Identifying lifestyle patterns and awareness of cardiovascular disease among women in lombardy-italy: insights from the a call for women project
Authors: Castelvecchio S , Rosario Caruso R C , Lucia Ramputi L , Aggarwal B , Cardani R , Baroni I , Asteria C , Mazzaccaro D , Conte G L , Dubini C , Boveri S , Cerri A , Paglione G , Piepoli M 
Published: June 2024

Abstract

Background
In Italy, cardiovascular disease (CVD) remains the leading cause of death among women. Raising awareness among women about their main health threats still remains an unmet goal.

Purpose
To assess health determinants, including sociodemographic and clinical variables and lifestyle patterns, among women in the Lombardy region (Italy) and their relationships to CVD awareness.

Methods
Women (≥18 years of age) living in Lombardy were invited from September 2022 to November 2023 to complete a web survey created with the SurveyMonkey® software. The anonymous, population-based web survey, which consisted of multiple choice questions, was distributed to the general population in different social, economic and cultural environments through a link publicly available on various platforms. We used t-distributed stochastic neighbour embedding (t-SNE) to simplify 25 lifestyle related questions into distinct components (X1 and X2) to visualize high-dimensional data in a lower-dimensional space, preserving relationships among 25 questions. Hierarchical cluster analysis with the ward method helped identify the optimal number of clusters, considering dendrogram structures and silhouette analysis. Clusters were formed based on education, marital status, country of residence, and occupation. We standardized the dataset and used color-coded t-SNE scatterplots for visualization. The study then compared the characteristics of respondents across clusters.

Results
Out of 3,549 women who completed the survey (mean age 47 ± 13 years), t-SNE revealed two components, visualized in Figure 1a. Three clusters were identified, as shown in Figure 1b, where women were 2,200 (61.9%), 368 (10.4%), and 907 (27.7%) in Clusters 1, 2, and 3, respectively. Compared to other Clusters, Cluster 1 exhibited the healthiest behaviours in relation to eating habits (all comparisons showed p&lt;0.001), with primarily Italian women (Cluster 1 = 58.6%; Cluster 2 = 10.6%; Cluster 3 = 30.8%; p&lt;0.001), well-educated (University Degree in Cluster 1, 2, and 3 were 14.4%, 2.1%, and 8.3%, respectively; p&lt;0.001), with normal BMI (Cluster 1 = 81.2%; Cluster 2 = 69.1%; Cluster 3 = 74.2%; p&lt;0.001) and younger age (mean age are 46.5 ± 12.3, 47.8 ± 10.3, and 48.5 ± 12.4 in Cluster 1, 2, and 3, respectively; p&lt;0.001). Surprisingly, awareness of CVD as the leading cause of death showed no significant difference across clusters (Awareness was 34.9%, 35.1%, and 37.3% in Cluster 1, 2, and 2, respectively; p=0.428).

Conclusions
This study identified distinct health behaviour patterns among women living in the Lombardy region, with three clusters showing significant behavioural differences. However, awareness of CVD as a leading cause of death was uniformly low across these clusters (between 34.9% and 37.3%). This result highlights the need for targeted strategies to enhance awareness in women and encourage a widespread culture against CVD among women.