Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS) heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA) 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed public health education efforts.
 AHA Writing Group Members (2012) Executive summary: Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125, 188-197. http://dx.doi.org/10.1161/CIR.0b013e3182456d46
 Petrea, R.E., Beiser, A.S., Seshadri, S., Kelly-Hayes, M., Kase, C.S. and Wolf, P.A. (2009) Gender differences in stroke incidence and poststroke disability in the Framingham Heart Study. Stroke, 40, 1032-1037. http://dx.doi.org/10.1161/STROKEAHA.108.542894
 Heidenreich, P.A., Trogdon, J.G., Khavjou, O.A., Butler, J., Dracup, K., Ezekowitz, M.D., Finkelstein, E.A., Hong, Y., Johnston, S.C., Khera, A., Lloyd-Jones, D.M., Nelson, S.A., Nichol, G., Orenstein, D., Wilson, P.W.F., Woo and Y.J. (2011) Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation, 123, 933-944. http://dx.doi.org/10.1161/CIR.0b013e31820a55f5
 Lloyd-Jones, D.M., Wilson, P.W.F., Larson, M.G., Beiser, A., Leip, E.P., D’Agostino, R.B. and Levy, D. (2004) Framingham risk score and prediction of lifetime risk for coronary heart disease. American Journal of Cardiology, 94, 20-24. http://dx.doi.org/10.1016/j.amjcard.2004.03.023
 Grundy, S.M., Cleeman, J.I., Merz, C.N.B., Brewer, H.B., Clark, L.T., Hunninghake, D.B., Pasternak, R.C., Smith, S.C. and Stone, N.J. (2004) Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation, 110, 227-239. http://dx.doi.org/10.1161/01.CIR.0000133317.49796.0E
 Swanoski, M.T., Lutfiyya, M.N., Amaro, M.L., Akers, M.F. and Huot, K.L. (2012) Knowledge of heart attack and stroke symptomology: A cross-sectional comparison of rural and non-rural U.S. adults. BMC Public Health, 12, 283. http://dx.doi.org/10.1186/1471-2458-12-283
 Moser, D.K., Kimble, L.P., Alberts, M.J., Alonzo, A., Croft, J.B., Dracup, K., Evenson, K.R., Go, A.S., Hand, M.M., Kothari, R.U., Mensah, G.A., Morris, D.L., Pancioli, A.M., Riegel, B. and Zerwic, J.J. (2006) Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke a scientific statement from the American heart association council on cardiovascular nursing and stroke council. Circulation, 114, 168-182. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.176040
 Wall, H.K., Beagan, B.M., O’Neill, H.J., Foell, K.M., Boddie-Willis, C.L. (2008) Addressing stroke signs and symptoms through public education: The Stroke Heroes Act FAST Campaign. Preventing Chronic Disease, 5, A49.
 Lutfiyya, M.N., Bardales, R., Bales, R., Aguero, C., Brady, S., Tobar, A., McGrath, C., Zaiser, J. and Lipsky, M.S. (2010) Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States. Journal of Immigrant and Minority Health, 12, 761-768. http://dx.doi.org/10.1007/s10903-009-9250-y
 Lutfiyya, M.N., Ng, L., Asner, N. and Lipsky, M.S. (2009) Disparities in stroke symptomology knowledge among US midlife women: An analysis of population survey data. Journal of Stroke and Cerebrovascular Diseases, 18, 150-157. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2008.09.009
 Lutfiyya, M.N., Lipsky, M.S., Bales, R.W., Cha, I. and McGrath, C. (2008) Disparities in knowledge of heart attack and stroke symptoms among adult men: An analysis of behavioral risk factor surveillance survey data. Journal of the National Medical Association, 100, 1116-11124.
 Lutfiyya, M.N., Cumba, M.T., McCullough, J.E., Barlow, E.L. and Lipsky, M.S. (2008) Disparities in adult African American women’s knowledge of heart attack and stroke symptomatology: An analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data. Journal of Women’s Health, 17, 805-813. http://dx.doi.org/10.1089/jwh.2007.0599
 Lambert, C., Vinson, S., Shofer, F. and Brice, J. (2012) The relationship between knowledge and risk for heart attack and stroke. The Journal of Stoke and Cardiovascular Diseases, in press. http://dx.doi.org/10.1016/j.bbr.2011.03.031
 Mokdad, A.H., Stroup, D.F. and Giles, W.H. (2003) Public health surveillance for behavioral risk factors in a changing environment: Recommendations from the Behavioral Risk Factor Surveillance Team. Morbidity and Mortality Weekly, 52, RR09.
 Camarata, P.J., Heros, R.C. and Latchaw, R.E. (1994) Brain attack: The rationale for treating stroke as a medical emergency. Neurosurgery, 34, 144-157. http://dx.doi.org/10.1227/00006123-199401000-00021
 Chaturvedi, S. (2007) Should stroke be considered both a brain attack and a heart attack? Stroke, 38, 1713-1714. http://dx.doi.org/10.1161/STROKEAHA.107.487223
 Al Hamarneh, Y.N., Crealey, G.E. and McElnay, J.C. (2011) Coronary heart disease: Health knowledge and behavior. International Journal of Clinical Pharmacy, 33, 111-123. http://dx.doi.org/10.1007/s11096-010-9467-9
 Maguire, T.A., McElnay, J.C. and Drummond, A. (2001) A randomized controlled trial of a smoking cessation intervention based in community pharmacies. Addiction, 96, 325-331. http://dx.doi.org/10.1046/j.1360-0443.2001.96232516.x
 Tsuyuki, R.T., Johnson, J.A., Teo, K.K., Simpson, S.H., Ackman, M.L., Biggs, R.S., Cave, A., Chang, W.C., Dzavik, V., Farris, K.B., Galvin, D., Semchuk, W. and Taylor, J.G. (2002) A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: The study of cardiovascular risk intervention by pharmacists (SCRIP). Archives of Internal Medicine, 162, 1149-1155. http://dx.doi.org/10.1001/archinte.162.10.1149
 Zillich, A.J., Sutherland, J.M., Kumbera, P.A. and Carter, B.L. (2005) Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). JGIM, 20, 1091-1096. http://dx.doi.org/10.1111/j.1525-1497.2005.0226.x
 McLean, D.L., McAlister, F.A., Johnson, J.A., King, K.M., Makowsky, M.J., Jones, C.A. and Tsuyuki, R.T. (2008) A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: Study of cardiovascular risk intervention by pharmacists-hypertension (SCRIPHTN). Archives of Internal Medicine, 168, 2355-2361. http://dx.doi.org/10.1001/archinte.168.21.2355
 Sinclair, H.K., Bond, C.M., Lennox, A.S., Silcock, J. and Winfield, A. (1998) Knowledge of and attitudes to smoking cessation: The effect of stage of change training for community pharmacy staff. Health Bull, 56, 526-539.