Methodological approaches to assessing population cardiovascular risk under urbanization

The object of the study is population cardiovascular risk in urbanized environments. In the 21st century, urbanization is associated with transformation of the risk factor structure under the influence of environmental, social, and behavioral determi-nant, which results in apparent intra-urban heterogeneity of morbidity and mortality indicators. Cardiovascular diseases remain the leading cause of mortality worldwide, accounting for approximately 19.8 million deaths annually (32 % of all deaths), which highlights the need to improve methodological approaches to population-level risk assessment and management.

The aim of the study was to analyze current methodological approaches to assessing population cardiovascular risk under urbanization with an emphasis on integration of clinical, socio-economic, and environmental factors. The study was performed as an analytical review with elements of a structured literature search in international and Russian databases. We analyzed classical epidemiological risk stratification models (including SCORE2 and its national adaptations), evaluated their limitations in large urban agglomerations and summarized available data on integrative, multilevel, and geospatial approaches accounting for intra-urban heterogeneity of exposure to ambient air pollutants, peculiarities of urban developed areas and social stratification of the population. Special attention was paid to digital analytics, geographic information systems, and machine learning methods for developing context-adapted predictive models. Transition from isolated assessment of traditional clinical indicators to multilevel models integrating individual, social, and infrastructural determinants was shown to improve risk stratification accuracy and provide a methodological basis for evidence-based population risk management in urban settings.