Cardiovascular disease (CVD) is a global problem.

The condition includes all diseases of the heart and circulation, and more people die from it worldwide than any other cause. According to the latest World Health Organization (WHO) statistics, CVD claims the lives of around 17.5 million people a year – that’s 31% of all global deaths.

What’s shocking is that approximately half of those deaths occur in Asia.

Yet, statistics like these are nothing new. Cases of CVD both in Asia and most of the rest of the world have been steadily increasing over the past few decades. A report published in the New England Journal of Medicine showed that in 2013 the number of deaths due to CVD globally was 17.3 million – up by 40.8% from the 1990’s figure. Central and Western Europe were the only areas that saw rates decline, while Southern Latin America, Australasia and North America saw no detectable change.

That same study showed how the picture in Asia is so different.

South Asia had the largest increase in the rate of mortality from CVD, reporting 1.7 million more deaths in 2013 than in 1990 – an increase of 97.4%. In East Asia the numbers aren’t quite as stark, but still a troubling 1.2 million more deaths in 2013 – that’s an increase of 47.2% compared to 1990.

So why has Asia seen such a spike in numbers in comparison to much of the rest of the world?

South Asia had the largest increase in the
rate of mortality from CVD, reporting 1.7
million more deaths in 2013 than in 1990 –
an increase of 97.4%.

Cardiovascular disease risk factors

If we examine the factors behind CVD and assess their prevalence in Asia, a link soon becomes apparent. These are some of the key areas.

Inactivity: According to a 2014 study published in the British Journal of Sports Medicine that focused primarily on women, inactivity potentially ranks higher than smoking, obesity and high blood pressure as a leading cause of CVD for those over 30 years of age. Such is the increased risk that the World Heart Federation suggests a sedentary lifestyle across both sexes increases the risk of CVD by up to 50%. Why? Well, not only does exercise increase circulation and help to clear arteries, but being physically inactive also contributes to a plethora of medical conditions that in turn also increase CVD risk. We will look at some of these next.

Diabetes: A major risk factor in both coronary heart disease and stroke, it is a serious issue throughout the continent. In fact, according to the Asian Diabetes Prevention Initiative, more than half of the world’s diabetes sufferers live in Asia.

Hypertension: Also known as high blood pressure, this is the single biggest risk factor for stroke. In a paper published earlier this year in the Journal of the American College of Cardiology, it is shown to be increasing throughout Asia while simultaneously declining throughout much of the rest of the world.

Overweight and obesity: This can greatly increase the risk of dying from a heart attack. Data from the Global Burden of Disease report shows that very few countries are immune. According to the report, 44.3% of men aged 20 or over are overweight in Singapore; the same is true of 43.8% in Malaysia; 36.9% in South Korea; 33.8% in Taiwan, and 32.1% in Thailand. Of course, while it still may not appear to be a serious issue just by looking around you in these countries (that is, we still do not see a very large number of obviously overweight individuals), to be classified as overweight by the World Health Organization one needs to have a body mass index (BMI) of 25 or more. And so if one is just over this limit, from a purely “appearance” point of view we would in many cases not be talking about someone who is “clearly” overweight, yet the damage is certainly being done within the body.

Overall lifestyle: So as we can see, it is largely these conditions mentioned above that lead to greater instances of CVD in Asia. And it is worth saying again – lifestyle factors such as inactivity and poor diet cause around 31% of coronary heart disease according to the World Heart Federation, while smoking causes nearly 10% of all CVD cases.

This must be addressed to truly solve Asia’s CVD problem.  

A case study in prevention

Now we have identified some of the well-known culprits, what can be done to get on top of the CVD epidemic that is plaguing Asia? Let’s start with a lesson from Scandinavia.

Back in 1972, the province of North Karelia in Finland faced a health crisis: Its men were dying of heart attacks at the highest known rates in the world. A young doctor, Pekka Puska – who would later become director of non-communicable disease prevention for the World Health Organization – was appointed to solve the problem. In a move that was seen as pioneering at the time, Puska argued that it was more effective medically and in terms of costs to prevent diseases that lead to heart attack rather than cure them.

So Puska ran a high-profile awareness campaign which educated locals on diet and nutrition – encouraging them to swap unhealthy foods for healthy alternatives, cut down on salt and stop smoking. Today, Puska’s strategy is credited with lowering male cardiovascular mortality in a population of 170,000 Finns by around 80%.

Puska’s tale may be small-scale and idealistic, but consider the impact that such a high profile government campaign could have on smoking. In China, 68% of men smoke yet according to the World Heart Federation only 4% know it causes heart disease – so the case for a Puska-like plan in Asia looks very strong indeed.

Puska’s strategy is credited with lowering
male cardiovascular mortality in a
population of 170,000 Finns by around 80%.

What can corporations take away from this? Well, with employees spending the majority of their waking life at work, there is no better place to instil the important message of a healthy lifestyle through education from medical professionals and other wellness initiatives. The first place to start is in encouraging physical activity. This can be done in a number of ways – be it offering free or discounted health club memberships, organising competitions such as running races, as well as events like aerobics, spinning and team sports.

Employers can also do their bit when it comes to early detection – it has been shown that those enrolled in a workplace wellness programme found out about their condition as a result of medical assessments and screening as part of the scheme.

It’s in screening and health assessments where insurers have the biggest part to play too. By implementing recurring medical check-ups and screenings for all policyholders – designed to spot early biomarkers for CVD – insurers could help to drastically bring down the number of cases through prevention and early treatment. Insurers should also ensure that all health benefits packages supplied to corporations and their employees include coverage for clinical services which can help to detect and control CVD-related conditions such as hypertension, diabetes, as well as being overweight or obese. 

Turning the tide on CVD

The need to solve Asia’s CVD crisis is obvious. Quite simply, too many people throughout the continent are dying from a largely preventable health condition. But even putting the human cost aside, there is huge financial incentive to tackling the epidemic as well. Latest figures from the World Heart Federation put the global cost of CVD at USD 863bn in 2010 – estimating that to rise to a staggering USD 1,044bn by 2030.

This number is simply unacceptable when the solution is largely in our hands. There are no dark arts at play when it comes to the CVD epidemic. As Puska’s pilot study showed, improve lifestyles and watch cardiovascular mortality rates plummet. The challenge then is not in what we do but how we do it.

The lifestyle factors that so heavily contribute to CVD are far ingrained within many cultures and habits such as unhealthy eating, drinking and smoking are not easy to kick. However, attitudes can be modified and the challenge now – for governments, insurers, corporations and the medical profession – is to do everything within their power to start that process.


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Inova care is an industry leading consulting and health care administration company specializing in managed care, clinical pathways and cost containment solutions for corporations and insurance companies.


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