Cross-sectional and longitudinal trends in the World Health Organization cardiovascular risk score: Sector-specific evidence from occupational health Examinations in Belgium (2019–2023)

Background In Belgium, time series data starting from the early 1990s show a steady decrease of the prevalence of the main risk factors (e.g., smoking, high systolic blood pressure, and high body-mass index) for cardiovascular diseases (CVDs) until 2020. However, in 2021, a steep rise in risk factor prevalence has been observed. In this study, we aim to quantify the magnitude of CVD risk over time as well as to describe the evolution in non-laboratory metabolic and behavioral CVD risk factors since 2019. Methods An observational study consisting of two parts has been conducted. First, general and sector-specific time series of CVD risk and CVD risk factors were described based on repeated cross-sectional data collected between 2019 to 2023 by Mensura, an occupational health service in Belgium. More specifically, 456,505 medical examinations in 230,708 Belgian workers were considered. The World Health Organization cardiovascular risk chart was used to determine risk profiles based on five biological and lifestyle variables (age, sex, systolic blood pressure, smoking status, and body mass index). Second, longitudinal relationships between CVD risk and its risk factors were inferred using linear mixed models to accommodate within-person association in repeated measurements on the same individual over time. Results Most employees with >10% CVD risk were men (94.7%). Occupational sectors exhibiting the lowest CVD risk were the healthcare, public, and education sector, while persons in construction, logistics, and metal industry showed the least favorable risk profiles. Across occupational sectors, the prevalence of people having risk of CVD > 10% risk increased (0.7 to 4.7%-point) from 2019 until 2021 but decreased again (0 to −4.5%-point) in 2022 in almost all sectors. Further in-depth analyses showed that both upward and downward trends were strongly associated with the evolution in high systolic blood pressure among participants. Conclusions Continued tracking of the evolution of CVD risk is essential. On the one hand, it guides where interventions are required (i.e., in high CVD risk occupational sectors). On the other hand, decomposing CVD risk into risk factors informs how interventions can be expedient (i.e., with focus on reducing high systolic blood pressure).