The burden of cardiovascular diseases in Asia from 1990 to 2023

Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality and disability worldwide. Asia bears a disproportionate share of this burden, with substantial heterogeneity across subregions. Methods: Using data from the Global Burden of Disease (GBD) 2023 Study, we assessed the burden of CVDs in Asia and its subregions from 1990 to 2023, including prevalence, deaths, and disability-adjusted life years (DALYs), stratified by age and sex. Temporal trends were evaluated using Joinpoint regression, and decomposition analysis was performed to quantify the contributions of population growth, aging, and epidemiological changes. Population attributable fractions of level 2 risk factors and rankings of the most detailed risk exposures were assessed across subregions. Estimates for prevalence, deaths, DALYs, and population attributable fractions with corresponding 95% uncertainty intervals (UI) were derived. Results: From 1990 to 2023, age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) declined across all Asian subregions, whereas age-standardized prevalence rates remained stable or increased in several regions. Joinpoint regression analysis revealed transient increases in ASMR and ASDR during specific periods in certain subregions. In 2023, East Asia had the largest absolute burden (140.5 million cases [95% UI: 130.7–152.8]; 4.7 million deaths [95% UI: 4.1–5.2]), while South Asia recorded the highest DALYs (102.3 million [95% UI: 90.6–113.5]). Central Asia exhibited the highest age-standardized rates (ASMR: 400.7 [95% UI: 374.0–418.6]; ASDR: 8,111.4 [95% UI: 7,734.2–8,421.9] per 100,000), whereas high-income Asia Pacific had the lowest. Despite the declines in age-standardized rates, absolute CVD deaths increased in all subregions, with decomposition analysis showing this rise was primarily driven by population aging and population growth. Ischemic heart disease and stroke accounted for over 86% of deaths and DALYs in most subregions, with ischemic heart disease predominating in Central Asia and stroke contributing disproportionately in Southeast Asia. South Asia showed a notable burden of rheumatic heart disease, along with elevated early-life DALYs primarily driven by stroke and cardiomyopathy/myocarditis. Metabolic risk factors dominated across regions, with high systolic blood pressure and high low-density lipoprotein (LDL) cholesterol as the leading contributors. Conclusions: Although age-standardized CVD mortality and DALYs have declined across Asia, the overall burden remains substantial and heterogeneous. Region-specific strategies targeting dominant risk factors are essential to effectively reduce CVD burden across diverse Asian populations.