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Cardiovascular risk and health literacy: an inverse relation

Comment by Maria Antonopoulou, Primary Care and Risk Factor Management Section

Risk Factors and Prevention

This randomised control trial (RCT) study aimed to examine the role of health literacy as a recently emerged and under evaluation non- traditional cardiovascular risk factor. Health literacy, referring as the ability to read and understand medical information, has been already associated with adherence to healthier lifestyle, but the direct association of health literacy to subclinical cardiovascular disease (CVD), as the presence of carotid artery plaques suggest, have not been fully estimated.

The VINPIZA (Visualisation of asymptomatic atherosclerotic disease for optimum cardiovascular prevention) study invited 4,177 asymptomatic subjects aged > 40 years in northern Sweden with different levels of CVD risk. Demographics, lifestyle habits as well as assessment of psychological, social and biomedical markers of CVD were registered. Health literacy level was assessed using the Three-item Brief Health Literacy Screen (BHLS). Individual CVD risk was calculated with both the Framingham Risk Score (FRS) and the European Systematic Coronary Risk Evaluation (SCORE). Ultrasound measurements of carotid artery plaques and carotid intima-media wall thickness (CIMT) were also performed.

Interesting findings of the study were that health literacy, LDL cholesterol, systolic blood pressure, smoking and fasting plasma glucose were independently associated with the presence of carotid artery plaques. The probability of having carotid artery plaque was higher in subjects with low compared to them with high health literacy, odds ratio (OR) (95% confidence interval (CI)) of 1.54 (1.28–1.85), finding held for both men and women, smokers and non-smokers. On the other hand, carotid intima-media thickness (CIMT) was only inversely associated to health literacy for men but not for women (probably due to women reported higher levels of health literacy). Low health literacy was significantly associated with increased CVD risk assessed by FRS and SCORE, mainly for men.

Since CVD prevention strategies focus on the management of multiple cardiovascular risk factors, the level of health literacy of the patients arises as an additional parameter taken in mind, when communicating health information to patients, to promote adherence and enhance healthier lifestyle practices.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Maria Antonopoulou commented on this article:

Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk
Bernt Lindahl , Margareta Norberg , Helene Johansson , Kristina Lindvall , Nawi Ng , Maria Nordin , Steven Nordin , Ulf Näslund , Amanda Persson , Davide Vanoli , Peter J Schulz; Eur J Prev Cardiol 2020 Jan; 27(2):209-215