Review highlights need to develop CVD prevention strategies, research in Asia
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A new review on systematic studies and analyses highlighted the urgent need for the development of CVD prevention strategies and research to impede CVD epidemics in Asia.
In 2019, 58% of CVD deaths worldwide occurred in Asia, according to the review.
“As the continent with the largest population and greatest diversity of ethnicities, cultures, socioeconomic status and health care systems, Asia faces many challenges in CVD prevention and treatment,” Dong Zhao, MD, PhD, from the department of epidemiology at Beijing Anzhen Hospital at Capital Medical University at the Beijing Institute of Heart, Lung and Blood Vessel Diseases, wrote in the inaugural issue of the Journal of the American College of Cardiology: Asia. “Timely information on the burdens and epidemiological features of CVD in Asian countries is crucial to understanding the challenges and orienting the development of reasonable policies, strategies and actions to combat the CVD epidemic.”
In 2019, CVD caused 10.8 million deaths in Asia, with 39% defined as premature. Of these deaths, 87% were due to ischemic heart disease (47%) or stroke (40%). Premature deaths in Asia were higher than premature CVD deaths in the U.S. (23%), Europe (22%) and globally (34%).
Regionally, the highest CVD mortality rate in Asia was in Georgia with 810.7 per 100,000 population and the lowest CVD mortality rate was in Qatar with 39.1 per 100,000 population. In central and eastern Asia, CVD rates were higher compared with southern and southeast Asia. In addition, among total CVD deaths, the rate of premature CVD deaths was elevated in many low- and middle-income Asian countries but was lower in higher-income countries, including Japan (11%) and Israel (15%).
Among subtypes, ischemic heart disease was the most dominant cause of CVD death, accounting for 62% of deaths in central Asia, 60% in western Asia and 57% in southern Asia. However, stroke death was more common than death due to ischemic heart disease in eastern Asia (48% vs. 41%) and southeastern Asia (49% vs. 39%). Some Asian countries demonstrated significant differences between mortality for ischemic heart disease and stroke, such as a seven times higher mortality rate for ischemic heart disease in Lebanon and more than three times higher mortality rate for stroke in Armenia and Uzbekistan.
“It is critical to recognize the characteristics of different transition stages of the CVD epidemic in different Asian countries to guide the identification of priority issues in public health, resource allocation and research in these countries,” Zhao wrote.
For the first or early stage of CVD epidemics in Asia, characteristics including lower CVD mortality rates and proportions of CVD among total deaths; high proportion of premature CVD deaths among CVD deaths; deaths due to communicable, maternal, neonatal and nutritional diseases; lower proportion of cancer deaths than CVD deaths; and fewer deaths caused by dementia were identified in lower-income countries.
According to Zhao, more Asian countries are currently in the second stage of the CVD epidemic. In this second stage, CVD mortality rates are very high, with CVD deaths higher than 40% among total deaths and fewer than 10% of deaths caused by communicable, maternal, neonatal and nutritional diseases.
The third stage of CVD epidemics is categorized by further extension of life expectancy, lower proportions of CVD deaths and lower premature CVD deaths. Also, deaths caused by cancer will become more dominant, and there will be an increase in deaths caused by dementia. Many high-income or developed Asian countries, such as Japan and South Korea, demonstrated this stage over 30 years. There was a reduction in CVD deaths among total deaths in Japan and South Korea from 1990 to 2019 (Japan, 34.9% vs. 26.6%; South Korea, 36.2% vs. 24.3%). In Japan and South Korea, there was also an increase in cancer deaths and dementia deaths from 1990 to 2019.
The review highlighted the following risk factors as important determinants of Asian CVD epidemics:
- diet;
- smoking;
- obesity;
- hypertension;
- dyslipidemia;
- diabetes; and
- population aging.
“The information summarized in this review provides a complete picture of CVD epidemiology in Asia, highlighting specific requirements for the development of localized CVD prevention strategies and research, and may illuminate not only the current, but also future challenges faced by different Asian countries,” Zhao wrote.
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