Illness Perception of Patients with Familial Hypercholesterolaemia varies with Level of Education and Presence of Cardiovascular Disease


  • Salmi Razali Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA
  • Zaliha Ismail Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA
  • Najib Abdullah Department of Psychiatry and Mental Health, Hospital Sg Buloh, 47000 Sungai Buloh, Selangor, Malaysia
  • Hapizah M Nawawi Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, Malaysia



Familial hypercholesterolaemia, Illness perception, Sociodemography, Cardiovascular disease


Illness perception determines the healthy lifestyle of patients with Familial Hypercholesterolaemia (FH).  Despite the availability of advanced treatment and preventive measures, there is still sparse data on illness perception of FH patients. Hence, this study aimed to describe the illness perception of FH patients and investigate its association with sociodemographic and illness-related factors. 100 FH patients were assessed using Pro forma questionnaires and revised illness perception questionnaire (IPQ-R). Illness perception of FH patients varies according to the level of education and the presence of cardiovascular disease (CVD). These findings may help clinicians to improve the interventions suitable for FH patients.  

Keywords: Familial hypercholesterolaemia; illness perception; sociodemography; cardiovascular disease

eISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BYNC-ND license ( Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.


Al-Khateeb, A., Hamzan, N. S., Razali, R., Froemming, G. A., Rahman, T., Peng, H. B., & Nawawi, H. (2016). Genetic Study of Low-Density Lipoprotein Receptor Gene and Apolipoprotein B-100 Gene among Malaysian Patients with Familial Hypercholesterolaemia. International Archives of Medicine, 9.

Azian, M., Hapizah, M., Khalid, B., Khalid, Y., Rosli, A., & Jamal, R. (2006). Use of the denaturing gradient gel electrophoresis (DGGE) method for mutational screening of patients with familial hypercholesterolaemia (FH) and Familial defective apolipoprotein B100 (FDB). The Malaysian Journal of Pathology, 28(1), 7-15.

Beaglehole, R., Reddy, S., & Leeder, S. R. (2007). Poverty and human development: the global implications of cardiovascular disease: Am Heart Assoc.

Cohen, B. E., Edmondson, D., & Kronish, I. M. (2015). State of the art review: depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension, 28(11), 1295-1302.

Forouhi, N. G., & Sattar, N. (2006). CVD risk factors and ethnicity—a homogeneous relationship? Atherosclerosis Supplements, 7(1), 11-19.

Foxwell, R., Morley, C., & Frizelle, D. (2013). Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients. Journal of Psychosomatic Research, 75(3), 211-222.

Frich, J. C., Ose, L., Malterud, K., & Fugelli, P. (2006). Perceived vulnerability to heart disease in patients with familial hypercholesterolaemia: a qualitative interview study. The Annals of Family Medicine, 4(3), 198-204.

Gaughan, M. E. (2003). Heart Healthy Eating Selfâ€Efficacy: An Effective Tool for Managing Eating Behavior Change Interventions for Hypercholesterolaemia. Topics in Clinical Nutrition, 18(4), 229-244.

Hagger, M.S., Hardcastle, S.J., Hu M, Kwok, S, Lin J, Nawawi, H.M., Pang, J, Santos, R.D., Soran, H., Su TC, Tomlinson, B, Watts, G.F. (2018a) Effects of Medication, Treatment, and Behavioral Beliefs on Intentions to Take Medication in Patients with Familial Hypercholesterolemia. Atherosclerosis for the FH special issue, Atherosclerosis.;277:493-501.

Hagger, M.S., Hardcastle, S.J., Hu M, Kwok, S, Lin J, Nawawi, H.M., Pang, J, Santos, R.D., Soran, H., Su TC, Tomlinson, B, Watts, G.F. (2018b) Health literacy in familial hypercholesterolemia: A cross-national study. European Journal of Preventive Cardiology: DOI: 10.1177/2047487318766954

Hagger, M. S., Hardcastle, S. J., Hingley, C., Strickland, E., Pang, J., & Watts, G. F. (2016). Predicting self-management behaviours in familial hypercholesterolaemia using an integrated theoretical model: The impact of beliefs about illnesses and beliefs about behaviours. International Journal of Behavioral Medicine, 23(3), 282-294.

Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology and Health, 18(2), 141-184.

Hsiao, C.-Y., Chang, C., & Chen, C.-D. (2012). An investigation on illness perception and adherence among hypertensive patients. The Kaohsiung Journal of Medical Sciences, 28(8), 442-447.

Institute for Public Health (IPH). (2015). National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems; 2015.

Leventhal, H., Nerenz, D. R., & Purse, J. (1984). Illness representations and coping with health threats.

Alicezah M.K., Rahman, M.T. & Koshy, M. (2014). Homozygous familial hypercholesterolaemia. The Malaysian Journal of Pathology, 36(2), 131.

Morgan, K., Villiers-Tuthill, A., Barker, M., & McGee, H. (2014). The contribution of illness perception to psychological distress in heart failure patients. BMC Psychology, 2(1), 50.

Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology and Health, 17(1), 1-16.

Pang, J., Hu, M., Lin, J., Miida, T., Nawawi, H. M., Park, J. E., . . . Gonzalez-Santos, L. E. (2017). An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the ‘Ten Countries Study’. BMJ Open, 7(10), e017817.

PetriÄek, G., Vrcić-Keglević, M., Vuletić, G., CeroveÄki, V., OžvaÄić, Z., & Murgić, L. (2009). Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study. Croatian Medical Journal, 50(6), 583-593.

Petrie, K. J., Cameron, L. D., Ellis, C. J., Buick, D., & Weinman, J. (2002). Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosomatic Medicine, 64(4), 580-586.

Razak, S. A., Rahmat, R., Kasim, N. M., Rahman, T. A., Muid, S., Nasir, N. M., . . . Nawawi, H. (2016). Diagnostic performance of various familial hypercholesterolaemia criteria compared to the Dutch lipid clinic criteria in an Asian population. Atherosclerosis, 252, e27-e28.

Ross, S., Walker, A., & MacLeod, M. J. (2004). Patient compliance in hypertension: role of illness perceptions and treatment beliefs. Journal of human hypertension, 18(9), 607.

Senior, V., Marteau, T., & Weinman, J. (2004). Genetic Risk Assessment for FHTSG. Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: The role of illness perceptions. Cardiovasc Drugs Ther, 18, 475-481.

Watts, G. F., Ding, P. Y., George, P., Hagger, M. S., Hu, M., Lin, J., . . . Nawawi, H. M. (2016). Translational research for improving the care of familial hypercholesterolaemia: the ‘ten countries study’ and beyond. Journal of atherosclerosis and thrombosis, 23(8), 891-900.

Witteman, C., Bolks, L., & Hutschemaekers, G. (2011). Development of the illness perception questionnaire mental health. Journal of Mental Health, 20(2), 115-125.




How to Cite

Razali, S., Ismail, Z., Abdullah, N., & Nawawi, H. M. (2019). Illness Perception of Patients with Familial Hypercholesterolaemia varies with Level of Education and Presence of Cardiovascular Disease. Environment-Behaviour Proceedings Journal, 4(10), 72–78.

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