Abstract Body (Do not enter title and authors here): Background
Accurate cardiovascular risk perception is essential for preventive behavior adoption, yet predictors of risk perception accuracy in reproductive-age women remain poorly understood. We examined whether polysocial risk and cardiovascular health (CVH) status predicts cardiovascular risk perception and tested for differences by age and risk factor burden.
Methods
Cross-sectional analysis of 139 reproductive-age women (18-49 years, mean 32.0±8.1). CVH was assessed using Life's Essential 8 score and categorized as Low (<50), Moderate (50-79), or High (≥80). Risk perception accuracy was measured by comparing perceived 10-year CVD and stroke risk to calculated risk. Underestimation was defined as perceiving "below average" risk when calculated risk was average or above. We used Cochran-Armitage tests, Mantel-Haenszel analyses, and multivariable logistic regression.

Multivariable regression identified significant independent predictors of risk perception underestimation. Black race was a significant predictor for both CVD risk underestimation (OR = 3.40, 95% CI: 1.55-7.43) and stroke risk underestimation (OR = 4.39, 95% CI: 1.95-9.87). High polysocial risk (tertile 3) was associated with higher CVD risk underestimation (OR = 3.14, 95% CI: 1.28-7.71) and stroke risk underestimation (OR = 2.57, 95% CI: 1.05-6.28) compared to the lowest tertile. CVH risk factors: 2-3 factors (CVD: OR=1.40; stroke: OR=1.84) and 4-5 factors (CVD: OR=1.05; stroke: OR=2.38).
Conclusions
CVH status strongly predicts risk underestimation, with moderate CVH women showing highest rates (83-87%). Black race and high polysocial risk are the strongest independent predictors. These findings identify Black women with high polysocial risk and moderate CVH as highest priority for targeted risk communication interventions.
Clinical Impact: Results provide evidence-based criteria for identifying women at highest risk for cardiovascular risk underestimation, highlighting critical cardiovascular burden, racial and socioeconomic disparities requiring targeted interventions.