The role of health literacy in the prevalence of cardiovascular diseases: A systematic review

Cardiovascular diseases (CVDs) remain a major public health challenge, and health literacy (HL) is a key tool in health promotion that can improve outcomes in both patients and healthy populations. While the relationship between HL and secondary and tertiary prevention of CVD has been studied, its role in primary prevention has received less attention. This systematic review aimed to examine and synthesize the existing literature on the relationship between HL and CVD prevalence. A systematic review was conducted in accordance with the PRISMA guidelines between September and December 2023 in the scientific databases PubMed, Google Scholar, and Scopus. The search had a 15-year timeframe and used specific keywords. Included studies were freely available in full-text, published in English and focused on healthy adults or populations without diagnosed CVDs. Studies were screened by title, abstract, and full-text review, and duplicates were removed prior to selection. Sixteen articles met the inclusion criteria, encompassing participants mainly over 40 years of age, and focusing on populations with elevated cardiovascular risk. HL was inversely associated with CVD prevalence and risk factors, including hypertension, diabetes, hyperlipidemia, and obesity, with low HL positively associated with increased cardiovascular risk. Differences were observed across population characteristics and study contexts. Findings suggest that improving HL may contribute to primary CVD prevention by enhancing knowledge, risk recognition, and engagement in preventive behaviors. Targeted interventions and supportive policy frameworks are needed to address HL gaps and strengthen its role as a core component of effective CVD prevention and health promotion.