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

Inadequate health literacy may contribute to poor health outcomes, but population-level evidence from Asia remains limited. This study examined its associations with cardiovascular risk factor burden, guideline-based target attainment, and estimated atherosclerotic cardiovascular disease risk in nationally representative Korean adults.

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. Health literacy was assessed with a validated instrument and classified as inadequate (<30) or adequate (≥30) per an established cutoff. Outcomes were vascular risk factor burden; guideline-based blood pressure, glycemic, smoking, weight, and lipid thresholds; and pooled cohort equation-based atherosclerotic cardiovascular disease risk classification among adults aged 40-79 years. Adjusted prevalence ratios were estimated using modified Poisson regression with robust variance.

Inadequate health literacy was associated with poorer blood pressure, glycemic, smoking, and weight profiles, but not lipids. Among adults aged 40-79 years, it was associated with high estimated atherosclerotic cardiovascular disease risk (adjusted prevalence ratio=1.19; 95% CI=1.04, 1.36). In multivariable analysis, inadequate health literacy was independently associated with male sex, lower education and income, and more vascular risk factors (adjusted prevalence ratio=1.56 per additional factor; 95% CI=1.52, 1.60); the strongest sociodemographic correlate was middle-school education or lower (adjusted prevalence ratio=1.64; 95% CI=1.46, 1.83).

Inadequate health literacy is associated with a higher burden of cardiovascular risk factors and poorer guideline-based target attainment in Korea. Exploratory pooled cohort equation-based risk analyses were directionally consistent but should be interpreted cautiously, given the inability to exclude prior atherosclerotic cardiovascular disease.