Variations in ten-year cardiovascular disease risk and determinants in five countries

Background
This study assessed ten-year cardiovascular disease (CVD) risk and its determinants in five countries using the World Health Organization (WHO) STEPwise approach to non-communicable disease (NCD) risk factor surveillance (STEPS) data.

Methods
Adults aged 40-69 were analysed using multilevel models to identify individual- and community-level factors.

Results
The mean ten-year CVD risk was 18.3% in Jordan, 8.4% in Afghanistan, 6.8% in Mongolia, 5.3% in Nepal, and 5.0% in São Tomé and Príncipe. Higher ten-year CVD risk was associated with being widowed, divorced or separated in Nepal (β[beta coefficient percent] =1.36, 95%CI=0.19-2.53, p<0.05); urban residence in Afghanistan (β=0.59, 95%CI=0.01-1.17, p<0.05) and Nepal (β=0.46, 95%CI=0.003-0.93, p<0.05); being retired or unable to work in Afghanistan (β=1.49, 95%CI=0.58-2.41, p<0.001), Nepal (β=1.20, 95%CI=0.56-1.85, p<0.001), and Mongolia (β=0.83, 95%CI=0.11-1.56, p<0.05); and low physical activity in Jordan (β = 1.73, 95% CI=0.77-2.69, p<0.001), Mongolia (β = 1.04, 95%CI=0.46-1.61, p<0.001), and Afghanistan (β = 0.81, 95%CI=0.07-1.56, p<0.05).

Conclusions
This study reaffirms differences in primary CVD risk profiles across countries and indicates the need for focused interventions, such as promoting urban-based CVD prevention in Afghanistan and Nepal, increasing physical activity in Jordan and Mongolia, strengthening social support for widowed individuals in Nepal, and improving access to primary CVD prevention for retirees or those unable to work in Afghanistan, Mongolia and Nepal. Future research should assess cost-effectiveness, feasibility, and implementation challenges of interventions. Studies should also investigate the underlying mechanisms that drive primary CVD risk in higher-risk populations.