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Women's fight against cardiovascular disease faces challenges as most women underestimate the deadliness of the disease and most physicians give it lower priority and feel unprepared to assess risk, a survey found.

Almost half of U.S. women (45%) didn't know that cardiovascular disease is the leading cause of death among women -- with younger patients, those with lower income or level of education, and Hispanic and African American women even more likely to be unaware, according to C. Noel Bairey Merz, MD, of Cedars-Sinai Heart Institute in L.A., and colleagues of the Women's Heart Alliance.

Their survey results, published in the Journal of the American College of Cardiology, revealed that even though 74% of women reported having at least one heart disease risk factor, . Additionally, 45% said they have put off a doctor's appointment until losing weight.

Meanwhile, cardiovascular disease was a top concern for only 39% of primary care physicians; they tended to prioritize weight and breast health. Less than a quarter (22%) felt they were prepared to assess a woman's cardiovascular disease risk -- though cardiologists didn't do much better either, at 42%.

Even fewer said they fully followed guidelines for cardiovascular risk assessment (16% for primary care doctors and 22% for cardiologists).

"Cardiovascular disease in women was not the top concern for women or physicians," Bairey Merz and colleagues concluded. "Social stigma particularly regarding body weight appeared to be a barrier."

"Helping women overcome barriers to increasing physical activity and healthier eating habits may avoid the stigma of focusing on weight loss. Women are often the gate-keepers for family meals, activities, and healthcare, and a focus on healthy lifestyle habits may also encourage primordial prevention in the family as a whole," suggested Jennifer Robinson, MD, MPH, of University of Iowa in Iowa City.

When Bairey Merz's group asked if further investment in cardiovascular disease research for women and physician education are needed, women and physicians largely said yes.

"Most of the women endorsed the advocacy of medical tests designed for women, greater discussion of the threat of heart disease, and more physician attention in medical training, whereas physicians supported the advocacy of a national action campaign and improved physician education," the authors reported.

The Women's Heart Alliance plans a national awareness campaign, noted Robinson. "But to successfully improve risk factor control, awareness efforts must be coupled with quality clinician education and implementation programs."

The study authors surveyed 1,011 U.S. women, 200 primary care physicians, and 100 cardiologists in 2014. Limitations to their analysis include a relatively small sample size, although Bairey Merz and colleagues maintained that survey respondents were representative of the U.S. population.

Women could start getting regular cardiovascular disease health evaluations during their annual gynecologic exams, Robinson suggested.

"Pregnancy as a stress test can help identify women at higher risk of developing cardiovascular disease. It is essential to increase the comfort of obstetrician-gynecologists with performing cardiovascular disease risk assessment and lifestyle counseling, accompanied by establishing referral pathways to other primary care providers or cardiologists committed to prevention, who also need to address reproductive safety issues with preventive drug therapies," she said.