Underinformed and overlooked: Cardiovascular health literacy in Portuguese women

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is the leading cause of death in women, yet remains underrecognized. Cardiovascular health literacy - the ability to access, understand, and apply health information - is crucial for effective risk management. This study aimed to assess cardiovascular health literacy awareness in a sample of Portuguese women and to identify predictors of low self-reported awareness. METHODS: We conducted a cross-sectional study during a cardiovascular screening event in Portugal. Women aged ≥18 years completed a validated questionnaire assessing knowledge of cardiovascular risk factors, symptoms, prevention, and appropriate response. The primary outcome was self-reported lack of awareness. Secondary outcomes summarized cardiovascular health literacy domains and barriers to healthy lifestyles. Predictors of lack of awareness were examined using multivariate logistic regression. RESULTS: We included 204 women (mean age 55±16 years); 89.2% lived in urban areas and 24% had higher education. Only 5.6% felt well-informed, while 15.4% reported no knowledge. Only 27.7% recognized cardiovascular disease as the leading cause of death in women. Symptom recognition was suboptimal. The main barriers to healthy lifestyles were financial constraints (50%) and lack of time (36.7%). In multivariate analysis, older age (≥62 years: OR 4.20, 95% CI 1.57-11.22) and primary education (OR 3.60, 95% CI 1.43-9.09) independently predicted low awareness. CONCLUSIONS: Portuguese women demonstrate limited awareness and uneven cardiovascular health literacy. Older age and lower educational attainment were key predictors, highlighting the need for targeted, accessible education and mitigation of socioeconomic barriers to improve risk perception and health outcomes in this group.