The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions

Rachel Sze Jen Goh; Bryan Chong; Jayanth Jayabaskaran; Silingga Metta Jauhari; Siew Pang Chan; Martin Tze Wah Kueh; Kannan Shankar; Henry Li; Yip Han Chin; Gwyneth Kong; Vickram Vijay Anand; Keith Andrew Chan; Indah Sukmawati; Sue Anne Toh; Mark Muthiah; Jiong-Wei Wang; Gary Tse; Anurag Mehta; Alan Fong; Lohendran Baskaran; Liang Zhong; Jonathan Yap; Khung Keong Yeo; Derek J Hausenloy; Jack Wei Chieh Tan; Tze-Fan Chao; Yi-Heng Li; Shir Lynn Lim; Koo Hui Chan; Poay Huan Loh; Ping Chai; Tiong Cheng Yeo; Adrian F Low; Chi Hang Lee; Roger Foo; Huay Cheem Tan; James Yip; Sarita Rao; Satoshi Honda; Satoshi Yasuda; Takashi Kajiya; Shinya Goto; Bryan P Yan; Xin Zhou; Gemma A Figtree; Mamas A Mamas; Yongcheol Kim; Young-Hoon Jeong; Moo Hyun Kim; Duk-Woo Park; Seung-Jung Park; A Mark Richards; Mark Y Chan; Gregory Y H Lip; Nicholas W S Chew

doi:10.1016/j.lanwpc.2024.101138

The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions

Lancet Reg Health West Pac. 2024 Jul 10:49:101138. doi: 10.1016/j.lanwpc.2024.101138. eCollection 2024 Aug.

Authors

Rachel Sze Jen Goh¹, Bryan Chong¹, Jayanth Jayabaskaran¹, Silingga Metta Jauhari^{2

3}, Siew Pang Chan^{1

2

3}, Martin Tze Wah Kueh^{4

5}, Kannan Shankar¹, Henry Li⁶, Yip Han Chin⁷, Gwyneth Kong⁷, Vickram Vijay Anand⁸, Keith Andrew Chan^{3

9}, Indah Sukmawati¹⁰, Sue Anne Toh^{1

11

12

13}, Mark Muthiah^{1

14

15}, Jiong-Wei Wang¹⁶, Gary Tse^{17

18}, Anurag Mehta¹⁹, Alan Fong^{20

21}, Lohendran Baskaran^{22

23

24}, Liang Zhong^{23

24

25}, Jonathan Yap²², Khung Keong Yeo²², Derek J Hausenloy^{1

26

27

28}, Jack Wei Chieh Tan²², Tze-Fan Chao^{29

30}, Yi-Heng Li³¹, Shir Lynn Lim^{1

3

32}, Koo Hui Chan^{1

3}, Poay Huan Loh^{1

3

33}, Ping Chai^{1

3}, Tiong Cheng Yeo^{1

3}, Adrian F Low^{1

3}, Chi Hang Lee^{1

3}, Roger Foo^{1

3}, Huay Cheem Tan^{1

3}, James Yip^{1

3}, Sarita Rao³⁴, Satoshi Honda³⁵, Satoshi Yasuda³⁵, Takashi Kajiya³⁶, Shinya Goto³⁷, Bryan P Yan³⁸, Xin Zhou³⁹, Gemma A Figtree⁴⁰, Mamas A Mamas⁴¹, Yongcheol Kim⁴², Young-Hoon Jeong⁴³, Moo Hyun Kim⁴⁴, Duk-Woo Park⁴⁵, Seung-Jung Park⁴⁵, A Mark Richards^{46

47}, Mark Y Chan^{1

3}, Gregory Y H Lip^{48

49}, Nicholas W S Chew^{1

3}

Affiliations

¹ Yong Loo Lin School of Medicine, National University Singapore, Singapore.
² Department of Biostatistics, Cardiovascular Research Institute, National University Heart Centre (Singapore), NUHS.
³ Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
⁴ Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Malaysia.
⁵ UCD School of Medicine and Medical Science, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
⁶ University of New South Wales, Australia.
⁷ Ministry of Health Holdings, Ministry of Health, Singapore.
⁸ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
⁹ Section of Adult Cardiology, Chong Hua Hospital, Philippines Don Mariano Cui Street, Fuente Osmeña, Cebu City, 6000, Philippines.
¹⁰ Cardiovascular Department, Siloam Hospitals Lippo Village, Pelita Harapan University, Tangerang, Indonesia.
¹¹ Department of Medicine, National University Hospital, Singapore.
¹² NOVI Health, Singapore.
¹³ Regional Health System Office, National University Health System, Singapore.
¹⁴ Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
¹⁵ National University Centre for Organ Transplantation, National University Health System, Singapore.
¹⁶ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore.
¹⁷ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
¹⁸ Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, United Kingdom.
¹⁹ Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA.
²⁰ Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia.
²¹ Department of Cardiology, Sarawak Heart Center, Kota Samarahan, Malaysia.
²² Department of Cardiovascular Medicine, National Heart Centre Singapore, and Duke-National University of Singapore, Singapore.
²³ CVS.AI, National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore.
²⁴ Cardiovascular Sciences Academic Clinical Program & Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore, 169857, Singapore.
²⁵ Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore.
²⁶ Duke-NUS Medical School, Cardiovascular and Metabolic Disorders Programme, Singapore, Singapore.
²⁷ National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore.
²⁸ University College London, The Hatter Cardiovascular Institute, London, UK.
²⁹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
³⁰ Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³¹ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³² Pre-hospital Emergency Research Centre, Duke-NUS Medical School, Singapore.
³³ Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore.
³⁴ Department of Cardiology, Apollo Hospital, Indore, India.
³⁵ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
³⁶ Clinical Research Center, Tenyoukai Central Hospital, 6-7 Izumi-cho, Kagoshima, 892-0822, Japan.
³⁷ Department of Medicine (Cardiology), Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
³⁸ Department of Medicine & Therapeutics, The Chinese University of Hong Kong.
³⁹ Department of Cardiology, Tianjin Medical University General Hospital, 154, Anshan Road, Heping District, Tianjin, 300052, China.
⁴⁰ Department of Cardiology, Royal North Shore Hospital, Australia.
⁴¹ Keele Cardiovascular Research Group, School of Medicine, Keele University, United Kingdom.
⁴² Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea.
⁴³ CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
⁴⁴ Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea.
⁴⁵ Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴⁶ Christchurch Heart Institute, University of Otago, New Zealand.
⁴⁷ Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore.
⁴⁸ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
⁴⁹ Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Background: Given the rapidly growing burden of cardiovascular disease (CVD) in Asia, this study forecasts the CVD burden and associated risk factors in Asia from 2025 to 2050.

Methods: Data from the Global Burden of Disease 2019 study was used to construct regression models predicting prevalence, mortality, and disability-adjusted life years (DALYs) attributed to CVD and risk factors in Asia in the coming decades.

Findings: Between 2025 and 2050, crude cardiovascular mortality is expected to rise 91.2% despite a 23.0% decrease in the age-standardised cardiovascular mortality rate (ASMR). Ischaemic heart disease (115 deaths per 100,000 population) and stroke (63 deaths per 100,000 population) will remain leading drivers of ASMR in 2050. Central Asia will have the highest ASMR (676 deaths per 100,000 population), more than three-fold that of Asia overall (186 deaths per 100,000 population), while high-income Asia sub-regions will incur an ASMR of 22 deaths per 100,000 in 2050. High systolic blood pressure will contribute the highest ASMR throughout Asia (105 deaths per 100,000 population), except in Central Asia where high fasting plasma glucose will dominate (546 deaths per 100,000 population).

Interpretation: This forecast forewarns an almost doubling in crude cardiovascular mortality by 2050 in Asia, with marked heterogeneity across sub-regions. Atherosclerotic diseases will continue to dominate, while high systolic blood pressure will be the leading risk factor.

Funding: This was supported by the NUHS Seed Fund (NUHSRO/2022/058/RO5+6/Seed-Mar/03), National Medical Research Council Research Training Fellowship (MH 095:003/008-303), National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme, NUHS Clinician Scientist Program (NCSP2.0/2024/NUHS/NCWS) and the CArdiovascular DiseasE National Collaborative Enterprise (CADENCE) National Clinical Translational Program (MOH-001277-01).

Keywords: Asia; Cardiovascular disease; Disability-adjusted life years; Global burden; Mortality; Risk factors.