May 8 (UPI) -- Rapidly rising rates of heart disease across Southeast Asia, East Asia and Oceania are being driven by differing, localized consequences of industrialization and rapid economic growth, according to research released Thursday.
In a study unveiled at the American College of Cardiology Asia 2025 scientific meeting in Singapore, researchers from India's Gujarat Adani Institute of Medical Sciences reported their data analysis shows that although ischemic heart disease soared across all three regions from 1990 to 2021, the factors driving the increases aren't the same everywhere.
These "region-specific, modifiable risk factors" include toxic air pollution in East Asia and ultra-processed dietary dependence in Oceania, according to the authors.
ischemic heart disease, or IHD, is a condition in which the heart is starved of oxygen due to a reduced blood supply, most commonly caused by a build-up of fatty plaque in the wall of one of the arteries supplying blood to the heart.
As the plaque enlarges, it gradually obstructs the flow of blood, which deprives the heart of oxygen and nutrients, often resulting in strokes and heart attacks.
IHD usually doesn't cause signs or symptoms until it severely narrows or totally blocks an artery. It is now the leading cause of premature death in 146 countries for men and 98 countries for women, according to the World Heart Federation.
Previous research has shown that with rapid industrialization and resulting lifestyle changes, cardiovascular disease across Asia and Oceania has become a major concern, but the latest research shines a spotlight how the phenomenon differs from place to place.
"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 2 billion people," said lead author Hardik Dineshbhai Desai, an independent researcher at the Gujarat Adani Institute.
His analysis tapped data from the landmark 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 the three regions.
Among the nations included in the study were China, North Korea, Taiwan, the Philippines, Sri Lanka, Thailand and American Samoa.
The study revealed that during the 31 years from 1990 to 2021, the annual percentage change for total prevalence of ischemic heart disease across all three regions rose by 3.79%, while ISD-related deaths rose by 4.12%.
Disability-adjusted life years, or DALYs -- representing the total years of life lost due to premature mortality and the time lived with a disability -- went up by 3.24%.
Regionally, East Asia experienced the highest burden over the last three decades. Those younger than age 70 showed a "significant increase" in heart disease incidences and DALYs, while those 70 or older saw a rise in deaths during the same period.
East Asian deaths from heart disease attributable to modifiable risk factors such as high blood pressure, unhealthy diets and air pollution rose by 2.4%, while DALYs rose by 1.71% from 1990 to 2021, the authors estimated.
Meanwhile, the highest age-standardized IHD mortality rate was found in the nations of Oceania, including American Samoa, Papua New Guinea, Fiji, Guam, Tuvalu and Vanuatu. Those countries posted a rate of 170.9 deaths per 100,000 people in 2021, mainly attributable to the rise in heavily processed foods in local diets, according to Desai.
"The rise of IHD in Oceania -- and increasingly in parts of Southeast Asia and East Asia -- is strongly tied to the proliferation of ultra-processed foods, a byproduct of globalized food systems," he told UPI in emailed comments.
"These foods, often high in trans fats, refined sugars and sodium and low in fiber or essential nutrients, are aggressively marketed, widely accessible and economically attractive, especially in low- and middle-income settings."
In Oceania, particularly among Pacific Island nations, "traditional diets rich in root crops, fruits and fish have been steadily replaced by imported, calorie-dense packaged products such as processed meats, sugary beverages, instant noodles and refined snacks," he added.
"This dietary shift is not simply a matter of personal choice, but reflects deeper structural issues -- including food import dependence, limited local food production, urbanization and economic constraints.
"The epidemiological outcome is a dramatic rise in obesity, type 2 diabetes, hypertension and dyslipidemia -- key metabolic risk factors driving IHD."
Across all of Asia, the rising levels of heart disease are evidence of what Desai called an "economic paradox" in which "the very forces driving economic growth -- urbanization, industrialization, and globalized food systems -- are simultaneously accelerating the burden of ischemic heart disease."
In parts of Southeast and East Asia, he said, "modern food environments and sedentary urban lifestyles are rapidly displacing traditional, balanced diets. What makes this particularly concerning is that the metabolic consequences emerge earlier and progress more aggressively in these populations, often without adequate health system capacity to respond."
The study's findings "demonstrate an alarming rise of ischemic heart disease across Southeast Asia and East Asia," said Dr. Kevin Shah, a cardiologist with the MemorialCare Heart & Vascular Institute at Long Beach Medical Center in California.
Shah, who has conducted research focused on heart disease in the South Asian community, was not connected to the Indian study. He told UPI its results "underscore how globalized changing dietary patterns have converged with traditional risk factors to create a 'perfect storm' for cardiovascular disease in a region representing nearly a third of global economic activity."
The study, he said, is "particularly valuable" due to its detailed mapping of regional disparities and the identification of metabolic risk factors as the fastest-growing contributors to mortality.
"As we confront the reality that ischemic heart disease now accounts for nearly 15% of all deaths in this region, this study provides further support for developing targeted interventions that can address both the socioeconomic determinants and clinical management of heart disease across diverse Asian populations," Shah said.
Desai, the study's chief author, agreed that it could provide a roadmap for Asian policymakers to move from "reactive to preventive" cardiovascular strategies and to concentrate on localized approaches, such as controlling air pollution control in East Asia and lipid and blood pressure screening in Southeast Asia.
"One-size-fits-all approaches have failed in the past because they overlook local context; our findings offer a data-driven roadmap for precision public health," he said.
And more broadly, the findings can serve a guide for implementing "bold, localized policy" across multiple sectors of governments, including not only health ministries but those covering agriculture, trade, urban planning and education.
"For example, governments can implement front-of-pack food labeling, regulate trans fats and added sugars, subsidize healthier local produce, and limit the marketing of ultra-processed foods, especially to children," Desai said.
"Investments in primary care infrastructure for early detection of hypertension and metabolic risks can also be scaled in high-burden areas."
Dr. Annabelle Santos Volgman, a cardiologist, researcher and professor at Rush College of Medicine in Chicago, said the study's findings are all too familiar.
"We have been seeing a trend in these regions of the world for the increasing mortality from cardiovascular disease versus communicable disease," she told UPI.
"The reasons for this increase have been explained by the authors, but the challenge is that social determinants of health are a major barrier to decreasing cardiovascular mortality in many nations."
"I completely go along with these developments -- currently air pollution is in the top ten ranking of reasons for death," added Dr. Thomas Muenzel, a senior professor of cardiology at the University Medical Center at Johannes Gutenberg University Mainz in Germany, who has published extensively on the effects of the environment on cardiovascular health.
"Air pollution is not only causing vascular damage, inflammation of the vasculature, endothelial dysfunction and oxidative stress, it also increases the risk of diabetes and hypertension.," he told UPI.
"[Cleaning up] the environment is the best way to get this 'killer number one.' We know that a phase-out of fossil fuel will save 5.1 million people per year, but nobody cares."
The 28th and 29th United Nations Climate Change Conferences "were disasters and we have a new president in the U.S. who is saying, 'Drill baby drill!' Climate change will cause more wildfires which will further increase pollution," Muenzel warned.
