<p>Funnel plot of SBP by geographical regions.</p>

Cardiometabolic diseases (CMDs) disproportionately affect vulnerable populations worldwide. Community health worker (CHW)–led interventions may reduce risk and improve preventive care, but their effectiveness remains unclear. This systematic review and meta-analysis evaluated their effectiveness on cardiometabolic outcomes in vulnerable groups. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, ClinicalTrials.gov, and Cochrane Library was performed from January 1, 2000 to December 20, 2025, for randomized trials of CHW-led interventions on cardiometabolic outcomes. Primary outcomes were systolic and diastolic blood pressure; secondary outcomes were body mass index (BMI), glycosylated hemoglobin (HbA1c), and low-density lipoprotein cholesterol (LDL-C). Outcomes were pooled as mean differences using the generic inverse variance method; heterogeneity was assessed using I². Thirty randomized trials (15,295 participants) were included. CHW-led interventions significantly improved systolic blood pressure (WMD = −3.72 mmHg; 95% CI: −5.94 to −1.51; I² = 99.1%) and diastolic blood pressure (WMD = −2.22 mmHg; 95% CI: −3.50 to −0.95; I² = 98.6%); 95% prediction intervals crossed the null for all five outcomes (e.g., SBP: −15.12 to 7.67 mmHg), indicating uncertainty at a new site. BMI and HbA1c improved modestly but were attenuated to non-significance by trim-and-fill analysis, suggesting publication bias; LDL-cholesterol effects were not significant. SBP reductions were significant in low- and middle-income countries (LMICs) (WMD = −5.09 mmHg; 95% CI: −7.57 to −2.60) but not high-income countries (HICs), with the largest effects in Africa. GRADE certainty was low for blood pressure, moderate for BMI, very low for HbA1c, and low for LDL-cholesterol. CHW-led interventions modestly improve cardiometabolic outcomes in vulnerable populations, with low-to-very-low certainty evidence for blood pressure and glycemic control and moderate certainty for BMI, supporting a potential role in cardiovascular risk-reduction strategies, particularly in LMICs. However, wide prediction intervals and non-significant meta-regression for intervention design features (contact frequency, duration, delivery format) warrant cautious, hypothesis-generating interpretation pending higher-quality trials.

Systematic review Registration

Registration Number: PROSPERO 2025 CRD420251248842