The number of people dying from cardiovascular disease in Asia is increasing rapidly, with over half of all cardiovascular disease deaths globally in 2019 occurring in Asian countries, according to a state-of-the-art review paper published June 15 in the inaugural issue of JACC: Asia. The data demonstrate an urgent need to understand the burdens and epidemiological features of cardiovascular disease in Asian countries to develop localized cardiovascular disease prevention strategies to combat the epidemic.

In the paper, Dong Zhao, MD, PhD, a deputy editor of JACC: Asia, reviewed data on cardiovascular disease epidemiology in Asian countries from multiple sources and identified five epidemiological features in Asia: continuously increasing cardiovascular disease mortality rate; geographic differences in cardiovascular disease mortality; regional differences in the dominant cardiovascular disease subtype; countries that are in different transition stages of the cardiovascular disease epidemic; and the increasing epidemics and massive burdens of key modifiable cardiovascular disease risk factors in most countries with inadequate capacities for management.

Results showed that from 1990-2019, the proportion of cardiovascular disease deaths among total deaths in Asia increased from 23% to 35%, and crude cardiovascular disease mortality rates grew in both men and women. The rising crude cardiovascular disease mortality rates indicate the increasing burden of cardiovascular disease in Asian populations.

There were significant geographic differences in crude cardiovascular disease mortality rates among Asian countries in 2019. The highest cardiovascular disease mortality rate in Asia was in Georgia (810.7 per 100,000 population) and the lowest was in Qatar (39.1 per 100,000 population), representing a 20-fold difference.

While ischemic heart disease (IHD) and stroke are the most common causes of cardiovascular disease in Asia, epidemics of these two types of cardiovascular disease varied substantially between Asian regions and countries. IHD was the most dominant cause of cardiovascular disease deaths in Central, Western and Southern Asia, whereas deaths from stroke were more common than IHD deaths in Eastern and Southeastern Asia. In China, the dominant subtype of cardiovascular disease deaths has shifted from stroke to IHD. According to Zhao, the underlying cause of the differences in the dominant cardiovascular disease subtypes among Asian regions or countries is still not well understood.

The paper also compared the characteristics of cardiovascular disease spectrums (the distributions of relevant disease categories in total deaths) in low-, middle- and high-income (or developed) Asian countries since countries at different stages of economic development may feature different transition stages of the cardiovascular disease epidemic.

Most Asian countries are in the second stage of the rapidly increasing cardiovascular disease epidemic. In these countries like China, cardiovascular disease mortality rates are relatively high, with the proportion of cardiovascular disease deaths among total deaths generally greater than 40%. Characteristics of cardiovascular disease epidemics in high-income or developed countries feature the third stage of the epidemiological transition, with lower proportions of cardiovascular disease deaths. In Japan and South Korea, the proportions of cardiovascular disease deaths among total deaths decreased from 34.9% and 36.2% in 1990, to 26.6% and 24.3% in 2019, respectively.

According to Zhao, the increasing prevalence of cardiovascular disease risk factors is a major modifiable cause of the rising cardiovascular disease epidemics in Asia. These risk factors include dietary, smoking, dyslipidemia, diabetes and hypertension, among many others.

"The information summarized in this review provides a complete picture of cardiovascular disease epidemiology in Asia, highlighting specific requirements for the development of localized cardiovascular disease prevention strategies and research, and may illuminate not only the current but also future challenges faced by different Asian countries," Zhao concludes.

JACC: Asia is the first region-specific cardiovascular journal with original peer-reviewed content, and features state-of-the-art reviews, original research papers, editorial comments and research letters by Asian authors and focused on Asian patient populations.

Don't miss the Editor's page by Editor-in-Chief Jian'an Wang, MD, PhD, FACC, and a second Editor's Page by JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC. Summary podcasts recorded by editorial board members also accompany the issue. Read the full issue here and sign up for editorial alert emails to never miss an issue.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Diet, Hypertension, Smoking

Keywords: ACC International, Asia, Diet, Hypertension, Diabetes Mellitus, Stroke, Myocardial Ischemia, Smoking, Dyslipidemias

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