Abstract Body: Objective
Cardiovascular disease remains the leading cause of mortality in women, yet discrepancies between perceived and actual risk may impede preventive behaviors. We examined the discordance between perceived cardiovascular risk and actual cardiovascular health (CVH) in this high-priority population.
Methods
We conducted a cross-sectional analysis of 139 women (18-49y) from the SAFE HEART Women Study. Perceived risk was assessed via a validated 7-point Likert scale. Actual CVH was quantified using AHA’s Life’s Essential 8 (LE8) score. Discordance was defined as LE8 < median (71.25) with Likert ≤4 (underestimation) or LE8 ≥71.25 with Likert >4 (overestimation). Analyses included Spearman correlation and Kruskal-Wallis tests.
Results
Participants had a mean age of 32.1±6.8 years; 68% were racial/ethnic minorities. A weak inverse correlation was found between perceived risk and LE8 scores (ρ = -0.207, p = 0.015). Significant differences in perceived risk were observed across LE8 categories (Low/Moderate/High CVH; p=0.021), with the lowest perceived risk in High CVH (Median Likert=4). Despite this gradient, 65.2% of women with suboptimal CVH (LE8<80) underestimated their risk, including 73.2% of High CVH (≥80) women and 65.2% of Moderate CVH (50-79) women. Underestimation affected >50% of women with suboptimal CVH, with similar prevalence in uninsured (57.7%) and insured (52.8%) groups (p=0.67). Among women with suboptimal cardiovascular health who underestimated their risk, nearly half exhibited high stress levels (49.1%) and suboptimal health literacy (49.1%), while one-third lacked primary care affiliation (35.8%). Notably, the majority (71.7%) had health insurance, suggesting coverage alone is insufficient for accurate risk perception. Notably, among women with elevated cardiovascular risk factors (≥2 risk factors), 81.9% perceived themselves as average or below-average risk.
Conclusion: Reproductive-age women demonstrate significant misperception of cardiovascular risk, with most underestimating risk despite suboptimal CVH. This perception gap—exacerbated by insurance disparities—highlights urgent needs for targeted risk communication strategies during key life stages to mitigate future cardiovascular morbidity.