Health Literacy and Cardiovascular Risk Factors: A Nationally Representative Study of Korean Adults

Inadequate health literacy (HL) may contribute to poor health outcomes, but population-level evidence from Asian settings remains limited. This study aimed to examine the associations of health literacy with cardiovascular risk factor burden and guideline-based target attainment in a nationally representative Korean adult population. Associations with pooled cohort equation (PCE)-based estimated atherosclerotic cardiovascular disease (ASCVD) risk classification were also assessed.

This study included 5,262 adults aged ≥19 years from the 2023 Korea National Health and Nutrition Examination Survey. Data were collected in 2023 and analyzed in 2025-2026. HL was assessed using a validated instrument and classified as inadequate (<30) or adequate (≥30) based on the validated cutoff reported in the instrument development study. Outcomes included vascular risk factor burden, guideline-based blood pressure, glycemic, smoking, weight, and lipid thresholds, and PCE-based ASCVD risk classification among adults aged 40-79 years. Modified Poisson regression with robust variance was used to estimate adjusted prevalence ratios (aPRs).

Inadequate HL was associated with poorer blood pressure, glycemic, smoking, and weight profiles but not with lipid levels. Among adults aged 40-79 years, inadequate HL was associated with a higher probability of high PCE-based risk classification (aPR 1.19, 95% confidence interval [CI] 1.04-1.36; p=0.010). In multivariable analysis, inadequate HL was independently associated with male sex, lower educational attainment and household income, and a greater number of vascular risk factors (aPR 1.56 per additional factor, 95% CI 1.52-1.60); among sociodemographic correlates, the strongest association was observed for educational attainment up to middle school (aPR 1.64, 95% CI 1.46-1.83).

Inadequate HL is associated with a higher burden of cardiovascular risk factors and poorer guideline-based target attainment in Korea. Exploratory analyses of PCE-based ASCVD risk classification were directionally consistent but should be interpreted cautiously given the inability to exclude prior ASCVD.