BACKGROUND: Heart disease is the leading cause of death (LCOD) for women in the United States. However, despite decades of public health campaigns, awareness of heart disease among women, especially those with racial/ethnic minority backgrounds and young women, significantly declined from 2009 to 2019. OBJECTIVES: The aim of this study was to compare the differences in heart disease awareness as the LCOD among Black, Hispanic, White, and Asian/Other women groups. METHODS: In this cross-sectional, online survey study, 422 community-dwelling women were analyzed. Heart disease as the LCOD was categorized as the correct answer. We implemented log-linear models via a Poisson regression to estimate unadjusted and adjusted relative risks [RRs] of race in predicting correct knowledge of LCOD. RESULTS: The mean age was 41.2 (±12.9) years. The sample represents 39.8 % Hispanic, 28.4 % White, 19.9 % Black, 11.9 % Asian/others. After adjusting for age and cardiovascular disease risks, Black and Hispanic women, as compared to White women, had significantly lower awareness of heart disease as the LCOD [(Adjusted RR=0.69, 95 % CI: 0.52, 0.92)
(Adjusted RR= 0.78, 95 % CI: 0.78 -0.94), respectively]. Additionally, physical inactivity and hypertension medication intake were significantly associated with this level of awareness (P <
0.5). CONCLUSION: Lower heart disease awareness in Black and Hispanic women persists. It is crucial to develop more effective approaches to close this disparity. Testing new methods, such as applying artificial intelligence to send more culturally appropriate and personalized messages, is urgently needed to raise women's awareness of their heart disease risk.