European Journal of Cardiovascular Medicine

Noncommunicable diseases (NCDs), particularly cardiovascular disease (CVD), have become a predominant global health burden, contributing significantly to morbidity, premature mortality, and overburdening the public health infrastructure. Over the past decades, factors such as urbanization, globalization, increased life expectancy, and the widespread adoption of harmful lifestyle behaviours had  a detrimental effect on direct and indirect healthcare costs associated with CVDs1–3.  It results from the interplay of a wide range of genetic, socioeconomic, individual, physician-related, environmental factors and healthcare delivery system-related factors. These factors collectively shape an individual's cardiovascular risk, influencing disease progression and treatment outcomes through behavioral patterns, healthcare accessibility, and genetic predisposition.

The World Health Organization estimated that 17.9 million people died from CVDs in 2019, and one-third of these deaths occurred in low and middle-income countries4. The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 identifies cardiovascular diseases (CVDs) as a leading cause of disability and mortality. This trend is expected to remain unchanged by 20505. India, as one of the largest contributors to the global noncommunicable disease burden, mirrors this trend. Recent estimates indicate that the self-reported prevalence of CVDs among older adults in India stands at 29.4%, with notable variations across socio-demographic groups. In Andhra Pradesh, the prevalence is lower at 5.4%, highlighting regional disparities in disease burden and healthcare accessibility.

Cardiovascular risk is the probability of occurrence of a cardiovascular event and is based on the presence of risk factors. Various factors contribute to the increased risk of cardiovascular diseases (CVDs) in individuals. These modifiable risk factors include poor dietary habits, insufficient physical activity, dyslipidaemia, hyperglycaemia, hypertension, obesity, and tobacco use.6 In view of the interplay of multiple factors in the etiology of CVDs, it will be wrong to adopt a single risk factor for predicting cardiovascular risk. This study uses the WHO/International Society of Hypertension (WHO/ISH) non-laboratory-based risk assessment tool, which provides an affordable and non-intrusive method to predict major cardiovascular events over 10 years. Through an analysis of important modifiable risk factors like obesity, diabetes, hypertension, smoking, and physical inactivity, this study seeks to identify high-risk groups, direct preventative measures, and support early intervention initiatives. Assessing cardiovascular risk among individuals aged 40 years and above is crucial, as these demographic experiences a heightened susceptibility to major cardiovascular events. This study focuses on individuals attending a tertiary care hospital in Prakasam District to evaluate risk profiles and inform targeted prevention strategies

This study employed a cross-sectional design to evaluate cardiovascular risk among adults. The Government General Hospital in Ongole, located in the Prakasam district of Andhra Pradesh, was chosen for its diverse patient population, making it an ideal setting to assess cardiovascular risk across various socio-economic backgrounds. Participants aged over 40 years attending the general outpatient departments were recruited on Wednesdays and Thursdays from 9 AM to 12 PM. Exclusions included individuals with a history of myocardial infarction (MI) and stroke, non-ambulatory patients, and those with cognitive impairments. A total of 365 eligible participants attended the outpatient department (OPD) on designated days between August 2024 and September 2025. Data collection was conducted using a pretested semi-structured questionnaire, which included sociodemographic details and components of a non-laboratory-based cardiovascular disease (CVD) risk assessment tool. The interviewer, a final-year MBBS student, was trained in data collection methods, including the use of WHO non-laboratory risk assessment charts.  Participants were approached at the registration desk on the designated days, informed about the study's purpose, provided oral consent, and interviewed on the same day

The World Health Organization (WHO) non-laboratory-based cardiovascular disease (CVD) risk assessment tool, tailored the South Asian region, predicts the 10-year risk of a major cardiovascular event without requiring invasive laboratory measurements. The risk estimation is based on five key variables: age, sex, systolic blood pressure, smoking status and body mass index (BMI)

All participants had their blood pressure measured following WHO-recommended standardized procedures, with the average of two readings taken five minutes apart used for analysis. BMI was calculated using the formula weight (kg)/height (m²) based on measured weight and height. Smoking status was assessed through structured interviews conducted by trained personnel.  Smokers were defined as those who were currently smoking and those who had stopped smoking within a year before the interview. Weight and height measurements were obtained using standardized anthropometric tools to ensure accuracy and reliability. Weight was measured using a calibrated digital weighing scale, Height was recorded using a stadiometer, following WHO-recommended procedures. Body Mass Index (BMI) was then calculated using the formula weight (kg)/height (m²) and categorized based on the Asian BMI classification, which accounts for variations in body fat distribution and metabolic risk among Asian populations. Individuals with BMI between 18.5 and 22.9 kg/m² were classified as normal, those between 23.0 and 24.9 k/m² were considered overweight, and those with a BMI of 25.0 kg/m² or higher were classified as obese.  Cardiovascular disease (CVD) risk is quantified as a percentage using the World Health Organization (WHO) non-laboratory-based cardiovascular disease (CVD) risk assessment tool, tailored the South Asian region into five distinct risk bands: <5%(green), 5–<10%(yellow), 10–<20%(orange), 20–<30%(red), and ≥30%(dark red). These bands correspond to different levels of risk: low risk (<10%), moderate risk (10–<20%), high risk (20–<30%), and severe risk (≥30%)7.  Data were entered and analyzed using Microsoft Excel. The data was analyzed using SPSS-17 software. The mean and standard deviation for height, weight, age, blood pressure, body mass index and CVD risk score were calculated. The chi-square test was used to compare dichotomous variables; a P-value of less than 0.05 was considered significant.

Among 365 responders, the mean age was 54.9 years, with a standard deviation of 8.5 years, indicating that a large proportion were between the ages of 45 and 55.  Participants comprised comprisedcomprised 64% males, with 56% of respondents from rural areas. Additionally, approximately 40% of the participants were illiterate. Most participants were not getting enough physical activity, which is a notable risk factor for cardiovascular disease (CVD). Frequent junk food consumption (>3 times per week) is relatively low. Most people limit their junk food intake, but a marginal percentage still consume it regularly, which can contribute to obesity and CVD risk. The data indicates a substantial gender-based disparity in smoking prevalence, with 52.8% of males reporting a history of smoking compared to a mere 5.3% of females. Hypertension is slightly more prevalent in women. The history of Diabetes is more prevalent among males than females- Male: 35.6%, Female: 26.5%. Diabetes is a significant risk factor for CVD and affects more than one-third of the male group.

Most of the participants (39.0%) were categorised as having  <5% risk and with 109 people (30.1%) presenting a 5-10% risk, the majority of the study population is low-risk. These two subgroups together make up about 69.1% of the entire sample, indicating the study group's low risk. However, a considerable percentage (27.4%) has a moderate risk (10–20%), which indicates an increased chance of eventually developing CVD.

When stratified by gender, a significantly higher proportion of females were categorized as low risk compared to males. Particularly, 64.2% of females fell into the <5% category, and 88.6% of them had a CVD risk score of less than 10%.  On the other hand, a greater percentage (36.6%) of males were categorised as moderate-risk, while only 57.9% were categorised as low risk.  However, no females were categorised as high risk, but 5.4% of males were.

These results imply that there is a gender difference in cardiovascular risk, with men showing a significantly higher risk profile than women.  It's possible that underlying variations in behavioural, physiological, or socioenvironmental risk factors account for the increased prevalence of moderate to high risk in men.  On the other hand, the higher proportion of women in the lower-risk groups might indicate protective variables such as hormonal effects, better lifestyle choices, or increased health consciousness.

The mean age of participants (54.9 ± 8.5 years) indicates that most individuals fall within the middle-aged category (45–55 years), which is a critical phase for cardiovascular risk assessment. Males comprised 64% of the study population, while 56% of respondents were from rural areas. A significant proportion (40%) of participants were illiterate, which may affect health awareness and preventive behavior regarding cardiovascular disease (CVD). Physical inactivity was prevalent, which is a major modifiable risk factor for CVD. Frequent junk food consumption (>3 times per week) was relatively low, suggesting dietary control among participants. However, a marginal percentage still consumes it regularly, contributing to obesity and metabolic risk factors. Smoking prevalence was significantly higher in males (52.8%) compared to females (5.3%), reflecting gender differences in behavioral risk factors. Hypertension was slightly more prevalent among females, likely influenced by postmenopausal physiological changes. Diabetes history was higher in males (35.6%) compared to females (26.5%), further reinforcing the gender disparity in metabolic risks.

The distribution of cardiovascular disease (CVD) risk scores among the study population (n=365) indicates that the majority fall within the low-risk categories, while a smaller subset presents moderate-to-high risk profiles. The findings of this study are consistent with previous research on cardiovascular risk assessment using WHO non-laboratory-based prediction charts. A nationally representative survey of older Indian adults found that two-thirds (68.8%) of participants had a 10-year CVD risk of <10%, similar to the 69.1% low-risk prevalence observed in this study8. Similar findings were reported in a previous literature on cardiovascular risk assessment in Indian adults, particularly those utilizing WHO non-laboratory-based risk prediction charts. A nationally representative survey from the National Noncommunicable Disease Monitoring Survey (NNMS) (Indian Journal of Medical Research, 2024) assessed 10-year CVD risk among adults aged 40–69 years and found that the majority of participants (84.9%) had low risk (<10%), similar to the 69.1% low-risk prevalence observed in this study9. A study published in Wellcome Open Research examined CVD risk estimation in urban Indian populations using three different models. Despite variations in risk estimation across models, the study found similar trends in CVD risk distribution as with the current study10.

When stratified by gender, a significant majority of females (88.6%) fell into the low-risk group, with 64.2% having a CVD risk score of less than 5%. In contrast, only 57.9% of males were in the low-risk group. Moreover, 36.6% of males were in the moderate-risk category, and 5.4% were at high risk, whereas no females were categorized as high risk. The observed higher CVD risk among males aligns with findings from the EPIC-Norfolk cohort study, which estimated that men have a 40–50% higher lifetime risk of CVD compared to women11. This study's findings regarding higher CVD susceptibility in males compared to females, particularly in the moderate-to-high risk categories, are further validated by a prospective cohort study12. This similarity implies that behavioural, hormonal, and physiological differences contribute significantly to gender-based risk variations.

Limitations of the Study: ‘

Cross-sectional design of the study prevents assessment of causal relationships or long-term risk trends. The hospital-based sampling may introduce selection bias, as individuals attending tertiary care centers may differ from the general population. Self-reported data for smoking and diabetes may lead to recall bias, affecting accuracy.

This study shows significant gender differences and behavioural influences that contribute to individual CVD risk. Men had a much higher risk for cardiovascular disease than women, due to a higher prevalence of smoking and diabetes. A significant percentage of participants (27.4%) exhibit intermediate risk, requiring early preventative actions, even if the majority of participants (69.1%) fall into low-risk categories. To mitigate cardiovascular disease (CVD) risk, targeted interventions are essential. Gender-sensitive strategies, including hypertension monitoring for women and tailored lifestyle recommendations, can further enhance preventive efforts.

Conflict of interest: There is no conflict of Interest.

Funding: Nil

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