Risk of cardiovascular disease? A qualitative study of risk interpretation among patients with high cholesterol

Pia Kirkegaard, Adrian Edwards, Mette Bech Risør, Janus Laust Thomsen, Pia Kirkegaard, Adrian Edwards, Mette Bech Risør, Janus Laust Thomsen

Abstract

Background: Previous studies have shown the importance of paying attention to lay peoples' interpretations of risk of disease, in order to explain health-related behavior. However, risk interpretations interplay with social context in complex ways. The objective was to explore how asymptomatic patients with high cholesterol interpret risk of cardiovascular disease.

Methods: Fourteen patients with high cholesterol and risk of cardiovascular disease were interviewed, and patterns across patient accounts were identified and analysed from an ethnographic approach.

Results: Information from the general practitioner about high cholesterol and risk of cardiovascular disease was reinterpreted in everyday social life. The risk associated with fatty foods was weighed against the pleasures of social and cultural events in which this type of food was common and cherished.A positive mindset was applied as a strategy to lower the risk of having high cholesterol, but knowledge about risk was viewed as a cause of anxiety and self-absorption, and this anxiety made the body susceptible to disease, hampering the chances for healthy life.

Conclusion: Interpretations of high cholesterol and risk of cardiovascular disease are embedded in social relations and everyday life concerns. This should be addressed in general practice in preference-sensitive cases about risk-reducing medication.

Trial registration: ClinicalTrials.gov: NCT01187056.

References

    1. Alwan A. Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants. Italy: WHO Press; 2011.
    1. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008;117(23):3031–3038. doi: 10.1161/CIRCULATIONAHA.107.738732.
    1. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–1278.
    1. Narla V, Blaha MJ, Blumenthal RS, Michos ED. The JUPITER and AURORA clinical trials for rosuvastatin in special primary prevention populations: perspectives, outcomes, and consequences. Vasc Health Risk Manag. 2009;5:1033–1042.
    1. Schedlbauer A, Schroeder K, Fahey T. How can adherence to lipid-lowering medication be improved? A systematic review of randomized controlled trials. Fam Pract. 2007;24(4):380–387. doi: 10.1093/fampra/cmm030.
    1. Chaudhry HJ, McDermott B. Recognizing and improving patient nonadherence to statin therapy. Curr Atheroscler Rep. 2008;10(1):19–24. doi: 10.1007/s11883-008-0004-4.
    1. Frishman WH. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. Cardiol Rev. 2007;15(5):257–263. doi: 10.1097/CRD.0b013e3180cabbe7.
    1. Kim HY, Lee JA, Kim YS, Sunwoo S, Oh HJ, Kim CS, Yum K, Choi C, Jeong YS, Song SW, Kim DH, Kim YS. Factors of compliance in patients with hypercholesterolemia using rosuvastatin in primary care. Korean J Fam Med. 2012;33(5):253–261. doi: 10.4082/kjfm.2012.33.5.253.
    1. Wisniowska B, Skowron A. Evaluation of patients’ adherence to statins in Poland. Curr Med Res Opin. 2011;27(1):99–105. doi: 10.1185/03007995.2010.536745.
    1. Wu JR, Lennie TA, Chung ML, Frazier SK, Dekker RL, Biddle MJ, Moser DK. Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart Lung. 2012;41(2):107–114. doi: 10.1016/j.hrtlng.2011.09.009.
    1. Kulkarni SP, Alexander KP, Lytle B, Heiss G, Peterson ED. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151(1):185–191. doi: 10.1016/j.ahj.2005.02.038.
    1. Garcia Ruiz FJ, Marin Ibanez A, Perez-Jimenez F, Pinto X, Nocea G, Ahumada C, Alemao E, Yin D. REALITY Study Group. Current lipid management and low cholesterol goal attainment in common daily practice in Spain: the REALITY study. Pharmacoeconomics. 2004;22(3):1–12.
    1. Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Legare F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10:CD001431.
    1. Douglas M. Purity and danger: an analysis of the concepts of pollution and taboo. London: Ark; 1984.
    1. Douglas M. Risk and blame: essays in cultural theory. London: Routledge; 1994. Paperback ed. ed.
    1. Gifford SM. In: Anthropology and epidemiology: interdisciplinary approaches to the study of health and disease. Janes CR, Stall R, Gifford SM, editor. Dordrecht, Lancaster: Reidel; 1986. The meaning of lumps: a case study of the ambiguities of risk.
    1. Farrimond H, Saukko PM, Qureshi N, Evans PH. Making sense of being at ‘high risk’ of coronary heart disease within primary prevention. Psychol Health. 2010;25(3):289–304. doi: 10.1080/08870440802499382.
    1. Wheatley EE. Bodies at risk: an ethnography of heart disease. England: Ashgate; 2006.
    1. Alonzo AA. Health as situational adaption: a social psychological perspective. Soc Sci Med. 1985;21(12):1341–1344. doi: 10.1016/0277-9536(85)90440-X.
    1. Aronowitz RA. The converged experience of risk and disease. Milbank Q. 2009;87(2):417–442. doi: 10.1111/j.1468-0009.2009.00563.x.
    1. Kirkegaard P, Edwards AG, Hansen B, Hansen MD, Jensen MS, Lauritzen T, Risoer MB, Thomsen JL. The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice. BMC Fam Pract. 2010;11:70. doi: 10.1186/1471-2296-11-70.
    1. Kirkegaard P. Negotiating risks. SUN-TRYK Aarhus: Aarhus University; 2011.
    1. Christensen B. Forebyggelse af iskæmisk hjerte-kar-sygdom i almen praksis [Prevention of ischaemic cardiovascular disease in general practice] Odder: Dansk Selskab for Almen Medicin, Zeuner Grafisk; 2007.
    1. Puri KS, Suresh KR, Gogtay NJ, Thatte UM. Declaration of Helsinki, 2008: implications for stakeholders in research. J Postgrad Med. 2009;55(2):131–134. doi: 10.4103/0022-3859.52846.
    1. American Anthropological Association (AAA) Ethics.
    1. Hammersley M, Atkinson P. Ethnography: principles in practice. 3. London: Routledge; 2007.
    1. Kvale S. Doing interviews. Los Angeles: Sage Publications; 2009.
    1. Hvas L, Gannik DE. Discourses on menopause–part II: how do women talk about menopause? Health (London) 2008;12(2):177–192. doi: 10.1177/1363459308091428.
    1. Barth F. Other knowledge and other ways of knowing. J Anthropol Res. 1995;51(1):65.
    1. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–1367. doi: 10.1007/s11606-012-2077-6.
    1. Felde LKH, Elverdam B. Konsultationen som intermezzo. Utposten. 2007;8:20–26.
    1. Sangren H, Reventlow S, Hetlevik I. Role of biographical experience and bodily sensations in patients’ adaptation to hypertension. Patient Educ Couns. 2009;74(2):236–243. doi: 10.1016/j.pec.2008.08.007.
    1. Rubow C. In: Ind i verden: en grundbog i antropologisk metode. 2. Hastrup K, editor. Copenhagen: Hans Reitzel; 2010. Samtalen: interviewet som deltagerobservation.

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