Study reveals regional risk factors driving heart disease in Asia and Oceania

A new study puts the spotlight on the rising burden of ischemic heart disease across Southeast Asia, East Asia and Oceania, and calls for localized, equity-focused interventions in these regions. The researchers identified region-specific, modifiable risk factors that influence the increasing prevalence of ischemic heart disease, such as toxic air pollution in East Asia and ultra-processed dietary dependence in Oceania. The study will be presented at the ACC Asia 2025 Together With SCS 36th Annual Scientific Meeting in Singapore.

Ischemic heart disease (IHD) occurs when a narrowing of the arteries caused by plaque buildup reduces blood flow to the heart, preventing the heart muscle from receiving enough oxygen. The most common symptom of IHD is chest pressure or pain. Patients with IHD are at risk of a heart attack or arrhythmia. Treatments for IHD include medications, angioplasty (a minimally invasive procedure to open blocked arteries) or coronary bypass surgery.

Our study uncovers a critical and underreported dimension of the global cardiovascular crisis: the rapidly rising and regionally distinct burden of ischemic heart disease across Southeast Asia, East Asia, and Oceania-regions that together represent over two billion people. The global cardiovascular agenda cannot succeed if it overlooks the rapidly evolving crisis in these regions-and this study is a call to action for policymakers, researchers, and health systems worldwide to expand their lens and recalibrate their priorities."

Hardik Dineshbhai Desai, MBBS, lead author, independent Clinician-scientist, Public Health Researcher and senior remote research collaborator with the Global Burden of Disease Study, led by the Institute for Health Metrics and Evaluation at the University of Washington

The researchers used data from the Global Burden of Disease 2021 standardized methodology to assess the changing incidence and prevalence of IHD, along with rates of mortality and disability due to IHD, across Southeast Asia, East Asia and Oceania. They analyzed attributable risk factors stratified by age, sex, year and location from 1990-2021. The goal of the study was to establish a comprehensive, region-specific assessment of IHD burden and its attributable risk factors in these regions spanning the past three decades.

Southeast Asia included Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Maldives, Mauritius, Myanmar, Philippines, Seychelles, Sri Lanka, Thailand, Timor-Leste, and Viet Nam. East Asia included China, Democratic People's Republic of Korea, and Taiwan. Oceania included American Samoa, Cook Islands, Fiji, Guam, Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, Niue, Northern Mariana Islands, Palau, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, and Vanuatu.

The results showed from 1990- 2021 the annual percentage change (APC) of IHD prevalence increased by 3.79%. The IHD death rate rose by 4.12% and disability-adjusted life years increased by 3.24%. People younger than 70 years old showcased a significant increase in IHD incidence and disability-adjusted life years. On the other hand, the people who were older than 70 had an increase in deaths.

In 2021, Oceania had the highest age-standardized IHD mortality rate of 170.9 per 100,000 people, followed by Southeast Asia with a rate of 110.9 and East Asia with a rate of 108.9.

Looking at the long-term trends, the key findings are:

• East Asia had the highest burden of IHD over the last three decades, and it was the only region with a consistent rise across all major indicators from 1990 – 2021.
• The overall IHD mortality rate increased with an APC of +0.48% in East Asia, –0.21% in Oceania and –0.11% in Southeast Asia.
• Metabolic risk–related deaths in East Asia increased from 65.6 to 80.9 per 100,000 people with an APC of +0.68%. This was the sharpest increase across all three regions.
• Behavioral risk–related deaths rose modestly (APC: +0.03%) in East Asia, while both Oceania and Southeast Asia experienced declines.

"Our findings reveal a twofold story of urgency: Oceania bears the highest absolute burden of ischemic heart disease in 2021, while East Asia is experiencing the steepest long-term increase in mortality rates-across all major risk categories," he said.

Region-specific health disparities in IHD are primarily attributed to differing key risk factors, according to Desai. High blood pressure, unhealthy dietary patterns and air pollution are prevalent IHD risk factors in East Asia. In Southeast Asia, the leading risk factors are high blood pressure, dietary patterns, and heightened LDL cholesterol, pointing to a critical gap in lipid management and nutritional health. In Oceania, dietary risks are the most significant attributable risk factor for IHD, followed by high blood pressure and air pollution. High blood pressure was the most significant risk factor across all three regions, emphasizing the urgent need for comprehensive hypertension screening and control strategies.

"What our study brings to light is not just a health crisis-but an economic paradox. Across Southeast Asia, East Asia, and Oceania, the very forces driving economic growth-urbanization, industrialization, and globalized food systems-are simultaneously accelerating the burden of ischemic heart disease," Desai said. "In an era of globalization-where migration, environmental exposure, and chronic disease trends transcend borders-these findings carry major implications for global health security, including in high-income nations like the United States. By identifying these shifts early, this research equips health systems worldwide with the foresight to act decisively, equitably, and ahead of the curve."

Air pollution and highly processed, low-nutrient foods are byproducts of this economic growth. Prioritizing industrialization and globalized food systems puts a strain on health care systems and makes communities increasingly vulnerable to cardiovascular diseases.

"The patterns emerging in Asia-Pacific today could reflect the future of cardiometabolic disease elsewhere. By identifying these shifts early, this research equips health systems worldwide with the foresight to act decisively, equitably, and ahead of the curve," Desai said.