Determinants of cardiovascular risk awareness among italian women: evidence from the “a call for women” project
E Marseglia, G Guida, L Ramputi, L Mencarini, P Profeta, A Attanasio, G Disabato, R Cardani, I Baroni, G De Angeli, G Conte, M Piepoli, S CastelvecchioAbstract
Background
Cardiovascular diseases (CVDs) are the leading cause of death among women, yet risk awareness remains suboptimal. Results of the 2019 American National Survey showed that awareness that CVDs are the number one killer in women declined from 2009 to 2019. Understanding who is aware—and why—is critical to design effective prevention strategies.
Aims and methods
We analysed cross-sectional data from 3,986 Italian women leaving in Lombardy who were invited to complete a web survey, “A Call for Women” project. Awareness was defined as correctly identifying CVDs as the leading cause of death (LCOD) in women. Multivariable logistic regression models examined associations with age, education, marital status, motherhood, occupation, health conditions (hypertension, diabetes, hypercholesterolemia, obesity), depression, and main source of health information.
Results
In the full sample, only 32.3% of women were aware of CVDs as the LCOD. Awareness displayed a strong educational gradient: compared with women with compulsory education/high school, those with a bachelor’s degree had higher odds of awareness (OR 1.56, p<0.01), and those with a master’s degree or higher had more than double the odds (OR 2.10, p<0.01). An apparent age effect for women ≥55 years disappeared after adjustment for morbidities, suggesting mediation through disease exposure. Having at least one health issue was associated with a 44% higher likelihood of awareness (OR 1.44, p<0.01). Marital status and motherhood were not significantly associated with awareness. Stratified analyses indicate that the role of information sources differs by health status. Among women without morbidities, media-based information was associated with higher awareness compared with general practitioners (GP) (OR 1.29, p<0.01). This effect is largely driven by specialized health websites, while cardiology consultations also appear informative within the broader category of medical specialists. In contrast, among women with at least one health issue, information from medical specialists was more strongly associated with awareness than GP-based information (OR 1.52, p<0.05), suggesting that specialist care in the form of cardiology consultations is central to awareness formation in this group. (Table).
Conclusion
CVD risk awareness among Italian women remains low and is shaped primarily by education and exposure to disease rather than by age or other demographic factors. Cardiologists represent a central and effective source of awareness regardless of health status, and their dissemination efforts should be strengthened before disease onset. At the same time, general practitioners appear less systematically integrated into awareness formation. Public health strategies could therefore further leverage the role of cardiologists while also developing more coordinated and tailored communication approaches to women’s educational background and health status.FigureTable