of their personal likelihood of developing heart disease and objective risk was calculated using the Framingham Index. Depressive symptoms were measured by the CES-D and overall perception of health by the EuroQuol. CVD risk factors were measured directly using standardized procedures. The sample was 73% female and 93% Black. Mean age was 54 ± 11 years, 32% had not graduated from high school and 55% had annual household incomes <$20,000. CVD risk factor burden was high: 70% were obese; 68% had BP≥130/80; 56% had high LDL-C; and 31% were current smokers. The Framingham 10 year CVD risk ranged from 1–33% with average risk of 11.4 ± 7.2%. In contrast, only 18% of patients perceived themselves at high risk for developing heart disease. Objective and perceived CVD risk were not significantly associated (β=−0.38; p<0.31). Increased levels of perceived risk were associated with younger age (β= −0.648; p=0.007), greater depressive symptoms (β=0.87; p<.000), poorer general health perception (β= −0.51; p<.000); and current smoking (β=14.27; p=0.02); but there was no association with HgA1c, LDL-C, or blood pressure levels. In a multivariate model, greater depressive symptoms, poorer general health perceptions, and current smoking were independently associated with perceived risk for CVD. Urban, disadvantaged diabetics in this study of predominately Black women had many CVD risk factors and increased objective risk for developing CVD. However, there was a gap between perceived and actual risk of CVD. Attempts to improve the cardiovascular health of underserved groups should include interventions to increase awareness and control of CVD risk factors among type II diabetics, particularly aimed at racial/ethnic minority women.