JACC Adv. 2026 Jul 22;5(8):103048. doi: 10.1016/j.jacadv.2026.103048. Online ahead of print.
ABSTRACT
BACKGROUND: Cardiovascular disease (CVD) is the leading global cause of mortality and disproportionately affects low- and middle-income countries (LMICs). Although screening is essential for prevention and early detection, its effectiveness and implementation in LMICs remain unclear.
OBJECTIVES: The objective of the study was to evaluate the diagnostic performance, detection yield, and linkage-to-care outcomes of CVD and major cardiometabolic risk-factor screening programs in LMICs.
METHODS: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO, CRD420251241426). Databases were searched through November 2025. Observational and interventional studies assessing cardiovascular or major cardiometabolic screening programs in LMICs were included. Primary outcomes were detection rates and linkage to care. Secondary outcomes included risk-factor control, cardiovascular events, mortality, and cost-effectiveness. Owing to heterogeneity, results were synthesized narratively.
RESULTS: Seventeen studies from Asia, sub-Saharan Africa, and Latin America were included. Screening approaches comprised risk-prediction models, point-of-care testing, community health worker-led programs, and mobile health platforms. Diagnostic performance ranged from area under the curve 0.64 to 0.91. Locally adapted risk models generally outperformed imported scores, whereas simplified tools showed acceptable discrimination. Screening identified a substantial burden of undiagnosed disease, with up to 55% meeting hypertension criteria and approximately 40% classified as high risk for diabetes. However, considerable attrition occurred across the care cascade, with preventive service uptake ranging from 15% to 58% and confirmatory testing as low as 22%. Community health worker-led programs demonstrated >90% sensitivity and specificity compared with clinician assessment.
CONCLUSIONS: CVD screening programs in LMICs can effectively identify unmet cardiometabolic risk, but weak linkage to care limits impact. Strengthening integrated screening-to-treatment pathways is essential to improve outcomes.
PMID:42485717 | DOI:10.1016/j.jacadv.2026.103048