The present research project aims to assess, through a survey, awareness of general and sex/gender-specific cardiovascular risk factors, as well as the perception of the risk of developing further cardiovascular diseases, among patients in secondary prevention.

Despite the well-established impact of various factors, some of which are specific to biological sex and/or gender, on the risk of developing cardiovascular disease, awareness of these factors and perception of cardiovascular risk remain insufficient in the general population. This is even more evident among women, who demonstrate limited knowledge of risk factors (including sex-specific factors such as early menopause, gestational diabetes, polycystic ovary syndrome, and systemic inflammatory and autoimmune disorders) and a markedly underestimated perception of cardiovascular risk, as shown in several studies conducted in primary prevention samples.

To date, however, there are no available data on awareness and risk perception, among either men or women in secondary prevention, investigating the potential influence that a prior cardiovascular event may exert on perceived risk of recurrence and on knowledge of risk factors, including those specific to sex and gender.

Based on assumptions derived from various Health Behavior Theories, the cognitive and emotional changes that occur following an acute event should enhance both knowledge and risk perception and, consequently, influence health-related behaviors and decision-making. However, healthcare professionals do not always observe such changes after an acute event. This shift would be particularly critical among women who, compared to men in secondary prevention, exhibit lower rates of treatment adherence and reduced participation in follow-up programs, behaviors that increase their likelihood of recurrence and contribute to poorer long-term outcomes.

Inclusion criteria:

• Male or female participants aged ≥ 18 years at the time of signing informed consent.
• Individuals with atherosclerotic cardiovascular disease (ASCVD), defined as at least one of the following:
• Ischemic heart disease (e.g., documented myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or ≥50% coronary stenosis in at least two coronary territories);
• Cerebrovascular disease (e.g., documented ischemic stroke; transient ischemic attack, primary intracerebral hemorrhage, and subarachnoid hemorrhage are not qualifying conditions; carotid stenting or endarterectomy);
• Peripheral arterial disease (e.g., peripheral arterial intervention, stent placement, surgical revascularization, lower limb amputation due to obstructive disease, or intermittent claudication with ABI <0.90 in the past 12 months);
• Atherosclerotic aortic disease (e.g., abdominal or descending thoracic aortic aneurysm).
• Signed informed consent.

Exclusion Criteria:

• Inability or difficulty in completing the questionnaires in Italian and/or functional illiteracy.
• History of or current severe psychiatric disorder that could compromise the reliability of questionnaire responses.
• Refusal or withdrawal of informed consent.

The study involves the recruitment of adult patients attending the cardiology outpatient clinics of the participating centers who meet the inclusion criteria. Participation will be voluntary and contingent upon the signing of informed consent. Patients will complete the questionnaire in a self-administered format, either on paper or digitally via their own device (smartphone or tablet), according to their preference.