The aim of this investigation was to analyze the knowledge of cardiovascular risk factors in a sample of Italian university students. In general, a high proportion of participants was able to identify the most common risk factors, showing a satisfactory awareness about the issue. However, about the half of the sample was not aware of the role of other important factors, such as gender, sleep quality, and waist circumference. Interestingly, a very small part of the sample attributed to environmental factors a role in determining CVDs.

Although the evidence regarding the knowledge of CVD risk among undergraduates is still scarce, previous studies on this topic reported that young people have rather limited awareness of certain risk factors of CVD (Reiner et al. 2012, Aminde et al. 2017).

In 2019, Güneş analyzed the awareness of CVD risk in a sample of healthy university students from Turkey (2019). The majority of the sample, ranging from 72.3% to 44.4%, identified high cholesterol, stress, hypertension, smoking, obesity, diabetes, inactivity, and CVD in family history as main risk factors for CVD; unhealthy diet, exposure to second-hand cigarette smoking, and poor socioeconomic status were also considered to be important by a sample proportion ranging from 15.3% to 34.0%. In line with these results, our findings underline that some risk factors whose association with CVDs has been proven are still unknown by the majority of the sample. This highlights the need of improving the information in the target population regarding cardiovascular risk factors.

Several aspects can influence the individual’s level of knowledge about risk factors. In our study, the regression analyses showed that higher age and healthcare educational area were the main predictors of correct knowledge, maybe as a consequence of lived experiences and acquired information. Similarly, Reiner reported that the knowledge of some CVD risk factors was significantly better among graduating students respect to the freshmen; however, even in that study the knowledge of participants, in general, was considered not sufficient (Reiner et al. 2012). As expected, participants attending healthcare educational courses had better knowledge of risk factors than the others. This is in line with the higher level of health literacy found in a previous study among healthcare students from the same undergraduate populations (Gallè et al. 2020). Given the burden of CVDs, this result highlights the need for improving knowledge about CVD risks in those university students who attend non-healthcare courses.

In addition, our finding show that males seem to be more aware of the relationship between the proposed variables and cardiovascular risk than their female counterparts, even for outdoor air quality. This is in contrast with previous studies in this field whose female participants showed higher awareness of CVD risk than their male counterpart (Güneş et al. 2019, Aminde et al. 2017).

In the perspective of CVD prevention, we also tried to assess the correspondence between knowledge of cardiovascular risk factors and adoption of healthy behaviors. Surprisingly, no significant correlations were found regarding diet, physical activity, tobacco smoking and alcohol consumption. Thus, the knowledge of cardiovascular risk factors does not necessary correspond to the adoption of the corresponding healthy behaviors. This discordance was already reported in literature, even for the same university population (Gallè et al. 2020). Similarly, in the survey by Tran et al. (2017), performed among a sample of college students, participants were knowledgeable on CVD risk factors but did not perceive themselves at risk for CVD. Indeed, people perceive and respond to risks according to several influences such as individuals’ attitudes, beliefs, social or cultural values or dispositions; consequently, a better understanding of risk does not lead to a uniform response to it (Institute of Medicine (US) Vaccine Safety Forum 1997). Besides, it is well known that a relevant way to misperceive the occurrence and magnitude of risks is associated to an individual characteristic called “optimistic bias” or “unrealistic optimism”, that is the inclination to believe that risks is less serious for oneself than for other persons. For example, a smoker tends to think that smoking may be a threat for the health of other persons but not for him/her own (Paek and Hove 2018). Given the importance of adequately perceiving the risks deriving from unhealthy behaviors in order to change them, it is essential to find ways to increase the perception of these risks.

Only the identification of sleep quality as a factor associated with cardiovascular risk was found to be related with the number of hours slept per night, suggesting that individuals who are not engaged in such a healthy behavior are more aware of its role.

This study has some limitations. First of all, due to the sampling procedure, the sample cannot be considered representative of the undergraduates’ population examined. Moreover, the participants’ characteristics were not assessed objectively, which could have led to inaccurate information. Furthermore, in order to contain the length of the questionnaire, some aspects which could be related with cardiovascular risk awareness have not been explored.

However, this study offers a picture of the cardiovascular risk knowledge among Italian undergraduates and draws attention on some critical issues that should be addressed through targeted policies.

Notwithstanding a general good awareness about the most common cardiovascular risk factors, the findings of this study show an unsatisfactory level of knowledge about some important individual and environmental aspects in the sample examined. Being older and attending healthcare-related degree courses seem to favor a better information on the subject. Worryingly, a better knowledge seems not to be related with healthier behaviors. These aspects should be considered in the perspective of CVD primary prevention. Educational programs for schools and communities should include information about how also the lesser known factors can favor the development of CVDs and how they can be avoided. Universities should offer sensitization programs on CVDs to all the students, regardless of their field of study.