Forecasting Atherosclerotic Cardiovascular Disease in South Asia until 2040: A Bayesian Modeling Approach (JACC Asia October 2025)-Article: Forecasting Atherosclerotic Cardiovascular Disease in South Asia until 2040: A Bayesian Modeling Approach

Article: Forecasting Atherosclerotic Cardiovascular Disease in South Asia until 2040: A Bayesian Modeling Approach

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This study projects the burden of atherosclerotic cardiovascular disease (ASCVD)—comprising ischemic heart disease (IHD), stroke, and peripheral artery disease (PAD)—in South Asia through 2040 using Bayesian age-period-cohort models applied to data from the Global Burden of Disease (GBD) study and population forecasts. South Asia, including Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka, has 25% of the global population but accounts for 60% of global cardiovascular disease burden, driven by rising cardiometabolic risk factors, environmental exposures like air pollution, and social determinants.<br /><br />Key findings indicate that between 2021 and 2040, age-standardized prevalence rates of IHD and PAD in South Asia are projected to increase (IHD from ~9,435 to 9,847 per 100,000; PAD from ~1,810 to 1,880 per 100,000), while stroke prevalence remains relatively stable. Notably, the increase in IHD and PAD prevalence is disproportionately driven by females, who show rising rates, contrasting with males who experience stable or declining prevalence. Stroke prevalence slightly increases overall but diverges by sex—females show an increase, males a decrease. Mortality rates for IHD and stroke are projected to decline overall, driven mainly by reductions in males; however, IHD mortality may increase among females. These sex disparities underscore significant challenges in health equity.<br /><br />The study discusses contributing factors like rapid urbanization, socioeconomic inequalities, rising environmental hazards (e.g., extreme pollution), and systemic healthcare gaps—including limited access to guideline-based therapies, especially among women. Despite projected mortality declines, the rising prevalence, particularly among females, signals escalating healthcare and economic burdens for South Asia's low-middle income countries.<br /><br />Limitations include reliance on GBD and population projections, potential unmodeled confounders, and uncertainties inherent in Bayesian forecasting. Nevertheless, the findings highlight urgent policy needs: addressing environmental risks, expanding equitable healthcare access, and targeting sex-specific disparities to mitigate the looming ASCVD burden in South Asia by 2040.

Keywords

Atherosclerotic cardiovascular disease

South Asia

Ischemic heart disease

Stroke

Peripheral artery disease

Bayesian age-period-cohort models

Cardiometabolic risk factors

Sex disparities in cardiovascular disease

Environmental exposures

Health equity