Discordance Between Perceived Risk and Cardiovascular Health in Women of Reproductive Age

Figures

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  Figure 1. Study Flow Diagram This figure illustrates participant selection from the SAFE HEART Study Phase II. SAFE HEART = Social Determinants of the Risk of Hypertension Study in Women.

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  Figure 2. Risk Perception Discordance for Cardiovascular Disease and Stroke Distribution of risk perception accuracy categories, derived by cross-classifying perceived risk with Life's Essential 8 cardiovascular health status. Over half of participants underestimated both heart disease (56.8%) and stroke (58.3%) risk, whereas overestimation was rare (<3%). The similar pattern across both outcomes suggests shared mechanisms of discordance between perceived risk and objective CVH. Bar lengths represent participant counts; annotated values indicate percentages; error bars represent 95% CIs for the proportion of women in each category. Mod = moderate.

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  Figure 3. Predictors of Cardiovascular Disease and Stroke Risk Underestimation Among Women of Reproductive Age Multivariable logistic regression results identifying predictors of risk underestimation. Models included age, cardiovascular health literacy, polysocial risk, and race/ethnicity, selected by lowest Akaike information criterion (AUC = 0.75 for CVD; 0.71 for stroke; Hosmer-Lemeshow P = 0.453 and P = 0.310, respectively). Racial/ethnic minority status was the strongest predictor for both outcomes, suggesting structural factors in risk communication warrant attention. ORs are presented with 95% CIs. CVD = cardiovascular disease; CVHL = cardiovascular health literacy.

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  Central Illustration. Discordance Between Perceived Risk and Cardiovascular Health in Women of Reproductive Age Among 139 women aged 18 to 50 years in the SAFE HEART Study (Baltimore/Washington, DC), perceived CVD and stroke risk were compared with objective cardiovascular health assessed using the American Heart Association Life's Essential 8 metrics. More than half of participants underestimated both CVD and stroke risk relative to their peers. Racial/ethnic minority status emerged as the strongest predictor of risk underestimation, with additional contributions from lower cardiovascular health literacy, higher polysocial risk, and older reproductive age. These findings highlight gaps in cardiovascular risk perception and suggest integrating health literacy assessment, social risk screening, and culturally sensitive risk communication into preventive care. CVD = cardiovascular disease; LE8 = Life's Essential 8.