The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: Focus on Knowledge and Awareness Among Women with Cardiometabolic Risk Factors

Abstract

Background: The diversity of the U.S. population and disparities in the burden of cardiovascular disease (CVD) require that public health education strategies must target women and racial/ethnic minority groups to reduce their CVD risk factors, particularly in high-risk communities, such as women with the metabolic syndrome (MS). Methods: The data reported here were based on a cross-sectional face-to-face survey of women recruited from four participating sites as part of the national intervention program, Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Care in High-Risk Women. Measures included baseline characteristics, sociodemographics, CVD related-knowledge and awareness, and Framingham risk score (FRS). Results: There were 443 of 698 women (63.5%) with one or more risk factors for the MS: non-Hispanic white (NHW), 51.5%; non-Hispanic black (NHB), 21.0%; Hispanic, 22.6%. Greater frequencies of MS occurred among Hispanic women ( p < 0.0001), those with less than a high school education (70.0%) ( p < 0.0001), Medicaid recipients (57.8%) ( p < 0.0001), and urbanites (43.3%) ( p < 0.001). Fewer participants with MS (62.6%) knew the leading cause of death compared to those without MS (72.1%) ( p < 0.0001). MS was associated with a lack of knowledge of the composite of knowing the symptoms of a heart attack plus the need to call 911 (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-0.97, p = 0.04). Conclusions: Current strategies to decrease CVD risk are built on educating the public about traditional factors, including hypertension, smoking, and elevated low-density lipoprotein cholesterol (LDL-C). An opportunity to broaden the scope for risk reduction among women with cardiometabolic risk derives from the observation that women with the MS have lower knowledge about CVD as the leading cause of death, the symptoms of a heart attack, and the ideal option for managing a CVD emergency.

Women at Risk for Cardiovascular Disease Lack Knowledge of Heart Attack Symptoms

“…(9, 11) In contrast to merely 53% who knew to call 911 if experiencing symptoms of a heart attack in the previous work (2), in this study 89% answered correctly, and there was no difference by FRS or MS. This difference may be attributed to increasing efforts to improve action take for heart attack symptoms given suboptimal awareness of importance of calling 911 (25), such as in campaigns from the US Department of Health and Human Services “Make The Call, Don’t Miss a Beat”(26). Furthermore, a large percentage of racial/ethnic minority women residing in New York City utilize emergency services for many health care needs, which is a well-recognized target for improvement.…”

“…The association between lower knowledge of heart attack symptoms and higher FRS in patients without a previous event is troubling. Decreased knowledge of stroke and heart attack symptoms was described among self-reported high risk CVD participants, (13) and decrease knowledge of leading cause of death was found among those with MS. (25) This is a collective cause for concern because higher risk patients are most likely to experience stroke or heart attacks that are potentially preventable with risk factor modification. (22, 29–31)…”

Cardiovascular Disease Risk Among Young Urban Women

“…Details of the database have been described. 15,16 Participants were enrolled from April 2008 to December 2014. One goal was to document findings among a primary prevention group, and thus, women with preexisting events secondary to atherosclerosis were excluded; the exclusion criteria, based on high-risk Framingham Risk Score >20%, 17 included known history of coronary artery disease, CVD procedure (angioplasty, bypass surgery, placement of stent), myocardial infarction, stroke, peripheral vascular disease, and transient ischemic attack; pregnant women or those <18 years of age were excluded.…”

“…Accordingly, to gain insight into the attitudes of urban women, <50 years of age, we examined the Columbia University Heart Health in Action database to determine the extent of CVD risk burden, as well as perception of body size, knowledge, and awareness of CVD, and lifestyle behavior. 15 …”

Relationship Between Cardiovascular Disease Knowledge and Race/Ethnicity, Education, and Weight Status

“…By 2009, it improved again such that 54% answered correctly, however, was not superior to the immediate preceding report (57%) (13). Limited CVD knowledge has been reported among those with cardio-metabolic disorders who are at greater risk for CVD events (14). Due to concerns that other at-risk women might not know vital CVD facts, a primary aim was to assess CVD knowledge among overweight and obese participants who might be uninformed of the escalating CVD burden associated with excess weight.…”