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The study explored how women interpreted their risk for coronary heart disease (<jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>) and how this influenced their treatment\u2010seeking decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Efforts to reduce the incidence of cardiovascular disease, the number one killer of women, require aggressive risk factor modification, risk assessment and evidence\u2010based treatments. <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> is largely preventable; however, despite the availability of evidence on prevention and risk factor reduction, it appears that misunderstandings persist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A naturalistic case study design guided this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty women participated (<jats:italic>n<\/jats:italic>\u00a0=\u00a030); a within\u2010case analysis was followed by a cross\u2010case analysis. Data collection included participant diaries and face\u2010to\u2010face interviews. Data were analysed using modified analytic induction which allowed the emergence of theoretical insights.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This article provides insight into women's perception of risk for <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>, particularly in relation to smoking. The findings provide a platform for a wider discourse on women's interpretation of their risk for <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> and their treatment\u2010seeking decisions. The data reflect the ongoing misunderstanding that <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> affects men more than women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>More focus is needed on risk factor management and <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> symptom presentation in women. An emphasis on the chronic disease aspect of <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> may promote a timely focus on secondary prevention and the follow\u2010up needed through patient education and empowerment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>This study demonstrates that primary and secondary prevention education initiatives are needed for <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> risk factor management and symptom interpretation. The implications of smoking on cardiovascular health need further dissemination. Efforts to support smoking cessation need to be strengthened and widely accessible. Primary care can have a key role to play in managing <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> risk and supporting women with positive risk factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.14589","type":"journal-article","created":{"date-parts":[[2018,7,3]],"date-time":"2018-07-03T21:56:59Z","timestamp":1530655019000},"page":"3953-3967","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["\u201cHeart disease never entered my head\u201d: Women's understanding of coronary heart disease risk factors"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9090-9642","authenticated-orcid":false,"given":"Rita","family":"Smith","sequence":"first","affiliation":[{"name":"UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin 4 Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Frazer","sequence":"additional","affiliation":[{"name":"UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin 4 Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbey","family":"Hyde","sequence":"additional","affiliation":[{"name":"UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin 4 Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3020-9246","authenticated-orcid":false,"given":"Laserina","family":"O'Connor","sequence":"additional","affiliation":[{"name":"UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin 4 Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Davidson","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Nursing Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.32398\/cjhp.v11i1.1516","article-title":"Awareness of the red dress symbol and heart disease among college women","volume":"11","author":"Anderson S. 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