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Validity of Self-Report of Cardiovascular Risk Factors in a Population at High Risk for Stroke
Ayan K Dey1, Akram Alyass2, Ryan T Muir3
1Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Self-reported vascular risk factors like hypertension, hypercholesterolemia, and diabetes are often inaccurate in high-risk stroke patients. Clinicians should validate self-reports with objective measures due to low sensitivity, especially for cholesterol.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Self-report is a common method for screening vascular risk factors.
- Previous studies indicate low sensitivity of self-report in healthy populations.
- The validity of self-reported vascular risk factors in high-risk stroke populations remains underexplored.
Purpose of the Study:
- To investigate the accuracy of self-reported cardiovascular risk factors (hypertension, hypercholesterolemia, type II diabetes mellitus).
- To assess self-report validity in patients with recent high-risk transient ischemic attack or minor stroke.
Main Methods:
- Extracted data from 101 patients' questionnaires and medical records.
- Assessed agreement between self-report and clinical measures (blood pressure, glucose, lipids, medications).
- Calculated sensitivity, specificity, and predictive values for each risk factor.
Main Results:
- 49% of patients inaccurately self-reported at least one vascular risk factor.
- Self-report sensitivity was 84.5% for hypertension, 57.5% for hypercholesterolemia, and 77.8% for diabetes.
- Accuracy was significantly lower for hypercholesterolemia (42.6% under-reported), with better accuracy in younger males.
Conclusions:
- Clinicians must exercise caution with self-reported vascular risk factors due to poor sensitivity.
- Objective measures are crucial for validating self-reported data in at-risk populations.
- Findings suggest a potential lack of public awareness regarding these significant vascular conditions.
Background:
Screening for vascular risk factors is commonly assessed through self-report, despite reports of low sensitivity using this approach in healthy populations. The validity of self-reported vascular risk factors in a population at high risk for stroke has yet to be explored.
Aims:
This study investigated the validity of self-reported cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, and type II diabetes mellitus) in a population of patients with a recent history of high-risk transient ischemic attack or minor stroke.
Methods:
Data were extracted from patient questionnaire responses and medical records (n = 101). Agreement between self-report and clinical measures (blood pressure, fasting blood glucose, lipid profile, and active medications) was assessed using estimates of sensitivity, specificity, and positive and negative predictive values for each vascular risk factor.
Results:
Forty-nine percent of the study population inaccurately self-reported at least 1 vascular risk factor. Sensitivities of self-report for hypertension, hypercholesterolemia, and diabetes were 84.5% (confidence interval [CI]: 72.1-92.2), 57.5% (CI: 44.1-69.7), and 77.8% (CI: 57.3-90.6), respectively, while specificities were 76.7% (CI: 61.0-87.7), 83.3% (CI: 67.3-93.2), and 95.4% (CI: 87.8-98.9), respectively. Accuracy of self-report for hypercholesterolemia was significantly lower than that for diabetes (P < .001) and hypertension (P < .05), with 42.6% of those with high cholesterol under-reporting their diagnosis. Logistic regression revealed that odds of accurate self-report were greater among younger adults and males.
Conclusions:
These results highlight the need for clinicians, scientists, and epidemiologists to be cautious when screening for vascular risk factors using self-report measures as cross validation against objectives measures reveals poor sensitivity. Our results also highlight a lack of public education concerning these significant conditions.
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