While global stroke and ischemic heart disease (IHD) mortality dropped 51.7% and 38.2% respectively between 1990 and 2023, Western Sub-Saharan Africa (WSSA) achieved only a 21.8% stroke reduction and saw IHD mortality actually increase by 3.3%. Segmented regression of GBD 2023 data pinpointed a 2007 inflection point after which WSSA's IHD trend reversed from declining to rising. High systolic blood pressure remains the dominant attributable risk factor for both diseases, while obesity, ambient air pollution, and elevated fasting glucose posted the sharpest relative increases. Sociodemographic Index gains of 69.5% strongly correlated with stroke reduction (r = −0.87) but showed virtually no relationship with IHD mortality (r = 0.21), suggesting economic development alone is insufficient protection against the region's cardiovascular trajectory.
This ecological analysis exposes a troubling paradox: meaningful economic growth in WSSA has not translated into IHD control the way it has elsewhere. The 2007 breakpoint likely reflects the region's rapid nutritional and lifestyle transition — urbanization accelerating processed-food consumption and physical inactivity — outpacing health system capacity to manage hypertension and diabetes. Unlike high-income countries that built cardiometabolic infrastructure before epidemiological transition peaked, WSSA faces both simultaneously. The reliance on GBD modeled estimates rather than direct vital registration is a real limitation, as data quality varies across the 16 countries aggregated here. As an ecological study, causality cannot be established. This is a preprint not yet peer-reviewed, so findings warrant cautious interpretation. Still, the divergence is striking and directionally consistent with other regional analyses — classifying this as a confirmatory but urgency-amplifying contribution to global health policy.
