Epidemiology and cardiometabolic care in adults with ASCVD and high 10-year ASCVD risk: 2021 WHO STEPS study in Iran

Abstract Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and health burden worldwide. We aimed to assess ASCVD epidemiology, 10-year risk, and cardiometabolic care using nationally representative data in Iran. Using the 2021 Iran STEPS study, a cross-sectional analysis was conducted to evaluate ASCVD (self-reported myocardial infarction, angina, revascularization, or stroke) prevalence and annual event rate. The 2013 AHA/ACC pooled cohort equations estimated 10-year ASCVD risk in 10,298 participants aged 40–75 without ASCVD. Cardiometabolic care for hypertension, diabetes mellitus (DM), and hypercholesterolemia was assessed, along with statin use and cardiovascular health (CVH) metrics. Among 27,822 participants, representing 57.5 million adults, ASCVD prevalence was 7.4%. Among those without ASCVD, 19.1% had an intermediate and 5.4% had a high ASCVD risk. In the ASCVD group, hypertension and DM affected 77.0% and 34.7%, yet only 12.5% and 14.3% of the entire ASCVD group had them controlled, respectively. In adults without ASCVD, 2.9–5.3% of the entire risk groups achieved hypertension targets, 2.5–16.8% achieved glycemic targets, and 7.7–16.7% achieved lipid goals, despite condition prevalence spanning 47.4–94.4% for hypertension, 7.2–59.3% for DM, and 33.5–48.7% for hypercholesterolemia. CVH metrics were also unfavorable. The study revealed a high ASCVD burden and future risks with gaps in coverage, treatment, and control.