Stenting is easy; changing patient behaviors is hard, cardiologist says
WEDNESDAY, May 3, 2017 (HealthDay News) -- Sizable numbers of adults with risk factors for heart attack -- such as smoking, obesity or physical inactivity -- aren't inclined to do anything to improve their health, a large, new study finds.
Among those at greatest risk, meaning they having five or more risk factors, almost 1 in 5 did not feel they needed to make any changes, the study revealed.
Researchers can't say exactly why this disconnect exists.
"Our study suggests that the link between risk perceptions and behaviors is complex," said Dr. F. Daniel Ramirez, the study's lead author. He is a research fellow at the University of Ottawa Heart Institute in Ontario, Canada.
But Ramirez and his co-authors don't think indifference is simply due to a lack of education or appreciation of health consequences.
As study senior author Dr. Benjamin Hibbert explained in an American Heart Association news release, "Effectively convincing people to adopt and sustain healthy lifestyle changes requires a better understanding of what makes them tick."
Among people in the study who perceived a need to improve their physical health, more than half cited barriers to change. The most common were lack of self-discipline, work schedule and family responsibilities.
Cardiologist Dr. Vincent Bufalino, a spokesman for the American Heart Association, said conversations about reducing risk factors occur in examining rooms across America every day.
"Some folks are totally motivated and they're all over it: watching their diet, on their exercise program, mindful of their blood pressures and [blood] sugar," he said. "Then there's the folks that, you know what, no matter what we say, we can never quite move them on behavior."
The challenge is changing behavior, said Bufalino, who is president of Advocate Medical Group in Downers Grove, Ill.
"Putting a stent in someone [is] the easiest thing. Now we have to change the way you've been living the last 25 or 30 years," he tells patients. "That's hard."
Ramirez said little information exists on what really motivates people to adopt healthy behaviors. Hoping to shed some light on the topic, he and his team examined a database of more than 45,000 adults participating in the 2011-2012 Canadian Community Health Survey.
The survey gathered data on eight "modifiable" risk factors for heart attack: smoking, high blood pressure, diabetes, obesity, stress, excess alcohol consumption, lack of physical activity and poor diet.
Along with high cholesterol, which was not part of the study, these factors account for 90 percent of heart attack risk, the study authors noted.
Researchers calculated the number of risk factors per person based on survey responses. They also asked people if they thought there was anything they could do to improve their health.
Overall, almost three-quarters of respondents agreed there were ways to improve their health. The vast majority of these people identified a specific behavior change as being most important. Common responses included exercising more, losing weight, eating better, and quitting or cutting back on smoking.
The number of people acknowledging a need to make health changes increased with the number of risk factors they reported. Among those with three or more risk factors, nearly eight in 10 said they needed to change their health habits.
After adjusting for factors such as age, education, income and having a regular health care provider, older and white people were more likely than younger people and minorities to say they needed to improve their health.
Bonnie Spring is director of the Center for Behavior and Health at Northwest University's Feinberg School of Medicine in Chicago. She isn't "overly surprised" that some people have trouble perceiving that lifestyle changes can improve health.
Study participants seemed to be "connecting bad habits to weakened will, rather than poor health," Spring said.
Lack of education is rarely the root cause of unhealthy behavior, she explained.
However, "increasing people's confidence about being able to change" might help, Spring said.
The study found that people with diabetes or high blood pressure were no more likely to perceive a need to change than people without those conditions.
Perhaps that's because these medical conditions are not visible to others, unlike smoking, obesity and physical activity, Spring reasoned.
If that's true, "it sounds like positive social norms for healthy lifestyle may be starting to take effect," she said.
The study was published May 3 in the Journal of the American Heart Association.