Knowledge gaps in cardiovascular health among (peri)menopausal women: insights from the CARAMEL-WOMEN study

Background Despite cardiovascular disease (CVD) being the leading cause of death in women, persistent misconceptions and knowledge gaps may undermine prevention during midlife. The CARAMEL-WOMEN study examined cognitive, perceptual, and behavioural dimensions of cardiovascular awareness among peri- and postmenopausal women. Purpose This analysis aimed to assess knowledge of cardiovascular risk factors, symptom awareness, and healthcare engagement among midlife women participating in the CARAMEL-WOMEN study, and to identify key educational gaps to inform the development of a tailored digital prevention tool. Methods A cross-sectional online survey was conducted among 7,470 women in 6 European countries (Ireland, Greece, Croatia, Lithuania, the Basque and Andalucia) and Colombia. The ethically- approved, anonymous online survey was administered via the Qualtrics Survey Platform, and the women completed the Menopause and Heart Health Questionnaire about their experiences and knowledge of menopause, cardiovascular health behaviours, cardiovascular disease and perceived cardiovascular risk. Sociodemographic characteristics were also collected. Descriptive statistical analyses and several indices were performed. Results Recognition of major heart attack symptoms was high, with chest pain identified by 94.6%, pain in the arm (84.5%), and shortness of breath by 81.1%. Awareness declined for other symptoms, including cold sweats (57%), nausea (47.2%), and indigestion (37.7%). Misconceptions persisted: 25.5% believed heart disease is more of a male issue, and 16.0% considered it primarily a postmenopausal concern. Importantly, 55.2% reported experiencing a moment when they believed something might be wrong with their heart; however, GP contact (19.7%) and emergency activation were rare (3.4%), and 20% of women did nothing. The created CVD knowledge index demonstrated marked inter-country variability. High knowledge predominated in Ireland (86.2%), Croatia (82.2%), the Basque Country (78.6%), Andalucia (77.9%), and Lithuania (77.2%), with minimal low-knowledge prevalence (≤0.4%). In contrast, Greece showed a distinct pattern, with the majority classified as moderate knowledge (83.7%), only 5.3% achieving high knowledge, and 11.1% falling into the low category. Colombia demonstrated an intermediate distribution (53.2% high, 45.2% moderate, 1.7% low). Conclusions The findings reveal that despite high general knowledge and frequent symptom concern, engagement with medical care and emergency action remained limited, highlighting missed opportunities for menopause-stage cardiovascular education and symptom triage training.