Coronary heart disease risk assessment.

A coronary heart disease (CHD) risk assessment was conducted on 883 patients enrolled in two primary-care rural practices in western Maryland to evaluate the relationship among presence of cardiovascular disease, major risk factors, and self-perception for CHD among the clients. Patients with preexisting cardiovascular disease other than peripheral vascular disease were more likely to perceive themselves at increased risk. However, 16% (39/246) regarded themselves to be at below average risk. These patients tended to have lower income, education, and anxiety levels. Nineteen percent of patients without preexisting cardiovascular diseases regarded themselves to be at above average risk. These patients tended to be disabled, unemployed, and have increased anxiety levels. Regardless of the presence or absence of preexisting cardiovascular disease, a patient's self-perceived risk was not altered significantly by the presence of one or more risk factors other than a positive family history of CHD. Based on Framingham risk profiles, 7.3% (29/395) of the white patients 35-74 years of age without preexisting cardiovascular disease had scores of 0.301 and above. Women had 1.4 times lower estimates of risk compared to men. The discrepancy that can occur between perceived and actual risk for CHD among a significant percentage of patients attending a primary-care rural practice underscores the importance of ascertaining both prior to prescribing risk reduction interventions.