Unveiling the determinants of women's cardiovascular disease awareness in northern Italy: insights from the Call for Women project
Authors: Conte G , Ramputi L , Caruso R , Cardani R , Mazzaccaro D , Asteria C , Baroni I , Paglione G , De Angeli G , Cerri A , Dubini C , Boveri S , Piepoli M , Castelvecchio S 
Published: October 2024

Abstract

Background
Despite strides in prevention, diagnosis, and treatment of cardiovascular disease (CVD), CVD remains the leading cause of death (LCOD) in women. While global initiatives aim to enhance awareness, recent studies reveal deficiencies, particularly in Europe where misconceptions prevail, hindering women’s understanding of CVD severity.

Purpose
To describe determinants affecting awareness of CVD as LCOD among women in the Lombardy region, Italy.

Methods
A web-based survey (the ‘Call for Women’ Project) was conducted from Sep 2022 to Nov 2023, including women aged 18 and above. The primary focus was awareness of CVD as the LCOD (scaled 1 [adequate] to 2 [inadequate]). The individual predictors (i.e., determinants) of adequate awareness were assessed through a logistic regression (LR) model. Variables exhibiting a point biserial correlation coefficient (rpb) with a p-value ≤ 0.1 were included in the LR model as independent variables. The goodness-of-fit for the LR model was determined using the Hosmer-Lemeshow test and Nagelkerke’s pseudo-R2. Independent variables were entered simultaneously into the model to examine each variable’s relatively unique contribution.

Results
Out of 3,487 women who completed the survey, only 35.6% (n = 1,240) showed adequate awareness. The Hosmer-Lemeshow test indicated a good model fit (p-value = 0.692), suggesting that the model adequately captures the relationships between the variables and the outcome. Figure 1 shows the contribution of each individual characteristic in modulating cardiovascular risk awareness. The odds of being aware of CVD as the LCOD were significantly influenced by age, decreasing by approximately 1.3% for each additional year of age (Adj. OR = 0.987; 95% CI = 0.981–0.993; p-value &lt; 0.001). Individuals with a lower secondary school diploma exhibited a substantial increase in the odds of awareness, with an Adj. OR of 4.999 (95% CI = 3.074–8.128; p-value &lt; 0.001). Similarly, those with an upper secondary school diploma, a bachelor’s degree, or a master’s degree also demonstrated higher odds of awareness (Adj. OR = 2.427, 1.673, and 1.429, respectively; all p-values &lt; 0.001). Regarding lifestyle, higher number of children was associated with increased odds of awareness, with an Adj. OR of 1.109 (95% CI = 1.027–1.197; p-value = 0.008). Consumption of dry fruits and fruits showed a positive association with an Adj. OR of 1.014 (95% CI = 1.005–1.024; p-value = 0.004), indicating a potential role of dietary habits in influencing awareness. BMI and physical activity did not exhibit statistically significant associations with awareness of CVD risk.

Conclusions
This pilot study, limited to one region only, reveals key determinants of awareness of CVD as the LCOD among women in northern Italy. Tailoring interventions to address these determinants has the potential to narrow the gaps in CVD awareness among women.