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

Background: Atherosclerotic cardiovascular disease (ASCVD) disproportionately impacts low-middle income countries, such as those in South Asia and understanding future ASCVD rates can inform public policy. Objectives: This study aimed to project the burden of ASCVD in South Asia till 2040. Methods: Yearly ischemic heart disease (IHD), stroke, and peripheral artery disease (PAD) counts for South Asia (Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) and mid-year population were obtained from Global Burden of Disease (1990-2021) in 5-year age brackets (40-79 years) and estimated mid-year national population (2022-2040) was collected. Age-adjusted prevalence (aaPR) and mortality rate (per 100,000) were projected with Bayesian age-period-cohort models in South Asia (overall, males, and females); trends were reported as the estimated annual percent change (EAPC). Results: Between 2021 and 2040, the IHD aaPR in South Asia was projected to increase (2021: 9434.6 [95% CI: 9,432.1-9,437.1], 2040: 9,846.6 [95% CI: 8,800.0-10,893.3], EAPC: 0.23% [95% CI: 0.08%-0.37%]) because of increased rates among females (EAPC: 1.16%; 95% CI: 1%-1.32%). The overall IHD age-adjusted mortality rate will reduce (2021: 254.7 [95% CI: 254.3-255.1), 2040: 224.0 [95% CI: 166.5-281.6), EAPC: −0.67% [95% CI: −1.61% to 0.27%]) but may increase in females (EAPC: 1.16%; 95% CI: 1%-1.32%). Stoke aaPR in South Asia is projected to increase slightly (2021: 1,065.5 [95% CI: 1,064.7-1,066.4], 2040: 1,074.6 [95% CI: 953.7-1,195.5]). The PAD aaPR is projected to increase (2021: 1809.5 [95% CI: 1,808.5-1,810.6], 2040: 1,879.5 [95% CI: 1,684.9-2,074.0], EAPC: 0.26% [95% CI: 0.04%-0.47%]) because of increased rates in females (EAPC: 0.29%; 95% CI: −0.01% to 0.59%). Conclusions: IHD and PAD prevalence rates are projected to increase in South Asia with a disproportionate increase among females.