Arch Fam Med. 2000;9:506-515. said:
CARDIOVASCULAR disease (CVD) is the leading cause of disability and death in both men and women in the United States.1-2 Annually, CVD accounts for about $274 billion in direct health costs and indirect costs, including lost productivity, and for more than 505,000 deaths among women in the United States alone.1 In contrast, the average annual number of deaths from all cancers for women in the United States is 265,900, including 43,300 deaths from breast cancer.3 Surveys of women in the United States have found that their perception of the effect of CVD is not in agreement with the severity of the known consequences of CVD on morbidity and mortality.4-5 Lack of awareness of the risk of CVD may impede preventive efforts as well as the adoption of positive lifestyle changes.
The National Council on Aging (Washington, DC) recently reported that only 9% of women between the ages of 45 and 64 years said that the condition they most feared was heart disease; this is in contrast to 61% of these women who reported that they most feared breast cancer.4 In 1995, Pilote and Hlatky5 reported results from a random survey of 337 women, aged 48 to 52 years, who graduated from Stanford University between 1967 and 1971. The authors noted that 73% of the respondents perceived that their risk of developing heart disease by age 70 years was less than 1%, and twice as many women reported being worried about breast cancer (59%) as heart disease (29%). Other surveys have also indicated that many women are unaware that they have symptoms of early heart disease or that they possesses risk factors for developing CVD.6-8 Legato et al9 reported that 44% of women in the United States surveyed believed that it was somewhat or very unlikely that they would suffer a heart attack, and 58% believed they were as likely or more likely to die of breast cancer than heart disease; yet 74% of these women rated themselves as fairly or very knowledgeable. Of those women who saw a physician regularly, 59% reported that their physician never spoke to them about heart disease, including 44% of women 60 years or older. Few of these studies have examined these issues in diverse populations of women, and these studies have not extensively evaluated knowledge about CVD risk factors and prevention practices.
The objective of this study was to assess perceptions of heart disease and how it affects women, and the current level of knowledge of risk factors and warning signs for heart disease and stroke in a diverse, random sample of women in the United States. The perceived role of the physician in communicating information about heart disease was also assessed. The survey was commissioned by the American Heart Association (Dallas, Tex) to provide baseline data about current knowledge, awareness, and preventive behaviors related to heart disease and stroke prior to the implementation of a national education campaign on heart disease and stroke in women.
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Our data indicate the need for heart disease and stroke education programs for all women, including programs targeted for older adults (65 years) and younger adults (25-34 years). For this latter group, it is important to emphasize that adopting healthy lifestyle behaviors now can influence their risk for developing long-term disease. Recent data linking fatty streaks to atherosclerotic disease suggest that awareness of CVD risk at a young age may have an effect on the rate of disease development in the subsequent 20 to 40 years.17 Our findings support the continued use of education programs and materials that are also targeted to specific ethnic groups to close the gap between women's perceptions of heart disease risk and reality. It is also clear that physicians need to do a better job of providing health information to their female patients.
To address the issues raised in this survey, the American Heart Association initiated the National Women's Heart Disease and Stroke Campaign for the promotion of cardiovascular disease prevention and self-empowerment of women. The campaign consists of multiple components, including a national media campaign, educational materials and conferences, programs that address behavior change, and ongoing grassroots initiatives. The campaign was designed to increase public awareness and knowledge about heart disease and stroke. It was also designed to enable women to lower their risk for developing these diseases through improved lifestyle and better prevention practices.
