The impact and evolution of environmental/occupational, behavioural, and metabolic risk factors on CVD burdens in the Asia–Pacific region from 1990 to 2023: a secondary analysis of the Global Burden of Disease Study 2023
Abstract
Background Understanding epidemiological trends of the cardiovascular risk factors is integral in designing effective countermeasures in tackling cardiovascular diseases (CVD) in the Asia–Pacific. The study aims to examine the cardiovascular risk factor burden in the Asia–Pacific from 1990 to 2023, stratified by geographic subregion, sociodemographic index, and age-sex strata, to identify the region-specific risk factor targets for CVD prevention. Methods Estimates from the Global Burden of Disease Study 2023 were used to quantify cardiovascular mortality and disability-adjusted life years (DALYs) attributable to environmental/occupational, behavioural, and metabolic risk factors across 39 Asia–Pacific countries. Findings In 2023, cardiovascular risk factors contributed to 197.1 million DALYs, with an age-standardised DALY rate of 4463.7 per 100,000 population in the Asia–Pacific, which is 16.4% higher than the global estimate. Between 1990 and 2023, age-standardised DALYs declined by 34.9%, yet crude risk-attributable DALYs rose by 61.5%, as the demographic forces of population ageing (87.3%) and growth (45.3%) overwhelmed the gains from risk exposure reduction (−71.1%). Among risk factor categories, metabolic risk factors contributed to the fastest rise in CVD morbidity (74.3%), followed by behavioural (49.5%), and environmental/occupational risk factors (44.6%). The leading risk factors were high systolic blood pressure, dietary risks, air pollution and high LDL cholesterol. Interpretation The improvements in cardiovascular risk factor exposure in the Asia–Pacific have been offset by population growth and ageing. The metabolic-centric pattern in risk factors demands for strategies in tackling the region's high priority metabolic risk factor targets. Funding SingHealth Duke-National University of Singapore Cardiovascular Sciences Academic Clinical Programme, the National Medical Research Council of Singapore, and the Stafford Fox Foundation.
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Authors: Nicholas Chew, Anne Thushara Matthias, Khung Keong Yeo, Nicholas WS Chew, Yiming Chen, F Aaysha Cader, Bryan Chong, Clara K. Chow, Corina Grey, Yuming Guo, Haryo Raden Himan, Jayanth Jayabaskaran, Thushara Matthias, Srinithy Nagarajan, Adam J. Nelson, Marie Ng, Georgia Rejack, Anna Rolleston, Gregory Roth, Ambuj Roy, Navaneetha Sasikumar, Mitsuaki Sawano, Kathryn Choon Beng Tan, Jasper Tromp, Lijing L. Yan, Khung Keong Yeo, Stephen J. Nicholls, Carolyn S.P. Lam, Alan Fong, Amina Rakisheva, Chanchal Chandramouli, Grace Wangge, Gwyneth Kong, Junya Ako, Kyung Woo Park, Nusrat Majeed, Praveen Devarsetty, Quang Ngoc Nguyen, Tanayarat Aramsareewong, Maoyi Tian, Yuan Lu
Institutions: University of Washington, University of Alberta, University of Hong Kong, The University of Sydney, The University of Adelaide, Royal Adelaide Hospital, National University of Singapore, National University Health System, Monash University, Amrita Institute of Medical Sciences and Research Centre, All India Institute of Medical Sciences, Teikyo University, University of Auckland, University of Sri Jayewardenepura, National University Hospital, National Heart Centre Singapore, Institute for Health Metrics and Evaluation, Baim Institute for Clinical Research, Duke Kunshan University, Westmead Institute, Kettering General Hospital, Ibrahim Cardiac Hospital & Research Institute, The Centre for Health (New Zealand)