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

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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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