Cardiovascular risk perception in women: true unawareness or risk miscalculation?

Assessing the 'accuracy' of cardiovascular risk perception is a worthy scientific goal that may lead to targeted interventions aimed at improving risk communication and health outcomes. Current cardiovascular risk scores, however, have shown poor calibration when used in populations that differ temporally and/or geographically from the derivation sample, limiting their reliability as the reference standard for absolute risk. In addition, accurately assessing risk awareness is challenging, with few available validated tools for effectively accounting for the outcomes assessed (coronary heart disease vs. cardiovascular disease), the time span of prediction (10-year vs. lifetime risk), and concepts of absolute versus relative risk. In this context, assessing patient awareness of the role of age as the key, non-modifiable driver of absolute risk can be particularly challenging. This commentary will examine each of these issues, providing context for the interpretation of studies on 'discordance' between calculated and perceived cardiovascular risk, such as the one recently published by Oertelt-Prigione et al. Moreover, we explore alternative approaches aimed at overcoming those limitations, enhancing understanding of the factors and true magnitude associated with such discordance.