**Background:** Non-communicable diseases (NCDs) account for 71% of all deaths globally (41 million annually), with cardiovascular disease (CVD) being the single largest contributor at 17.9 million deaths per year, projected to rise to 22.2 million by 2030. In Turkey, NCDs are responsible for 86% of total deaths, and 37.8% of deaths are due to circulatory system diseases. Key modifiable risk factors include smoking, insufficient physical activity, unhealthy nutrition, obesity, hypertension, diabetes, and high cholesterol. Risk perception—a cognitive process guiding health behaviors—is a critical precursor to adopting risk-reducing behaviors. Individuals who do not perceive themselves at risk for CVD are unlikely to engage in healthy lifestyle practices. This study aimed to determine CVD risk perception levels and associated factors among Turkish adults.
**Methods:** A cross-sectional study was conducted from April to June 2019 in the Bornova district of İzmir, Turkey (population 442,839). The sample size was calculated using G-Power (α:0.05, β:0.05, d:0.5), yielding a required sample of 423; after accounting for a 10% nonresponse rate, 465 participants were approached. Nine neighborhoods were randomly selected from 45, and face-to-face surveys were administered to adults aged 18 years and older who could communicate in Turkish and provide informed consent. A total of 453 participants (97.4%) completed the questionnaire. Data were collected using a sociodemographic characteristics questionnaire (11 items covering age, gender, education, marital status, employment, income, chronic disease, familial CVD history, smoking, height, and weight), the Perception of Risk of Heart Disease Scale (PRHDS)—a 20-item, 4-point Likert scale (range 20–80) with three subscales (dread risk, risk, unknown risk)—and a single-item health perception rating (very good to very poor). BMI was classified per WHO criteria. Multivariate regression analysis was performed using SPSS version 20.0. Ethical approval was obtained (Approval Number:19-4T/45).
**Key Results:** Participants' mean age was 38.53 ± 13.42 years (range 18–86); 53.9% were women, 66.4% married, 76.2% employed, and 56.1% had a bachelor's degree or higher. The mean PRHDS score was 48.88 ± 8.12 (possible range 20–80). Subscale means were: dread risk 16.09 ± 4.34 (range 7–28), risk 15.22 ± 3.22 (range 6–23), and unknown risk 17.55 ± 3.49 (range 7–28). Multiple regression analysis revealed that the full model explained 27% of the variance in PRHDS (R² = 0.27, F = 16.11, p < 0.01), 22% for dread risk (R² = 0.22, F = 12.53, p < 0.01), 17% for risk (R² = 0.17, F = 9.21, p < 0.01), and 19% for unknown risk (R² = 0.19, F = 10.6, p < 0.01). Significant predictors of PRHDS included age (β = 0.24, p = 0.01), gender (β = 0.12, p = 0.01), education (β = 0.12, p = 0.03), marital status (β = 0.15, p = 0.01), employment status (β = 0.27, p = 0.01), health perception (β = −0.21, p = 0.01), familial CVD history (β = 0.14, p = 0.01), chronic disease status (β = 0.12, p = 0.01), smoking status (β = −0.10, p = 0.02), and BMI (β = −0.11, p = 0.02). Notably, smoking and higher BMI were associated with lower risk perception, while older age, being married, being employed, having a family history of CVD, and having chronic disease were associated with higher risk perception.
**Clinical Implications:** Despite CVD being the leading cause of death in Turkey and globally, risk perception among this adult sample was low (mean PRHDS 48.88/80), consistent with prior studies in Jordan and India. This disconnect is concerning because individuals who underestimate their risk are unlikely to adopt preventive behaviors such as smoking cessation, healthy eating, or regular exercise. The finding that smokers and individuals with higher BMI had lower risk perception is particularly alarming, as these are major modifiable risk factors. The study underscores the need for targeted educational interventions, especially for younger, single, less-educated, and unemployed individuals, as well as those with lower health perception. Nurses and public health professionals should implement community-based screening programs (including blood pressure and lipid measurements) and provide training to increase CVD risk awareness. The authors recommend that individuals with high objective risk but low perceived risk be identified early so that necessary interventions can be deployed. Longitudinal studies are needed to confirm causality.