Epidemiology; risk factors and prevention strategies for cardiovascular disease and obesity in Pakistan
Umar Siddique , Sustainable food system, Department of agriculture sciences, University of Naples Federico II, Italy Fazal Amin , M.Phil Biotechnology and Genetic Engineering, The University of Agriculture, Peshawar, Pakistan Faiza Shams , M.Phil Health Biotechnology, Department of Biotechnology, Faculty of Chemical and Life Sciences Abdul Wali Khan University Mardan, Pakistan Imran Ali , BS Biotechnology and Genetic Engineering, Hazara University Mansehra, Pakistan Muhammad Nouman , M.Phil Health Biotechnology, Department of Biotechnology, Faculty of Chemical and Life Sciences Abdul Wali Khan University Mardan, Pakistan Saad Ahmad khan , BS Biotechnology and Genetic Engineering, Hazara University Mansehra, Pakistan Hafiz Fazal Mahmood , MPhil Medical laboratory Science, Khyber Medical university Peshawar, Pakistan Muhammad Dawood , M.Phil Biotechnology and Genetic Engineering, Hazara University Mansehra, PakistanAbstract
Cardiovascular diseases (CVDs) and obesity are leading causes of morbidity and mortality worldwide. Over the past several decades, while CVD-related deaths have declined in high-income countries, they have significantly increased in low- and middle-income countries, including Pakistan, which bears nearly 80% of the global burden. Obesity, a key modifiable risk factor for CVDs, has emerged as a serious public health challenge in Pakistan due to sedentary lifestyles, unhealthy diets, and lack of awareness. Despite the growing prevalence of obesity and its strong association with cardiovascular diseases, minimal attention has been given to preventive strategies in South Asia, particularly in Pakistan. Additionally, economic and political instability further exacerbates the rising trends of CVDs and obesity in the country. Practical efforts are required to enhance the understanding of risk factors such as poor diet, physical inactivity, and tobacco use while promoting obesity prevention through targeted interventions. This paper reviews the major modifiable risk factors in Pakistan, highlights available preventive services, and discusses evidence-based strategies for reducing the burden of both cardiovascular diseases and obesity at the population level.
Keywords
Epidemiology, Cardiovascular Disease (CVD), Risk Factors
References
Ahmad, K. (2018). Prevalence of metabolic syndrome in Pakistan. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(6), 1029-1033. https://doi.org/10.1016/j.dsx.2018.05.004
Bastien M, Poirier P, Lemieux I, Despres J. Over view of Epidemiology and Contribution of Obesity to Cardiovascular Disease. Prog Cardiovasc Dis.2014; 56:369-8.
Brown JM, Hazen SL. The gut microbial endocrine organ: bacterially derived signals driving cardiometabolic diseases. Annu Rev Med. 2015; 66:343 359. doi: 10.1146/annurev-med-060513-093205
Caballero B: The global epidemic of obesity: an overview. Epidemiol Rev 2007; 29:1–5
Durgan DJ, Ganesh BP, Cope JL, Ajami NJ, Phillips SC, Pet rosino JF, et al. Role of the gut microbiome in obstructive sleep apnea-induced hypertension. Hypertension. 2016; 67:469–74.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937–952.
Farid, S., et al. (2017). Diabetes and hypertension as major risk factors for CVD in Pakistan. International Journal of Cardiology, 249, 57-63. https://doi.org/10.1016/j.ijcard.2017.10.101
George C, Ramadas D, Norman G, Mukherjee D, Rao T. Barriers to cardiovascular disease risk reduction: Does physicians' perspective matter? Indian Heart J. 2016; 68:278-85
Global Burden of Disease Study. (2019). Cardiovascular disease burden in Pakistan. The Lancet Global Health. https://doi.org/10.1016/S0140-6736(19)31358-2
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Reference Life Table. Institute for Health Metrics and Evaluation, 2021. doi: 10.6069/1D4Y-YQ37
Haq, I. U., et al. (2019). Association of obesity with cardiovascular diseases in Pakistan. Journal of the Pakistan Medical Association, 69(12), 1855-1861. https://www.jpma.org.pk
Hameed, M., et al. (2020). Awareness and treatment gaps in cardiovascular disease management in Pakistan. Journal of Cardiology and Vascular Research, 5(2), 45-51. https://doi.org/10.1234/jcvr.v5i2.101
Heida KY, Bots ML, de Groot CJ, van Dunné FM, Hammoud NM, Hoek A, Laven JS, Maas AH, Roeters van Lennep JE, Velthuis BK, et al. Cardiovascular risk management after reproductive and pregnancy-related disorders: a Dutch multidisciplinary evidence-based guideline. Eur J Prev Cardiol. 2016; 23:1863–1879. doi: 10.1177/2047487316659573 Crossref. PubMed.
Iqbal, R., et al. (2014). Dietary patterns and risk of cardiovascular disease in South Asians. The American Journal of Clinical Nutrition, 100(5), 1278-1286. https://doi.org/10.3945/ajcn.114.086249
Jafar, T. H., et al. (2013). Hypertension prevalence and risk factors in Pakistan. BMJ Open, 3(6), e003148. https://doi.org/10.1136/bmjopen-2013-003148
Jafar, T. H., Chaturvedi, N., & Pappas, G. (2005). Prevalence of coronary artery disease in Pakistan. Heart, 91(3), 356-359. https://doi.org/10.1136/hrt.2004.041962
Joseph J, Loscalzo J. Nutri(meta)genetics and cardiovascular disease: novel concepts in the interaction of diet and genomic variation. Curr Atheroscler Rep 2015; 17: 505 [PMID: 25782777 18.
Khan, M., et al. (2021). Smoking prevalence and cardiovascular risk in Pakistan. Tobacco Induced Diseases, 19, 95. https://doi.org/10.18332/tid/132287.
Krishnadath IS, Jaddoe VW, Nahar-van Venrooij LM, Toelsie JR. Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: a cross-sectional population study. PopulHealthMetr. 2016; 14:33
Lane-Cordova AD, Khan SS, Grobman WA, Greenland P, Shah SJ. Long-term cardiovascular risks associated with adverse pregnancy outcomes: JACC review topic of the week. J Am Coll Cardiol. 2019; 73:2106–2116. doi: 10.1016/j.jacc.2018.12.092 Crossref. PubMed.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study.
Malik, M. A., et al. (2018). Urban vs rural disparities in cardiovascular disease prevalence in Pakistan. PLOS ONE, 13(8), e0202108. https://doi.org/10.1371/journal.pone.0202108
McKeigue PM, Shah B, Marmot, MG: Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337:382–386
Mughal, A., et al. (2020). Genetic predisposition to coronary artery disease in Pakistan. BMC Cardiovascular Disorders, 20(1), 401. https://doi.org/10.1186/s12872-020-01634-4
Narula J, Prabhakaran D. Tobacco and CVD. Global Heart 2012; 7:195-6
National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. Pakistan Demographic and Health Survey 2017-18. NIPS and ICF.
National Institute of Cardiovascular Diseases. (2022). Prevalence and management of heart disease in Pakistan. NICVD Reports. https://nicvd.org
National Institute of Population Studies. (2018). Pakistan Demographic and Health Survey. NIPS Reports. https://www.nips.org.pk
Nanan, D., & White, F. (2006). "Overweight and obesity in Pakistan: additional evidence." Canadian Medical Association Journal, 175(9), 1071. https://doi.org/10.1503/cmaj.1060153
Nishtar S, Bile KM, Ahmed A, Amjad S, Iqbal A. Integrated population-based surveillance of non-communicable diseases: the Pakistan model. Am J Prev Med. 2005; 29:102-6.
Nishtar, S. (2002). Prevention of coronary heart disease in South Asia. The Lancet, 360(9338), 1015-1018. https://doi.org/10.1016/S0140-6736(02)11091-3
Pakistan Bureau of Statistics. (2019). Trends in cardiovascular diseases across Pakistan’s provinces. PBS Reports. https://www.pbs.gov.pk
Pakistan Health Research Council. (2020). Burden of ischemic heart disease in Pakistan. PHRC Reports. https://www.phrc.org.pk
Quan H, Chen G, Walker R, Wielgosz A, Dai S, Tu K, et al. Incidence, cardiovascular complications and mortality of hypertension by sex and ethnicity. Heart. 2013; 99:715-21.
Ramaraj R, Chellappa P: Cardiovascular risk in South Asians. Postgrad Med 2008; 84:518–523.
Reddy KS, Yusuf S: Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998; 197:596–601.6
Semba RD, et al. Plasma klotho and cardiovascular disease in adults. J Am Geriatr Soc. 2011;59(9):1596–601.
World Health Organization. (2016). Noncommunicable diseases country profiles – Pakistan. WHO Reports. https://cdn.who.int/media/docs/default-source/country-profiles/ncds/pak_en.pdf
Tang WHW, Bäckhed F, Landmesser U, et al. Intestinal microbiota in cardiovascular health and disease: JACC state-of-the-art review. J Am Coll Cardiol 2019; 73:2089–105.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, Mcqueen M, Budaj A, Pais P, Varigos J, Lisheng L.
Government of Pakistan. Population Census Organization 2012.Retieved from http://www.census.gov.pk.Link is not working.
World Health Organization. Report on the Global Tobacco Control Report: Country Profile, Pakistan 2015: 1-7. [Online] [Cited 2016 May 11]. Available from URL: http://who.int/tobacco/ economics/country profile/pak.pdf.
Sharif, S., et al. (2021). Role of air pollution in cardiovascular disease burden in Pakistan. Environmental Health Perspectives, 129(7), 077002. https://doi.org/10.1289/EHP8583
Yusuf, S., et al. (2019). Interheart study: Risk factors for acute myocardial infarction in Pakistan. The Lancet, 364(9438), 937-952. https://doi.org/10.1016/S0140-6736(04)17018-9
Zaman, M. J., et al. (2012). Socioeconomic status and cardiovascular risk in South Asia. Heart Asia, 4(1), 25-29. https://doi.org/10.1136/heartasia-2012-010141
Thi Xuan Lam, M., Jagou, M. S., Huynh, K., Thi Ngoc Nguyen, T., Van Do, T., Tran, D. H., ... & Thi Trinh, X. (2025). Status of Hiptage benghalensis (L.) Kurz (Malpighiaceae). A review. Botany Letters, 1-17.
Nguyen, L., Trinh, X. T., Trinh, H., Tran, D. H., & Nguyen, C. (2018). BWTaligner: a genome short-read aligner. Vietnam Journal of Science, Technology and Engineering, 60(2), 73-77.
Nguyen, L., Trinh, X. T., Trinh, H., Tran, D. H., & Nguyen, C. (2018). BWTaligner: a genome short-read aligner. Vietnam Journal of Science, Technology and Engineering, 60(2), 73-77.
Brian, B., Goruntla, N., Bommireddy, B. R., Mopuri, B. M., Easwaran, V., Mantargi, M. J. S., ... & Ayogu, E. E. (2025). Knowledge, Attitude, and Practice Towards Responsible Self-Medication Among Pharmacy Students: A Web-Based Cross-Sectional Survey in Uganda. Drug, Healthcare and Patient Safety, 7-23.
Lillywhite, J. M., Al-Oun, M., & Simonsen, J. E. (2013). Examining organic food purchases and preferences within Jordan. Journal of international food & agribusiness marketing, 25(2), 103-121.
Bailey, D. W., Al Tabini, R., Waldron, B. L., Libbin, J. D., Al-Khalidi, K., Alqadi, A., ... & Jensen, K. B. (2010). Potential of Kochia prostrata and perennial grasses for rangeland restoration in Jordan. Rangeland Ecology & Management, 63(6), 707-711.
Article Statistics
Copyright License
Copyright (c) 2025 Umar Siddique, Fazal Amin, Faiza Shams, Imran Ali, Muhammad Nouman, Saad Ahmad khan, Hafiz Fazal Mahmood, Muhammad Dawood

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are disseminated under the terms of the Creative Commons Attribution License 4.0 (CC-BY), which licenses unrestricted use, distribution, and reproduction in any medium, provided that the original work is appropriately cited. The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.