Cardiovascular diseases (CVDs) are a major public health concern, particularly in developing countries where the epidemiological transition is accompanied by an increasing prevalence of cardiovascular risk factors. According to the World Health Organization (WHO), the workplace directly influences the physical, mental, economic, and social well-being of workers, as well as the health of their families, communities, and society as a whole [1].

Long considered a feature of developed countries, industrialization is rapidly expanding in sub-Saharan Africa. In Benin, the agro-textile industry is one of the pillars of the national economy. Between 2017 and 2018, the cotton sector contributed approximately 12% - 13% of Benin’s Gross Domestic Product (GDP). This rapidly growing sector exposes workers to physical, chemical, and psychosocial conditions that may contribute to the development of cardiovascular diseases.

Cardiovascular diseases are the leading cause of death among non-communicable diseases (NCDs), accounting for an estimated 17.9 million deaths annually worldwide [2][3]. The occupational setting is not exempt from this burden. To improve the prevention of CVDs in the workplace, it is essential to focus on the prediction of global cardiovascular risk (CVR). Global CVR is defined as the probability of developing a symptomatic cardiovascular disease within a specified period, usually 10 years [4][5]. Global CVR prediction, therefore, targets individuals without clinically manifest cardiovascular disease, for whom the identification and management of risk factors may prevent, reduce, or delay the onset of cardiovascular disease [5]. Depending on the context, several tools can be used to assess global cardiovascular risk [6]-[8].

In Benin, studies on global CVR prediction have been conducted in the general population, vulnerable groups, and workers in the tertiary sector, but very few have focused on industrial workers. However, previous studies have reported associations between global CVR and occupational factors [9]-[11] such as noise exposure [12][13], shift work atypical working hours [10][14][15], and occupational stress [16][17], all of which are common exposures in the agro-textile industry. Therefore, this study aimed to determine the prevalence of global CVR and its associated factors among workers in Benin’s agro-textile industry in 2019, thereby addressing an important gap in the existing literature.

Data collection was conducted in five stages:

First, face-to-face interviews were conducted using a smartphone-based digital questionnaire implemented through KoBoCollect software. The questionnaire was adapted from the WHO STEPwise instruments for non-communicable disease surveillance. Data were recorded electronically using tablets equipped with the KoBoCollect application.

Second, participants underwent a physical examination performed by occupational physicians, following anthropometric measurements conducted by trained nurses. Weight, height, and waist circumference were measured using calibrated mechanical scales (SECA model 761), portable stadiometers, and flexible measuring tapes, respectively.

Blood pressure was measured using an automated electronic sphygmomanometer (SPENGLER^®) with an appropriately sized cuff. Measurements were taken with participants seated after at least 15 minutes of rest. The cuff was placed on the bare left arm, with the arm supported on a table and the palm facing upward. Three consecutive measurements were obtained at three-minute intervals, and the mean of the last two readings was used for analysis.

Third, fasting blood samples were collected after a minimum fasting period of 12 hours. Venous blood samples were drawn by a laboratory technician at the workplace into plain and ethylenediaminetetraacetic acid (EDTA) tubes.

Fourth, biochemical analyses were performed in the clinic, which is routinely responsible for employee health monitoring. All laboratory measurements were standardized according to the laboratory’s routine procedures and validated by the supervising clinical biologist.

Finally, the WHO/ISH cardiovascular risk prediction charts for the AFR-D subregion [18] and the D’Agostino et al.’s Framingham cardiovascular risk model [19] were used to estimate cardiovascular risk.

This study assessed cardiovascular risk and its associated factors among permanent workers in agro-textile factories in Benin. According to the WHO/ISH cardiovascular risk prediction charts, 6 workers (3.53%) had an absolute 10-year cardiovascular risk ≥ 10%. Using the Framingham cardiovascular risk model, 14 workers (8.24%) had an absolute 10-year cardiovascular risk ≥ 10%, while 29 workers (17.06%) had a Framingham-based risk difference > 5%. No statistically significant association was observed between the investigated sociodemographic, occupational, behavioral, or biological factors and a Framingham-based risk difference > 5%.

Comparison of our findings with those reported in the literature should be interpreted with caution because of differences in study populations, occupational settings, and cardiovascular risk assessment methods. In Spain, Chaparro et al. reported a prevalence of high cardiovascular risk of 5.59% among workers using the SCORE risk assessment tool [24]. Similarly, Vandersmissen et al. reported a prevalence of 7% among Belgian workers undergoing occupational health surveillance [25], while Strauss et al. reported a prevalence of 10.7% among German military officers in 2020 [26]. Differences in cardiovascular risk assessment methods, study populations, and occupational environments may partly explain the variation in cardiovascular risk estimates across studies.

In Algeria, Behlouli et al. reported no cases of high cardiovascular risk among workers in 2017 [27]. Differences between their findings and ours may be related to differences in the cardiovascular risk assessment methods and study populations, particularly as their study included only men. Similarly, Chebab et al. reported a prevalence of high cardiovascular risk of 13% among workers employed in an oil-sludge company in southern Algeria [28].

Higher prevalence estimates have been reported elsewhere. In Brazil, Bernhard et al. and Cezar-Vaz et al. reported prevalences of 22.3% [29] and 28.9% [30], respectively, among rural workers. These differences may reflect variations in cardiovascular risk assessment methods, occupational settings, working conditions, and population characteristics.

In the present study, none of the factors investigated was significantly associated with a Framingham-based risk difference > 5%. Nevertheless, several occupational factors have been identified as potential determinants of cardiovascular risk in previous studies. In particular, the association between occupational noise exposure and cardiovascular risk has been documented in several occupational settings. Studies conducted in Italy, as well as a meta-analysis from China, reported that workers exposed to occupational noise had an increased risk of cardiovascular disease and related outcomes, including hypertension and electrocardiographic abnormalities [31]-[33].

Evidence also suggests a dose-response relationship between prolonged occupational noise exposure and cardiovascular disease. Chronic exposure to noise may activate neuroendocrine stress pathways, resulting in elevated blood pressure and an increased risk of cardiovascular disease.

Although job tenure was not associated with a Framingham-based risk difference > 5% in the present study, associations involving job tenure, job position, and occupational category have been reported in previous studies [27][34]. Such relationships may reflect differences in occupational exposures across job categories and the cumulative effects of long-term exposure to occupational hazards.

In contrast to our findings, shift and night work have been identified as important determinants of cardiovascular risk in several occupational settings. Farha et al. reported an association between shift work and high cardiovascular risk among Jordanian workers [35]. Similarly, evidence from systematic reviews and meta-analyses supports a positive relationship between shift work and cardiovascular disease, with the risk increasing with longer durations of exposure [36].

This association may be explained by the disruption of circadian rhythms, which has been linked to neuroendocrine dysregulation, psychosocial stress, adverse dietary behaviors, and metabolic disturbances. These alterations may contribute to the development of obesity, hypertension, hyperglycemia, and dyslipidemia, thereby increasing cardiovascular risk [37].

No significant association was observed between occupational stress and a Framingham-based risk difference > 5% in the present study. However, previous studies have suggested that occupational stress, particularly job strain and long working hours, may increase the risk of cardiovascular disease [38][39]. The absence of a statistically significant association in our study may be related to the characteristics of the study population, the relatively small sample size, or differences in the assessment of occupational stress and cardiovascular risk.

Similarly, although alcohol consumption has been associated with cardiovascular risk and mortality in previous studies [40]-[42], no significant association was observed between alcohol consumption and a Framingham-based risk difference > 5% in our study.

This study provides valuable insights into cardiovascular risk among permanent workers in agro-textile factories in Benin. Its main strengths include the recruitment of permanent workers across the participating factories and the incorporation of occupational factors into the analysis. However, the cross-sectional design precludes causal inference, and the limited number of workers with a Framingham-based risk difference > 5% may have reduced the statistical power to detect significant associations. Furthermore, occupational exposures were classified primarily based on job characteristics and routinely performed tasks, rather than on individual quantitative measures of exposure intensity. Further prospective studies involving larger populations and more detailed occupational exposure assessment are warranted to better identify the determinants of cardiovascular risk in this occupational setting.

This study provides one of the first assessments of cardiovascular risk among permanent workers in agro-textile factories in Benin. Cardiovascular risk estimates varied according to the assessment method used. Although no investigated factor was significantly associated with a Framingham-based risk difference > 5%, the findings highlight the importance of regular occupational health surveillance, cardiovascular risk screening, and preventive interventions in this workforce. Further studies involving larger populations are needed to better identify the determinants of cardiovascular risk in this occupational setting.

Mênonli Adjobimey: Conceptualization, methodology, investigation, data collection, supervision, data analysis and statistical analysis, interpretation of results, and writing—original draft; Mama Cissé Ibrahim: Conceptualization, critical review and revision of the manuscript; Conchéta Tchibozo: Data analysis and statistical analysis; Nayéton Rose Mikponhoué: Critical review and revision of the manuscript; Paul Ayélo: Critical review and revision of the manuscript; Dismand Houinato: Conceptualization, critical review and revision of the manuscript; Vikkey Antoine Hinson: Conceptualization, critical review and revision of the manuscript. All authors: Read and approved the final version of the manuscript.