Precision Prevention of Premature Cardiovascular Disease Among African Men: The Triple-Risk Convergence Framework Integrating Psychosocial, Metabolic, and Inherited Cardiovascular Susceptibility

Premature cardiovascular disease (CVD) among African men is an escalating public health and health systems challenge across sub-Saharan Africa. Rapid urbanisation, psychosocial stress, cardiometabolic transition, and inherited cardiovascular susceptibility converge within contexts characterised by delayed healthcare engagement and fragmented preventive infrastructure. Current prevention strategies remain largely centred on metabolic risk factors and may inadequately capture the multidimensional nature of cardiovascular vulnerability. The objective of this conceptual paper is to develop and present the Triple-Risk Convergence Framework (TRCF), which integrates psychosocial stress, metabolic dysfunction, and lipoprotein(a) [Lp(a)]-associated inherited cardiovascular susceptibility to strengthen early cardiovascular risk recognition and precision prevention among African men. The framework was developed through an integrative narrative synthesis of literature published between 2019 and 2026. Evidence from preventive cardiology, men's health, psychosocial science, cardiovascular genetics, public health, and health systems research was synthesised to identify converging biological, behavioural, and contextual pathways that informed framework development. The conceptual synthesis supports the proposition that premature cardiovascular disease among African men may be more comprehensively understood through the dynamic convergence of psychosocial stress, metabolic dysfunction, and inherited cardiovascular susceptibility than by any single domain considered in isolation. The TRCF proposes that these interacting domains operate across the life course within a broader socioecological context that shapes their exposure, expression, interaction, detection, and management. Rather than constituting a fourth risk domain, social, cultural, environmental, socioeconomic, and health-system determinants are conceptualised as multilevel socioecological influences that shape and modify the three core domains across the life course. By integrating psychosocial assessment, metabolic evaluation, and inherited-risk stratification, the framework extends conventional prevention approaches centred predominantly on metabolic risk factors. The TRCF provides a conceptual foundation for precision prevention of premature cardiovascular disease among African men. By integrating psychosocial stress, metabolic dysfunction, and inherited cardiovascular susceptibility within a multilevel socioecological environment, the TRCF establishes a scientific platform for future empirical validation, implementation research, and precision prevention strategies designed to improve cardiovascular health equity in African populations.