Gain- versus loss-framed LDL-C risk messaging and willingness to pay for cardiovascular prevention among young adults

Background Loss-framed health messaging, emphasizing what is lost by inaction rather than gained by action is a common behavioral strategy to promote cardiovascular prevention. Whether framing influences prevention intentions in young adults (<40 years), a population newly targeted by the 2026 dyslipidemia guidelines, is unknown. We determined whether loss- and gain-framed cardiovascular risk messaging affects willingness to pay (WTP) for and intention to adopt preventive medication, exercise, and dietary changes among young adults. Methods We conducted a randomized experiment via an online diverse participant panel. Participants were US young adults without cardiovascular disease randomized to receive a loss-framed message (harm of not improving cholesterol) or a gain-framed message (benefit of improving cholesterol). The primary outcome was WTP for monthly preventive medication, exercise, and dietary changes, separately (continuous, 2026 U.S. dollars). Between-group comparisons used Mann-Whitney U tests; subgroup analyses examined effect modification across pre-specified characteristics. Results Among 2,382 participants (mean age 30.2 years; 51.3% female; 76.6% White), 1,159 were randomized to gain framing and 1,223 to loss framing. Loss framing increased median WTP for medication ($30 [IQR, $13–$50] vs $25 [IQR, $11–$50]; P=0.03). WTP did not significantly differ between loss or gain framing for exercise or diet interventions. Likert-scale behavioral intentions did not differ between groups for any modality (all P>0.05). Conclusions In this randomized experiment among young adults without cardiovascular disease, loss-framed risk messaging produced a modest $5/month increase in WTP for preventive medication ($30 vs $25; P = 0.03) without influencing behavioral intentions across any modality.