MS Biswas, DVAMC; PS Calhoun, DVAMC; HB Bosworth, DVAMC; LA Bastian, DVAMC

Objectives: Women veterans, like their male counterparts, are at increased risk for heart disease because they are more likely to be obese and smoke cigarettes than the general population. In order to develop clinical interventions that will improve risk behaviors among women veterans, we assessed their awareness of heart disease. The purpose of this study was to determine whether women veterans are worried about heart disease and to specify whether women with risk factors for coronary artery disease (CAD) are more likely to worry about heart disease compared to women without risk factors.

Methods: Cross-sectional survey of women veterans receiving primary care at the Durham VAMC. We measured demographics, CAD risk factors, other medical conditions, and worry about heart disease. Statistical analysis was performed using the chi-square test and logistic regression analysis using worry about heart disease as the outcome variable.

Results: Overall, 409 women veterans completed the questionnaire (response rate 71%). We excluded women with heart disease (n=64) and incomplete data (n=17). Our analyses are based on 328 women, mean age 49 years (range 36-90 years). Overall, only 42% worried about heart disease. In bivariate analyses, factors associated with worrying about heart disease were younger age (p=0.04), single marital-status (p=0.009), elevated cholesterol (p=0.002), obesity (p=0.03), and premature family history of CAD (p=0.001). Of those with family history, elevated cholesterol, or obesity, however, only 50% worried about heart disease. In logistic regression analyses, age, marital status, elevated cholesterol, obesity, and family history, were independently associated with worry about heart disease (p< 0.05). No other risk factors for CAD assessed in this study, including diabetes, smoking, hypertension, or post-menopausal status, were significantly associated with worry about heart disease. In fact, there were trends towards not being worried about heart disease despite having such risk factors as smoking (54% of smokers were not worried), hypertension (52% with hypertension were not worried), and post-menopausal status (61% of post-menopausal women were not worried). While women with increasing numbers of risk factors were more likely to worry about heart disease (p<0.001), it was not until the women had four or more risk factors that more than 50% of them worried about heart disease.

Conclusions: Despite evidence in the literature indicating that the strongest risk factors for CAD in women are diabetes, smoking, and hypertension, women veterans with these risk factors were not worried about heart disease. Of the traditional risk factors examined, only elevated cholesterol, obesity, and family history were significantly associated with worry about heart disease. The majority of women with multiple risk factors remained unworried.

Impact: Coronary artery disease is the leading cause of death among women in the U.S. and mortality trends for cardiovascular disease in women are on the rise. The current study strongly suggests that women who should be concerned about heart disease are not. Clinical interventions should be developed that emphasize risk behavior modification to reduce the risk of first coronary events in women veterans.