Awareness that heart disease is the No. 1 killer of women has grown substantially since 2000, but a knowledge gap remains, particularly for women younger than age 45 and for racial/ethnic minority groups, according to an American Heart Association survey of more than 1,000 women in 2003.

"The tide has now turned and for the first time women spontaneously cite heart disease as their leading cause of death more often than anything else, but there is still a lot of room for improvement," said Lori Mosca, M.D., M.P.H., Ph.D., lead author of an analysis of the survey results, which were published this month in Circulation: Journal of the American Heart Association.

The survey results were released along with new guidelines for cardiovascular disease (CVD) prevention in women. Harris Interactive, Inc., polled women to determine their awareness, perception and knowledge of cardiovascular disease in order to evaluate trends since the previous surveys in 1997 and 2000. The first survey coincided with the start of a massive public education campaign aimed at women, which appears to be making headway in several areas, said Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center.

Survey results are based on 1,024 telephone interviews that were conducted between June 26 and July 14, 2003, among a national random sample of women aged 25 years and older (695 white, 127 African-American, 125 Hispanic, 77 other).

According to American Heart Association statistics, CVD remains the leading killer of women in the U.S. and the world. CVD kills nearly 500,000 U.S. women each year, claiming more lives than the next seven causes of death combined, including cancer.

The American Heart Association’s first national survey in 1997 found that only 30 percent of women spontaneously listed heart disease as women’s leading cause of death, a figure that increased to just 34 percent in the 2000 survey. In 2003, that figure jumped to 46 percent, a significant improvement.

Awareness that heart disease is the leading killer of women was nearly twice as high among white women (55 percent) as among African-American (30 percent) and Hispanic (27 percent) women. Minority women face the highest risk of dying from CVD.

Nanette K. Wenger, M.D., professor of medicine in the division of cardiology at Emory University School of Medicine and a co-author of the new guidelines for CVD prevention in women, said the survey results are encouraging because awareness is the first step to saving lives.

"Lifestyle changes are a very effective way to substantially reduce risk, but to make those changes a woman must first feel that she is at risk," Wenger said. "Knowledge gives a woman the power to take charge of her health."

"However, when asked what they consider their own greatest health risk, only 13 percent of respondents cited heart disease, which indicates a disconnect between actual risk and a perceived health threat that they might act upon," Mosca said.

Although women have a good general knowledge of CVD risk factors, they often do not knowtheir own risks. For instance, when asked whether a specific activity could reduce the risk of getting heart disease, 90 to 100 percent of respondents recognized that exercise, losing weight, quitting smoking, avoiding dietary cholesterol and reducing salt intake are useful lifestyle changes. Yet, about 70 percent did not know their own levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL), two components of total cholesterol.

Meanwhile, in 2003 more women cited two unproven strategies as heart protective than in 1997. The survey showed that 64 percent of respondents said antioxidant vitamin supplements (E, C, A) could prevent CVD, although many studies have shown no benefit. Aromatherapy (inhaling fragrances) was named by 29 percent as a way to protect the heart and blood vessels.

The survey also found that 63 percent of respondents said they were confused about how hormone therapy affects a woman’s health. The American Heart Association recommends against using hormone therapy to reduce heart disease risk. The association bases its position on results from two large, controlled prospective studies the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI) both of which found that combined hormone therapy failed to protect the heart and might even increase heart attack risk during the first year of taking it. One in five of the women surveyed reported knowing the results.

Women’s understanding of heart disease was high across racial and ethnic groups in several areas. When asked as a true-false question, 95 percent of women overall knew that heart disease develops gradually over many years and can easily go undetected. Ninety-seven percent of white women, 91 percent of African-American women, and 91 percent of Hispanic women answered this question correctly. Yet fewer than half of all women, 40 percent, consider themselves very well informed or well informed about heart disease, a figure that is unchanged since 2000. Those aged 25-34 were least likely to report feeling very well/well informed (27 percent) and most likely to report feeling "not at all informed" (22 percent).

Co-authors include Anjanette Ferris, M.D.; Rosalind Fabunmi, Ph.D.; and Rose Marie Robertson, M.D.

The American Heart Association is partnering with the National Heart, Lung, and Blood Institute this year on the Red Dress Project, part of a national campaign by NHLBI called "The Heart Truth" designed to make women aware that heart disease is the No. 1 killer of both women and men and to encourage women to take control of their heart health by discussing their risk factors with their doctors and taking steps to reduce them.