Primary care patients' recognition of their own risk for cardiovascular disease: implications for risk communication in practice.

PURPOSE OF REVIEW: Guidelines on primary prevention of cardiovascular disease emphasize identifying high-risk patients for intensive risk-reducing management. These guidelines recommend the identification of individuals with high risk using risk score sheets or risk tables. Patients' misperceptions of risk seem to hamper implementation of the high-risk approach. How appropriate are the risk perceptions of patients? What is known about effective ways of risk communication? RECENT FINDINGS: Cardiovascular risk is often perceived inappropriately in primary care populations; by nearly four in five high-risk patients (incorrect optimism), and by one in five low-risk patients (incorrect pessimism). Communicating cardiovascular risk by means of natural frequencies seems effective to correct inappropriate risk perception, though effects are small. SUMMARY: In communicating cardiovascular disease risk, primary care physicians must be aware that they mostly encounter low-risk patients and that the perceived risk does not necessarily correspond with the actual risk. Professionals should be skilled in the use of effective formats for risk communication that are ideally integrated within patient decision aids for cardiovascular risk management