Perceived risk of cardiovascular diseases in the Italian population: a baseline cross-sectional analysis of participants enrolled in the INNOPREV trial

Cardiovascular disease (CVD) is the leading cause of death globally. This baseline cross-sectional analysis of participants enrolled in the Italian INNOPREV randomized controlled trial explored cardiovascular risk perception before randomization in adults aged 40–69 years old at moderate-to-high CVD risk and its association with socio-demographic, behavioural, and clinical characteristics. Cardiovascular risk perception was measured using the Health Beliefs Related to Cardiovascular Disease Scale (HBCVD; 25 items; four subscales: susceptibility, severity, benefits, barriers). Mean HBCVD scores were compared across socio-demographic variables (sex, age, marital status, education level, employment status, centre recruitment) and risk factors (smoking status, BMI, family history of cardiovascular conditions, SCORE2, and Life’s Essential 8 (LE8) score) using unadjusted non-parametric tests (Wilcoxon rank-sum or Kruskal–Wallis, as appropriate), with effect sizes reported as rank-biserial correlation (r) or epsilon-squared (ε²). Given the exploratory nature and the number of simultaneous comparisons, p-values were additionally corrected using the Benjamini–Hochberg false discovery rate procedure. Multivariable linear regression models with HC3 heteroskedasticity-consistent standard errors were subsequently fitted to assess whether significant associations persisted after adjustment for sex, age category, education level, and recruitment centre. Because all variables were assessed at a single pre-randomization time point, no causal inference can be made. A total of 1,019 participants (52.11% males; mean age: 55 years) were enrolled, and 988 questionnaires were returned and analyzed. The mean overall HBCVD score was 61.10 (± 6.61) out of 100. In unadjusted analyses, employment status ( p = 0.04; ε² = 0.01) and family history of hypertension ( p = 0.034; r = 0.07) showed an association with overall HBCVD score but these associations did not remain significant after Benjamini–Hochberg correction. After correction, only BMI category ( p < 0.001 ε² = 0.02; p.adj < 0.001) and LE8 score ( p < 0.001; ε² =0.02; p.adj < 0.001) remained significantly associated with overall HBCVD score, with small effect sizes. Multivariable analyses confirmed a higher HBCVD score among overweight (β = 1.13; p = 0.016) and obese (β = 2.94; p < 0.001) participants, and a lower score among those with moderate (β = −2.63; p < 0.001) or high LE8-based cardiovascular health (CVH) (β = −3.80; p < 0.001). Perceived susceptibility showed the strongest and most consistent associations with CVD risk factors, particularly BMI, family history, and LE8-based CVH. Perceived benefits varied primarily by socio-demographic characteristics, while perceived barriers were associated with both education level and LE8-based CVH. Perceived severity differed significantly by sex and age class only. CVD risk perception was overall moderate and varied by socio-demographic characteristics and CVD risk factors. These findings might support the development of tailored preventive strategies to enhance risk awareness and promote healthy behaviours.