Is family history risk for incident coronary heart disease in part because of fatalistic health beliefs' influence on health behavior? An empirical test of the Mickey Mantle effect using a population-based sample

Objective: To test the hypothesis that fatalistic health beliefs contribute to the association between family history and CHD incidence in a large population-based sample. Based on the health belief model to secondarily evaluate how fatalistic beliefs may lead to poor health behavior, especially in women. Methods: In 1995 2,688 Nova Scotians without prior heart disease were enrolled in the Nova Scotia Health Study (NSHS95) and followed for 10 years. Participants' age and sex were recorded from the medical registry. Physical activity, engagement in exercise, belief in preventability of heart disease, and family history of early CHD were gathered during a home interview. Incident CHD hospitalizations were determined from the provincial health care registry. Results: A fatalistic health belief contributed significantly to the prediction of CHD incidence with family history in the Cox regression model, (HR =2.149, p <.00001). Physical activity (HR= 1.18, p <.00001) and engagement in exercise (HR= 1.372, CI 1.053-1.789, p <.05) also contributed significantly to the prediction of incident CHD, with fatalistic health belief controlled. Gender was a significant effect modifier. Conclusion: The effect of family history on predicting coronary heart disease is mediated by fatalistic health beliefs. Physical activity and exercise, in turn, mediate fatalistic health beliefs predicting incident CHD. These results provide empirical verification of the “Mickey Mantle effect,” and that family history of CHD should not be viewed as an unmodifiable risk factor.