title: Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy.
abstract: OBJECTIVE
  To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD).
  
  
  METHODS
  Data were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D).
  
  
  RESULTS
  Among 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p < 0.01]. Nurse-coordinated care seemed to reduce CVD risk irrespective of health literacy levels without significant differences.
  
  
  CONCLUSIONS
  Inadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.|Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: van Schaik
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: H T
authors.initials: HT
authors.lastname: Jørstad
authors.affiliation: Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital, Antwerp, Belgium.|Department of Endocrinology, Diabetology and Metabolic Diseases, AZ Monica Hospital, Deurne/Antwerp, Belgium.
authors.forename: T B
authors.initials: TB
authors.lastname: Twickler
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: R J G
authors.initials: RJG
authors.lastname: Peters
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J P G
authors.initials: JPG
authors.lastname: Tijssen
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.p.fransen@amc.uva.nl.
authors.forename: M P
authors.initials: MP
authors.lastname: Fransen
keywords: Cardiovascular disease risk; Coronary artery disease; Health literacy; Nurse coordinated prevention program; Secondary prevention