Occurrence of selected cardiometabolic risk factors among clients of the health counselling centre in Košice in 2022 – 2025
The aim of the study was to analyse the occurrence of selected cardiometabolic risk factors among clients of the basic Health Counselling Centre of the Regional Public Health Authority based in Košice in 2022 – 2025.
The study was a retrospective descriptive analysis of secondary aggregated data from the annual reports of the Public Health Authority of the Slovak Republic, from the sections concerning the Regional Public Health Authority based in Košice. The assessed factors included smoking, overweight, obesity, elevated measured blood pressure, increased total cholesterol concentration, elevated measured glucose concentration, and physical activity.
Differences between annual samples and, for selected indicators, between men and women were evaluated using Pearson’s chi-square test at a significance level of p < 0.05.
During the observed period, the most frequently identified risk factors were increased total cholesterol concentration, ranging from 43.9% to 51.2%, and overweight, present in 28.1% to 35.5% of clients. Elevated measured blood pressure was recorded in 12.0% to 30.8% of examined individuals. Year-to-year differences in the occurrence of smoking, overweight, obesity, elevated measured blood pressure, increased total cholesterol concentration, and elevated measured glucose concentration were statistically significant. Overweight and elevated measured blood pressure occurred more frequently in men, whereas increased total cholesterol concentration was more common in women in several years. The findings indicate a frequent occurrence of modifiable cardiometabolic risk factors among clients of the Health Counselling Centre in Košice and support the importance of preventive counselling, screening, and interventions aimed at lifestyle modification. Key words: cholesterol, cardiometabolic risk factors, blood pressure, overweight, Health Counselling Centre, prevention.
Abstract: Cardiometabolic risk factors are important determinants of chronic non-communicable diseases, and their early identification is of considerable preventive importance.
The aim of this study was to analyse the occurrence of selected cardiometabolic risk factors among clients of the basic Health Counselling Centre of the Regional Public Health Authority based in Košice in 2022 – 2025.
The study was designed as a retrospective descriptive analysis of secondary aggregated data obtained from the annual reports of the Public Health Authority of the Slovak Republic, specifically from the sections concerning the Regional Public Health Authority based in Košice. The assessed factors included smoking, overweight, obesity, elevated measured blood pressure, increased total cholesterol concentration, elevated measured glucose concentration, and physical activity.
Differences among annual samples and, for selected indicators, between men and women were evaluated using Pearson’s chi-square test at a significance level of p < 0.05.
During the observed period, the most frequently identified risk factors were increased total cholesterol concentration, ranging from 43.9% to 51.2%, and overweight, present in 28.1% to 35.5% of clients. Elevated measured blood pressure was recorded in 12.0% to 30.8% of examined individuals. Year-to-year differences in the occurrence of smoking, overweight, obesity, elevated measured blood pressure, increased total cholesterol concentration, and elevated measured glucose concentration were statistically significant. Overweight and elevated measured blood pressure occurred more frequently in men, whereas increased total cholesterol concentration was more common in women in several years. The findings indicate a frequent occurrence of modifiable cardiometabolic risk factors among clients of the Health Counselling Centre in Košice and support the importance of preventive counselling, screening, and interventions aimed at lifestyle modification. Key words: cholesterol, cardiometabolic risk factors, blood pressure, overweight, Health Counselling Centre, prevention
Introduction
Cardiometabolic diseases represent a significant group of chronic non-communicable diseases that contribute to morbidity and mortality in the adult population. Several modifiable risk factors contribute to their development, particularly overweight and obesity, elevated blood pressure, disorders of glucose metabolism, dyslipidaemia, smoking, and insufficient physical activity. These factors often accumulate, and their concurrent presence can increase the likelihood of developing atherosclerotic cardiovascular diseases and type 2 diabetes mellitus (type 2 DM) (Fahed et al., 2022; Rus et al., 2023).
Increased body weight is of particular importance in shaping cardiometabolic risk. Overweight and obesity are associated with a higher occurrence of elevated blood pressure, dyslipidaemia, and disorders of glucose metabolism. The degree of risk depends not only on total body weight but also on the distribution of adipose tissue, especially the presence of abdominal obesity (Swarup et al., 2024; Fahed et al., 2022). The accumulation of metabolic and cardiovascular abnormalities is also typical of metabolic syndrome (MS), which represents a clinically significant indicator of increased risk of cardiovascular diseases and type 2 DM (Fahed et al., 2022; Alberti et al., 2009).
The occurrence of individual cardiometabolic risk factors is influenced by biological, behavioural, and social determinants. The most significant include age, sex, body weight, dietary habits, level of physical activity, smoking, and other lifestyle characteristics. Differences can be observed between men and women as well as between age groups, with the occurrence of several metabolic and cardiovascular abnormalities generally increasing with advancing age (Goddard et al., 2025; Islam et al., 2024; Swarup et al., 2024).
The aim of the study was to analyse the occurrence of selected cardiometabolic risk factors among clients of the basic Health Counselling Centre of the Regional Public Health Authority based in Košice in 2022 – 2025. The assessed factors included smoking, overweight, obesity, elevated measured blood pressure, increased total cholesterol concentration, and elevated measured glucose concentration. The study also included a descriptive evaluation of data on physical activity. The monitored indicators were compared between individual annual samples and by sex.
Methodology
The study was a retrospective descriptive analysis of secondary aggregated data. Data on clients of the basic Health Counselling Centre of the Regional Public Health Authority based in Košice for the years 2022 – 2025 were analysed. The data source was the relevant sections of the annual reports of the Public Health Authority of the Slovak Republic for each monitored year, which contained data on the activities of the Regional Public Health Authority based in Košice (Public Health Authority of the Slovak Republic, annual reports for 2022 – 2025).
Data on smoking, overweight, obesity, elevated measured blood pressure values, elevated total cholesterol concentration, elevated measured glucose concentration, and level of physical activity were evaluated. Relative frequencies were taken from source documents or calculated from the number of clients with available data for the respective indicator. Due to varying data availability, the number of evaluated clients differed between indicators and years.
The categorization of monitored indicators was based on the threshold values stated in the source documents. Overweight was defined as BMI 25.0 – 29.9 kg/m² and obesity as BMI ≥ 30.0 kg/m². An elevated measured blood pressure value was considered systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. An elevated total cholesterol concentration was considered a value ≥ 5.2 mmol/l and an elevated measured glucose concentration a value ≥ 6.0 mmol/l. Since data on fasting status, type of biological material, or measurement conditions were not available, the elevated measured glucose concentration was not interpreted as a diagnostic criterion for prediabetes or diabetes mellitus.
Source data came from preventive examinations conducted at the basic Health Counseling Center and within the mobile preventive activities of the RÚVZ based in Košice. Differences in the proportions of clients with individual monitored indicators between annual cohorts and, for selected indicators, also between men and women were evaluated using Pearson's chi-square test. The level of statistical significance was set at p < 0.05.
Results
In the years 2022 – 2025, selected behavioral, anthropometric, clinical, and biochemical risk factors were monitored among clients of the basic Health Counseling Center. The number of evaluated individuals varied between indicators and years depending on the scope of examinations performed and questionnaire surveys conducted.
Smoking was reported by a total of 106 out of 951 surveyed clients (11.1%) in 2022, 227 out of 983 clients (23.1%) in 2023, 105 out of 898 clients (11.7%) in 2024, and 249 out of 989 clients (25.2%) in 2025. The lowest proportion of smokers was recorded in 2022 and the highest in 2025. Differences in the proportion of smokers between individual annual cohorts were statistically significant (p < 0.001) (Table 1).
Overweight, defined as BMI 25.0 – 29.9 kg/m², was found in 320 out of 951 examined clients (33.6%) in 2022, 259 out of 922 clients (28.1%) in 2023, 266 out of 842 clients (31.6%) in 2024, and 335 out of 943 clients (35.5%) in 2025. The lowest proportion of clients with overweight was recorded in 2023 and the highest in 2025. Differences between annual cohorts were statistically significant (p = 0.005).
Obesity, defined as BMI ≥ 30.0 kg/m², was recorded in 140 out of 951 clients (14.7%) in 2022, 223 out of 922 clients (24.2%) in 2023, and 151 out of 943 clients (16.0%) in 2025. In 2024, the source data indicated a zero number of clients with obesity. Differences in the proportion of clients with obesity between the monitored years were statistically significant (p < 0.001) (Table 1).
Elevated measured blood pressure value was recorded in 289 out of 938 examined clients (30.8%) in 2022, 111 out of 926 clients (12.0%) in 2023, 195 out of 873 clients (22.3%) in 2024, and 263 out of 980 clients (26.8%) in 2025. The highest proportion was recorded in 2022 and the lowest in 2023. In the following two years, the proportion of clients with elevated measured blood pressure value increased again. Differences between individual annual cohorts were statistically significant (p < 0.001) (Table 1).
Elevated total cholesterol concentration ≥ 5.2 mmol/l was among the most frequently recorded cardiometabolic risk factors throughout the entire monitored period. In 2022, it was found in 361 out of 821 examined clients (44.0%), in 2023 in 456 out of 891 clients (51.2%), in 2024 in 382 out of 871 clients (43.9%), and in 2025 in 445 out of 975 clients (45.6%). The highest proportion was recorded in 2023 and the lowest in 2024. Differences between the monitored annual cohorts were statistically significant (p = 0.006) (Table 1).
Measured glucose concentration ≥ 6.0 mmol/l was found in 91 out of 609 examined clients (14.9%) in 2022, 155 out of 451 clients (34.4%) in 2023, 218 out of 546 clients (39.9%) in 2024, and 24 out of 576 clients (4.2%) in 2025. The highest proportion was recorded in 2024 and the lowest in 2025. Differences in the proportion of clients with measured glucose concentration ≥ 6.0 mmol/l between annual cohorts were statistically significant (p < 0.001) (Table 1).
Data on physical activity were available for 212 respondents in 2022, 426 in 2023, 222 in 2024, and 10 in 2025. In 2022, the most frequently reported was recreational physical activity, declared by 56.6% of respondents (n = 120), and similarly in 2023, reported by 60.6% of respondents (n = 258). In 2024, the most frequently reported was regular physical activity, in 70.7% of respondents (n = 157). The distribution of respondents by level of physical activity differed statistically significantly between the years 2022 – 2024 (p < 0.001).
In 2025, 50.0% of respondents (n = 5) reported no physical activity, 40.0% (n = 4) reported recreational activity, and 10.0% (n = 1) reported regular activity. Due to the low number of respondents, data for this year were not included in the statistical comparison (Table 1).
Table 1 Occurrence of selected cardiometabolic risk factors among clients of the basic Health Counseling Center in the years 2022 – 2025 (Processed according to the annual reports of the ÚVZ SR for the years 2022 – 2025, sections of RÚVZ Košice)
χ² - Pearson's chi-square test; BMI – body mass index; BP – blood pressure; Note: ¹ Data on physical activity for 2025 are based on only 10 respondents, therefore they were not included in Pearson's chi-square test; p-value refers to the comparison of years 2022 – 2024.
The proportions of selected cardiometabolic risk factors among clients of the basic Health Counseling Center in the years 2022 – 2025 are illustrated in Fig. 1. Throughout the entire monitored period, the highest proportion was recorded for elevated total cholesterol concentration, which ranged from 43.9% to 51.2%. Overweight was also among the most frequently identified risk factors; after a decline in 2023, its proportion increased again in the following years. The proportion of smokers and clients with elevated measured blood pressure value fluctuated between individual annual cohorts without a clear linear trend (Fig. 1).
Fig. 1 Proportions of selected cardiometabolic risk factors among clients of the basic Health Counseling Center in the years 2022 – 2025 [
](https://prohuman.sk/files/images/obr1_7.popup_800.png) Source: Processed according to the annual reports of the ÚVZ SR for the years 2022 – 2025, sections of RÚVZ Košice.
In the years 2022 – 2025, the proportion of smokers did not differ statistically significantly between men and women. In 2025, the proportion of smokers was numerically higher in men than in women (27.0% versus 23.9%), but the difference was not statistically significant (p = 0.276) (Fig. 2).
In all monitored years, overweight was statistically significantly more frequent in men than in women. The proportion of men with overweight ranged from 39.3% to 42.6%, while in women it ranged from 24.5% to 32.9%. The largest difference between sexes was recorded in 2023, when overweight was found in 40.3% of men and 24.5% of women (Fig. 2).
Elevated measured blood pressure was more frequent in men throughout the entire monitored period. In the years 2022–2024, it was statistically significantly more frequent in men than in women (p < 0.001). In 2025, the proportion of men with elevated measured blood pressure was higher than the proportion of women (29.9% vs. 24.8%), but the difference was not statistically significant (p = 0.078) (Fig. 2).
In 2022 and 2025, the proportion of clients with elevated total cholesterol concentration was statistically significantly higher in women than in men (p < 0.001). In 2023 and 2024, the proportion of women with elevated total cholesterol concentration was also higher, but the differences were not statistically significant (in 2023 p = 0.114; in 2024 p = 0.104) (Fig. 2).
Fig. 2 Occurrence of selected risk factors by sex in the years 2022–2025 [
](https://prohuman.sk/files/images/obr2_5.popup_800.png) Source: Processed according to the annual reports of the Public Health Authority of the Slovak Republic for the years 2022–2025, sections of the Regional Public Health Authority Košice.
Discussion
Health counseling centers represent one of the options for implementing primary prevention of chronic non-communicable diseases. Through preventive examinations and individual counseling, they allow for the preliminary identification of selected behavioral, anthropometric, clinical, and biochemical risk factors. Knowledge gained in this way can contribute to the early recognition of individuals with increased cardiometabolic risk and to the implementation of interventions aimed at lifestyle modification. However, when interpreting the results, it is necessary to consider the selective nature of the sample, as clients of health counseling centers do not represent a representative sample of the population.
In the analyzed sample, the most frequently recorded risk factors in the years 2022–2025 were elevated total cholesterol concentration and overweight. The results point to the importance of preventive assessment of body weight, lipid metabolism, and other cardiometabolic indicators.
The representation of cardiometabolic risk factors varies between populations and time periods. Sacramento-Pacheco et al. (2025), in a systematic review, highlighted considerable heterogeneity in the occurrence of overweight, hypercholesterolemia, hypertension, and other cardiovascular risk factors in European Union countries. Differences between studies were related, in addition to geographic and population characteristics, to data collection methodology and the definitions used. The heterogeneity of results emphasizes the need for long-term monitoring based on uniform definitions and standardized data collection.
The analyzed data came from clients of the basic Health Counseling Center and participants in mobile preventive activities. The observed differences therefore characterize separate annual samples and cannot be interpreted as changes in risk factors in the same individuals. The source documents did not allow for the identification of individual clients or verification of their possible repeated participation in examinations. The results could have been influenced by the different composition of the samples, the scope of examinations performed, and the data collection methodology. Temporal changes in cardiometabolic risk factors were also assessed by Ostrihoňová et al. (2017) in a nationwide analysis of health counseling center clients. In the period 2003–2012, they recorded an increase in the age-standardized prevalence of metabolic syndrome, abdominal obesity, and elevated triacylglycerols. Since the presented analysis did not allow for age standardization or assessment of metabolic syndrome as a whole, differences between the years 2022–2025 cannot be interpreted as a continuation of the mentioned trend, but only as differences between separate annual client samples.
Elevated total cholesterol concentration was the most frequently recorded risk factor throughout the entire monitored period. In all years, the proportion of clients with this value was higher in women than in men, with statistically significant differences found in 2022 and 2025. Since data on the age composition of clients by sex were not available, it is not possible to assess to what extent these differences may have been influenced by age or other characteristics of the sample. Moreover, total cholesterol represents only a basic indicator of lipid metabolism. For a more comprehensive assessment of cardiometabolic risk, it would be appropriate to include concentrations of LDL-cholesterol, HDL-cholesterol, and triacylglycerols.
The association between dietary habits and disorders of lipid metabolism is supported by the systematic review by Mambrini et al. (2023). In one of the included prospective cohorts, individuals with high consumption of ultra-processed foods had a 28% higher risk of isolated hypercholesterolemia and a 38% higher risk of mixed hyperlipidemia compared to individuals with low consumption. These results support the importance of assessing dietary habits in clients with elevated total cholesterol concentration. Swarup et al. (2024) also state that the assessment of metabolic syndrome includes, in addition to blood pressure and glucose, the assessment of triacylglycerols and HDL-cholesterol.
Overweight was present in approximately one-third of examined clients and occurred more frequently in men in all monitored years. Increased body weight is among the significant modifiable factors of cardiometabolic risk and is associated with disorders of glucose metabolism, an unfavorable lipid profile, and elevated blood pressure. Swarup et al. (2024) state that central obesity is among the basic components of metabolic syndrome and is associated with the development of insulin resistance, hypertension, and dyslipidemia.
However, BMI alone may not sufficiently capture cardiometabolic risk. Rakhmat et al. (2022), in a meta-analysis of 24 cross-sectional studies involving 75,201 adults, found that individuals with normal BMI but increased body fat percentage had, compared to individuals with normal BMI and normal body fat percentage, a 1.60-fold higher likelihood of hypertension, a 1.50-fold higher likelihood of dyslipidemia, and a 1.72-fold higher likelihood of diabetes mellitus. These findings support supplementing BMI assessment with indicators of body fat amount and distribution.
The association between body weight, physical activity, and metabolic risk is also supported by the results of Kovács et al. (2024), who analyzed data from three waves of the European Health Interview Survey in eleven European Union countries. Their findings highlighted associations of BMI and physical activity with the occurrence of diabetes mellitus and other lifestyle characteristics. Direct comparison with the results of the presented analysis is, however, limited, as the EHIS data came from a population survey and several indicators were based on self-reporting by respondents.
The prevalence of obesity varied among the individual annual cohorts. In 2024, no client with obesity was reported in the source data. This finding must be interpreted with caution, as it may reflect differences in recording or data reporting rather than a true absence of obesity in that cohort. Therefore, for further analyses, it is important to ensure uniform BMI categorization and a consistent method of data reporting across all monitored periods.
Elevated measured blood pressure was more frequent in men across all monitored years, with statistically significant differences between men and women in the years 2022–2024. According to data from the World Heart Federation for 2019, the prevalence of hypertension in Slovakia was higher in men than in women. However, these population data cannot be directly compared with the results of the presented analysis, as the Health Counseling Center involved a one-time screening measurement in a selected sample of clients. According to the recommendations of the European Society of Hypertension, the diagnosis of hypertension is established based on repeatedly measured office systolic blood pressure values ≥ 140 mmHg and/or diastolic blood pressure values ≥ 90 mmHg (Mancia et al., 2023). Therefore, a single elevated value primarily has screening significance and should lead to a recommendation for repeated measurement or further examination.
The proportion of smokers varied across the monitored years, with the highest values recorded in 2023 and 2025. Although it was numerically higher in men in all years, the differences between sexes were not statistically significant. Smoking represents a significant behavioral risk factor for atherosclerotic cardiovascular diseases. Gallucci et al. (2020) state that it increases cardiovascular risk through oxidative stress, inflammatory processes, platelet dysfunction, and adverse effects on vasomotor function. The findings therefore justify the inclusion of brief interventions aimed at smoking cessation in preventive counseling.
The proportion of clients with a measured glucose concentration ≥ 6.0 mmol/l varied significantly among the annual cohorts. Screening assessment of glucose metabolism is particularly important in individuals with overweight, obesity, or elevated measured blood pressure. Mahrouseh et al. (2021), based on three waves of the European Health Interview Survey from 2009, 2014, and 2019, recorded an increase in the prevalence of declared diabetes mellitus in Slovakia. However, direct comparison with the results of the presented analysis is not possible, as the fasting status, type of biological material, previous diagnosis, and other clinical data were not known in the analyzed cohort. Therefore, the proportion of clients with a measured glucose concentration ≥ 6.0 mmol/l cannot be interpreted as the prevalence of prediabetes or diabetes mellitus. It is a screening indicator that requires subsequent verification through a standardized laboratory examination.
Data on physical activity supplemented information on the behavioral characteristics of clients. In 2022 and 2023, recreational physical activity was most frequently reported, while in 2024, regular activity predominated. Differences between years may have been influenced by the varying number and composition of respondents, as well as the method of ascertaining physical activity. Data for 2025 were based on only ten respondents; therefore, they cannot be reliably compared with previous years. The practical significance of assessing physical activity lies primarily in the possibility of targeted education aimed at increasing physical activity, reducing body weight, and overall lifestyle modification.
The results support the monitoring of individual risk factors even in cases where all data necessary for assessing metabolic syndrome are not available. Miláček et al. (2021) pointed out that increased cardiometabolic burden can also occur in individuals who do not meet the criteria for MS. Noubiap et al. (2026) simultaneously emphasize the importance of the accumulation of multiple risk factors. In the conditions of the Health Counseling Center, it is therefore justified to pay attention also to the isolated occurrence of overweight, elevated measured blood pressure, elevated total cholesterol concentration, or elevated measured glucose concentration.
Among the main limitations of the work are the use of secondary aggregated data, the cross-sectional nature of the annual cohorts, and the varying availability of data for individual indicators. Despite these limitations, the results document the frequent occurrence of modifiable cardiometabolic risk factors among clients of the basic Health Counseling Center. Health Counseling Centers can thus play a significant role in their screening detection, provision of individualized counseling, and recommendation of further examination for individuals with identified abnormalities.
Conclusion
The analysis of data from the years 2022–2025 highlighted a significant representation of several modifiable cardiometabolic risk factors among clients of the basic Health Counseling Center of the RÚVZ based in Košice. The results also showed differences between individual annual cohorts, which emphasizes the need for uniform and systematic recording of the monitored indicators.
The acquired knowledge can be used in planning preventive activities, targeted client education, and early referral for further specialized examination. Given the nature of the analyzed data, the conclusions apply exclusively to the examined client cohorts and do not allow for assessing the population trend or the state of cardiometabolic risk in the entire population of Košice.
Authors:
Mgr. Andrea Houžvičková, PhD. prof. Mgr. MUDr. Erik Dorko, PhD., MPH, MBA Institute of Public Health and Hygiene, UPJŠ LF in Košice
The work was supported by grant projects KEGA of the Ministry of Education, Research, Development and Youth of the Slovak Republic No. 001UPJŠ-4/2024 and No. 003UPJŠ-4/2024.
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