Abstract Accurate cardiovascular risk prediction is crucial for preventive healthcare; however, the development of robust Artificial Intelligence (AI) models is hindered by the fragmentation of clinical data across institutions due to stringent privacy regulations. This paper presents a comprehensive architectural case study validating the engineering robustness of FedCVR, a privacy-preserving Federated Learning framework applied to heterogeneous clinical networks. Rather than proposing a new theoretical optimizer, this work focuses on a systems engineering analysis to quantify the operational trade-offs of server-side adaptive optimization under utility-prioritized Differential Privacy (DP). By conducting a rigorous stress test in a high-fidelity synthetic environment that reflects the feature space and clinical context of real-world datasets (Framingham, Cleveland), we systematically evaluate the system’s resilience to statistical noise. The validation results demonstrate that integrating server-side momentum as a temporal denoiser allows the architecture to achieve a stable F1-score of 0. 78 and an Area Under the Curve (AUC) of 0. 96 under the operational privacy budget (13. 4), compared to a non-private baseline of F1-score 0. 84. FedCVR statistically outperforms standard stateless baselines (FedAvg, FedProx) and other adaptive optimizers (FedAdagrad, FedYogi) under identical privacy constraints. Our findings confirm that server-side adaptivity is a structural prerequisite for recovering clinical utility under realistic privacy budgets, providing a validated engineering blueprint for secure multi-institutional collaboration.
Silva et al. (Sat,) studied this question.