The Changing Pulse of a Region: Ischemic Heart Disease and Its Drivers in the Asia-Pacific, 1990-2021.

Ischemic heart disease remains the leading cause of cardiovascular mortality globally, yet the burden in Southeast Asia, East Asia, and Oceania has followed a distinct trajectory that contrasts with global trends. Despite declining age-standardized rates reported in higher-income regions, these areas continue to experience rising absolute prevalence, mortality, and disability-adjusted life years, reflecting the combined effects of population aging, rapid urbanization, and persistent metabolic and environmental risk factors. Smaller nations and lower-resource settings, including Timor-Leste, the Maldives, Papua New Guinea, Indonesia, and parts of China, have experienced the steepest increases, highlighting widening regional disparities. Air pollution has emerged as a particularly important contributor to ischemic heart disease mortality, emphasizing the growing influence of environmental exposures alongside traditional cardiometabolic determinants such as hypertension, diabetes, hypercholesterolemia, and tobacco use. The increasing burden in these regions underscores the need for tailored, region-specific strategies that integrate public health, environmental, and cardiovascular prevention priorities. Early identification and management of modifiable risk factors, improvements in air quality, and expanded access to acute and preventive cardiac care are essential to curb future disease burden. Understanding the interplay between demographic shifts, environmental challenges, and persistent metabolic risks is critical for guiding policy and clinical interventions, particularly in lower-resource countries, and may offer a roadmap for mitigating emerging disparities and preventing avoidable cardiovascular deaths across diverse populations.