Estimation of 10-year cardiovascular risk using a non-laboratory-based WHO CVD risk chart among slum adults of Pokhara Metropolitan, Nepal: a cross-sectional study

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally, with a disproportionate burden in low- and middle-income countries. Early identification of individuals at high risk is essential for prevention, particularly in resource-limited settings. Slum populations are especially vulnerable due to poor living conditions, unhealthy behaviors, and limited access to healthcare. The study aimed to estimate the 10-year cardiovascular risk and identify factors associated with elevated CVD risk among adults residing in slums of Pokhara Metropolitan City, Nepal, using the WHO non-laboratory-based CVD risk prediction chart. A community-based cross-sectional study was conducted among 389 adults aged 40–74 years in selected slum areas of Pokhara Metropolitan City. Data were collected using a structured questionnaire based on the WHO STEPS tool. Blood pressure and anthropometric measurements were taken using standard procedures. The WHO non-laboratory-based CVD risk chart was used to estimate 10-year CVD risk. Descriptive statistics were used to summarize participant characteristics and CVD risk categories. Poisson regression with robust variance was used to estimate crude and adjusted prevalence ratios (CPRs and APRs) for factors associated with elevated estimated 10-year CVD risk (≥ 10%). The largest proportion of participants had very low 10-year CVD risk (44.0%; 95% CI: 39.5–49.4), followed by low (28.3%; 95% CI: 24.3–33.2), moderate (24.4%; 95% CI: 20.7–29.2), and high risk (3.3%; 95% CI: 2.0–5.7). Higher CVD risk categories were more common with increasing age. Moderate- and high-risk categories were more prevalent among males than females. In the multivariable analysis, illiteracy (APR = 4.40, 95% CI: 2.47–7.84), informal education (APR = 1.91, 95% CI: 1.07–3.41), former alcohol consumption (APR = 1.73, 95% CI: 1.08–2.78), current alcohol consumption (APR = 1.64, 95% CI: 1.11–2.40), and a family history of hypertension (APR = 1.77, 95% CI: 1.27–2.45) were associated with a higher prevalence of elevated estimated 10-year CVD risk (≥ 10%). After additional adjustment for age and sex, informal education remained associated with a lower prevalence of elevated CVD risk (APR = 0.58, 95% CI: 0.35–0.95). A considerable proportion of slum-dwelling adults had low to moderate estimated 10-year CVD risk, while a smaller proportion had high risk. Elevated estimated CVD risk was associated with level of education, alcohol consumption, and family history of hypertension in the primary multivariable model; however, these associations were attenuated after additional adjustment for age and sex, except for informal education, which remained statistically significant but changed direction. Community-based CVD risk assessment and targeted preventive interventions may help identify and address cardiovascular risk among slum-dwelling adults.