AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
The Burden of Ischemic Heart Disease in 11 ASEAN Member States, 1990-2023: Trends, Risk Factors, and Future Projections to 2050
By Bao Le PN, Luu BMT, Nguyen LV et al.
Introduction: Southeast Asia (ASEAN) encompasses over 700 million people undergoing rapid epidemiological and demographic transitions; however, country-specific data on ischemic heart disease (IHD) remain critically limited. Existing global burden estimates adequately capturing the profound within-region heterogeneity of this underrepresented and high-risk population are scarce. Hypothesis: We hypothesized that IHD burden across the 11 ASEAN member states would exhibit divergent national trajectories driven by distinct demographic and risk-factor transitions, with emerging metabolic and environmental risks increasingly dominating the attributable burden. Methods: Using Global Burden of Disease (GBD) 2023 data, we analyzed IHD prevalence, incidence, mortality, and DALYs from 1990 to 2023 across all 11 ASEAN nations. Joinpoint regression characterized temporal trends via Average Annual Percent Change (AAPC). Das Gupta decomposition partitioned absolute burden changes into population growth, aging, and epidemiological components. Future projections to 2050 employed competing Log-ARIMA and Quasi-Poisson models fitted to pre-pandemic (1990-2019) data, with model selection guided by RMSE minimization. Results: In 2023, ASEAN recorded 620,663 IHD deaths and 16.88 million DALYs, with the regional age-adjusted mortality rate (ASMR) (95.4/100,000) comparable with the global average (99.7/100,000) (Figure 1). National disparities were pronounced, ranging from an ASMR of 165.5/100,000 in the Philippines — the highest in the region — to 38.5/100,000 in Thailand. Demographic decomposition revealed that population aging (contributing 65.9% of the net change) and population growth (51.4%) drove a 165.7% rise in absolute deaths since 1990, despite a concurrent favorable epidemiological shift (–17.2%). Joinpoint regression identified deceleration or reversal of mortality improvement in the most recent trend segment, with males disproportionately affected. Among attributable risk factors, BMI-related DALYs increased 116.4% since 1990, while high-temperature-attributable DALYs rose 776.4%, signaling an emerging climate-cardiovascular challenge (Figure 2). By 2050, absolute regional DALYs are projected to reach 39.2 million (+132% from 2023), with Lao PDR, Timor-Leste, and Vietnam forecast to experience the steepest increases. Conclusion: IHD burden across ASEAN varies markedly by country, is amplified by population aging, and is shaped by shifting metabolic and environmental risk factors. Country-specific, climate-focus policies are urgently needed for a population representing nearly 9% of humanity that remains largely absent from cardiovascular literature.