Top Things to Know: Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease

Published: September 21, 2020

  1. The leading cause of death (LCOD) in women is heart disease. In 2018, almost 400,000 deaths occurred in women due to heart disease and stroke. Despite heart disease being the greatest cause of death among women, the level of awareness and knowledge of cardiovascular diseases (CVD) remains poor.
  2. This paper describes the 10-year longitudinal survey data collected in the U.S. between January 2009 and January 2019 by the American Heart Association, which reports the differences in women’s awareness of heart disease as the number one cause of death in that time period. Compared to prior surveys, the 2019 survey included younger-aged women (18-24 years). Race and ethnicity was self-reported as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and other non-Hispanic groups.
  3. Survey questions included a variety of cardiovascular-related questions such as medical history, awareness of LCOD, knowledge of warning signs of heart attack and stroke, what first action to take if someone is having a heart attack or stroke, and heart disease and stroke risk factors.
  4. Awareness was greater in 2019 in women who were of older age and with increased educational attainment, and lower in non-White women. There was an overall 10-year decline seen in all race/ethnic groups and ages in general, with the exception of women > 65 years.
  5. Comparing 2009 to 2019 data, the greatest declines in awareness were seen in Hispanic women, in non-Hispanic Black women, and in women ages 25-34 years.
  6. Comparing 2009 survey data to 2019 survey data, awareness that heart disease was the LCOD declined from 65% in 2009 to 44% in 2019.
  7. In the 2019 survey data, non-Hispanic Black, Hispanic and non-Hispanic Asian women were substantially less likely to identify heart disease as the LCOD among women at 58%, 59% and 67% less likely respectively as compared to non-Hispanic White women (after accounting for age, educational attainment, household income, and a history of diabetes, stroke and heart attack).
  8. In 2019, women were more likely to incorrectly identify breast cancer as the LCOD, and the association was greater in younger women. In 2018, heart disease was the leading cause of death among women (300,977) and all cancers (e.g. malignant neoplasms) ranked as the second-leading cause of death (283,721); breast cancer was the cause of death for 42,466 women in the U.S.
  9. In both surveys analyzed, higher educational attainment was strongly related to awareness that heart disease is the LCOD. Women who had a high risk for CVD (stroke or heart disease) had a higher awareness than women without CVD risk factors, but this did not continue in the 2019 survey. Diabetes was not associated with awareness in either survey period.
  10. Awareness of the LCOD in women has declined, prompting an urgent call for multi-level interventions to evaluate how to change behavior to prevent CVD, especially in Hispanic, Black and Asian women with a lower educational level. Culturally appropriate education and care within these communities, coupled with community health worker interventions, may be helpful for prevention. Assessment of risk within these populations is of upmost importance to prevent CVD in these populations.


Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ; on behalf of the American Heart Association. Ten-year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report from the American Heart Association [published online ahead of print September 21, 2020]. Circulation. doi: 10.1161/CIR.0000000000000907