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Cardiovascular risk communication often requires patients to interpret numerical information about risk and treatment benefits. However, how perceived difficulty interpreting this information relates to health self-efficacy remains unclear. We examined the association between perceived health numeracy difficulty and health self-efficacy among adults with cardiovascular disease (CVD) risk factors and assessed whether accounting for patient–provider communication influenced this association. We analyzed 2022 Health Information National Trends Survey (HINTS) data from 3,961 U.S. adults with ≥1 CVD risk factor. Perceived health numeracy difficulty was categorized as very easy/easy or hard/very hard. Health self-efficacy was assessed using a 5-level measure, and patient–provider communication using a 6-item composite score. Survey-weighted ordered logistic regression adjusted for CVD risk-factor burden and sociodemographic characteristics, with communication added in the final model. Participants were predominantly female (52.8%), non-Hispanic White (64.5%), with a mean age of 50.3 (SE 0.44) years. Complete health self-efficacy was more common among adults reporting easy numeracy than numeracy difficulty (28.9% vs 12.9%; P<0.001). Health numeracy difficulty was associated with lower health self-efficacy (aOR, 0.29; 95% CI, 0.23–0.36). After adjustment for communication, the association was attenuated but remained significant (aOR, 0.37; 95% CI, 0.29–0.46). Better communication was associated with greater health self-efficacy (aOR, 2.31; 95% CI, 1.96–2.74). Clear, personalized communication of numerical CVD risk information may support patients’ confidence and participation in shared decision-making for their cardiovascular health.