ABSTRACT
RATIONALE: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management. BEHAVIORS: physical activity, healthy eating, and taking cholesterol lowering medication. OBJECTIVE: The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries. METHOD: Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total Nâ¯=â¯726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors. RESULTS: Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across samples and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across samples and behaviors. CONCLUSION: Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across samples and behaviors highlights the imperative of identifying sample- and behavior-specific correlates of FH self-management behaviors.
Subject(s)
Health Knowledge, Attitudes, Practice , Hyperlipoproteinemia Type II/psychology , Intention , Patient Participation/psychology , Self-Management/psychology , Australia , Brazil , China , Cross-Sectional Studies , Female , Hong Kong , Humans , Hyperlipoproteinemia Type II/complications , Hyperlipoproteinemia Type II/therapy , Malaysia , Male , Patient Participation/methods , Patient Participation/statistics & numerical data , Self-Management/methods , Self-Management/statistics & numerical data , Surveys and Questionnaires , Taiwan , United KingdomABSTRACT
BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) is the commonest monogenic disorder that accelerates atherosclerotic cardiovascular disease. We compared and contrasted the characteristics of patients from three specialist centres in the southern hemisphere. METHODS: Adult index-cases with molecularly diagnosed heterozygous FH attending specialist lipid centres in Cape Town, Perth and São Paulo were studied. Myocardial infarction, revascularisation, hypertension, diabetes, smoking and lipid-lowering treatment were recorded at the time of diagnosis and compared across the three centres. RESULTS: The spectrum of genetic variants causative of FH was significantly different in patients attending the centres in South Africa compared with Australia and Brazil. Hypertension and diabetes were more prevalent in Brazilian and Australian patients, than in South African patients, but the frequency of smoking was significantly greater in South Africa than the other two centres (p<0.01). Age, male sex and smoking were significant independent predictors of coronary artery disease (CAD) in all three countries (p<0.05). CONCLUSIONS: Patients with FH in three specialist centres in the southern hemisphere exhibit a high prevalence of non-cholesterol cardiovascular disease risk factors. Older age, male sex and smoking were more common among subjects with CAD. In all three countries, there should be vigorous programmes for the control of risk factors beyond good control of hypercholesterolaemia among patients with FH. Promotion of a healthy lifestyle, especially anti-smoking advice, is of paramount importance.
Subject(s)
Cholesterol, LDL/blood , Healthy Lifestyle , Hyperlipoproteinemia Type II/diagnosis , Hyperlipoproteinemia Type II/therapy , Risk Reduction Behavior , Adult , Age Factors , Biomarkers/blood , Brazil/epidemiology , Comorbidity , Coronary Artery Disease/epidemiology , Coronary Artery Disease/genetics , Coronary Artery Disease/prevention & control , Early Diagnosis , Female , Genetic Markers , Genetic Predisposition to Disease , Heterozygote , Humans , Hyperlipoproteinemia Type II/epidemiology , Hyperlipoproteinemia Type II/genetics , Male , Middle Aged , Mutation , Phenotype , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Sex Factors , Smoking/adverse effects , Smoking/epidemiology , Smoking Cessation , South Africa/epidemiology , Western Australia/epidemiologyABSTRACT
Familial hypercholesterolemia (FH) significantly increases the risk of coronary heart disease. Most individuals are unaware they have the condition. In the Western Australian Pregnancy Cohort (Raine) Study, 1 in 267 adolescents were found to have FH. Universal cholesterol screening in childhood may offer the best strategy for diagnosing FH.