Global Trends in Key Modifiable Cardiovascular Risk Factors: A Joinpoint Analysis Across WHO Regions (1990-2022)

To examine temporal trends and quantify changes in prevalence of major cardiovascular disease risk factors (hypertension, tobacco use, elevated cholesterol, diabetes mellitus, insufficient physical activity) across World Health Organization (WHO) regions.

Analysis of WHO Global Health Observatory, a global database compiling health indicators from over 190 countries. Prevalence (%) estimates were extracted for key modifiable CVD risk factors from 1990 to 2022. Joinpoint regression analyses were conducted to calculate the annual percentage change (APC) for each segment identified to have a change in trend and the average annual percentage change (AAPC) with 95% confidence intervals across the entire time trend.

Global trends in CVD risk factors showed mixed patterns. Hypertension prevalence declined in most regions, with the greatest reduction in Europe (AAPC=-1.54, 95%CI -1.55, -1.53), whilst the Western Pacific showed a slight increase (AAPC=0.10, 95%CI 0.08, 0.12). Tobacco use decreased across all regions, most markedly in South-East Asia (AAPC=-3.50, 95%CI -3.56, -3.43), from 54.1% to 26.6%. Total cholesterol declined modestly in several regions, but increased slightly in the Western Pacific (AAPC=0.25, 95%CI 0.07, 0.43). Diabetes prevalence increased across all regions, highest in the Eastern Mediterranean (AAPC=2.58, 95%CI 2.57, 2.59) and lowest in Africa (AAPC=1.58, 95%CI 1.55, 1.61). Insufficient physical activity also increased in five regions, Africa being the only exception (AAPC=-1.10, 95%CI -1.19, -1.01).

Global trends in CVD risk factors show improvements in hypertension, tobacco use, and cholesterol, but worsening diabetes and insufficient physical activity, highlighting the need for region-specific strategies that drive sustainable, system-level change in modifiable risks.