Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future

Cardiovascular diseases (CVD) are rising in Pakistan.Situated at the crossroads of Central Asia, the Middle East, and South Asia, Pakistan is the fifth most populous country in the world.Over the last 30 years our country has seen economic/industrial growth, but regional conflicts, natural disasters, and limited government investment in health have stunted progress in health indicators.Compared with our neighbors to the east, Pakistanis have a lower average lifespan (men: 67 yrs, women: 69 yrs).Whereas infectious diseases remain endemic, our poorly resourced health systems are now grappling with the continuously rising and costly burden of non-communicable diseases, particularly CVD.According to the 2019 Global Burden of Disease study, the estimated age standardized incidence of CVD in Pakistan was 918.18/100,000 (Global: 684.33/100,000), and the age standardized death rate was 357.88/100,000 (Global: 239.85/100,000).1 In the National Socioeconomic Registry Survey that included demographic, socioeconomic, education, health and asset profiling of 34 million households across Pakistan, cardiovascular diseases were self-reported by 18.9% participants.For the foreseeable future this rising trend will continue as CVD risk factors are highly prevalent; age-adjusted comparative prevalence of diabetes is 30.8%;37% of adults have hypertension; ~25% of adult males smoke; and high consanguinity rates (58% married to first or second cousins) likely contribute to clustering of genetic risk.Together, these factors will fuel a large rise in CVD burden as a predominantly young population enters middle age.This will pose major challenges as health spending remains low ($43 per person; government health expenditure = 1.2% of GDP), and globally Pakistan falls in the lowest decile for the Universal health coverage effectiveness index.2,3 Features of CVD specific to Pakistan include a high burden of rheumatic heart disease and early onset coronary artery disease.Against this backdrop, Pakistan currently lacks a national strategy to monitor, prevent, and manage CVD in both rural and urban (37%) populations.Critical areas that need to be addressed include the following