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It highlights rising CVD deaths and incidence since 1990, with more than three quarters of CVD deaths occurring in low- and middle-income countries. The piece links Pakistan’s vulnerability to widespread metabolic and behavioral risks, including hypertension, diabetes, smoking, unhealthy diets, and air pollution. It calls for urgent, evidence-driven national action despite limited healthcare spending and lack of coordinated CVD surveillance, prevention, and long-term management.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pakistans-rising-cardiovascular-disease-burden-associated-with-modifiable-risk-factors-an-urgent-appeal-for-evidence-driven-action/435691/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pakistans-rising-cardiovascular-disease-burden-associated-with-modifiable-risk-factors-an-urgent-appeal-for-evidence-driven-action/435691.png","ImageObject",300,407,{"name":92,"@type":93},"ahduag","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is Pakistan highlighted as an especially concerning case for CVD burden?","Question",{"text":112,"@type":113},"Pakistan’s CVD deaths and related outcomes have risen substantially since 1990, with incidence and mortality remaining persistently high compared with global averages. The editorial also notes insufficient coordinated national strategy for surveillance, prevention, and long-term management.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which modifiable metabolic and behavioral risk factors are emphasized?",{"text":117,"@type":113},"The editorial points to high systolic blood pressure, elevated LDL cholesterol, rising body mass index, high fasting plasma glucose, and kidney dysfunction. It also highlights high-sodium and processed-food diets, widespread smoking and second-hand smoke exposure, and low physical activity.",{"name":119,"@type":110,"acceptedAnswer":120},"What role do environmental exposures play in Pakistan’s CVD burden?",{"text":121,"@type":113},"Ambient particulate matter–related risk continues to rise, and household air pollution remains above global levels. The editorial also states that risks linked to lead exposure and environmental extremes have shown little meaningful progress.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435691,1791169243,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985747870414,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Editorial  \nPakistan’s rising cardiovascular disease burdenassociated with modifiable risk factors: an urgentappeal for evidence-driven action  \nAhmed Kamal Siddiqi, MBBSa , Eshaal Mubashirb , Asad Ali Ahmed Cheema, MDc , Muhammad Noshab, MDc,*,Muhammad Naeem, MDd  \nCardiovascular disease (CVD) remains the leading cause of mor -tality worldwide [1] . In 2019, an estimated 18.6 million peopledied from CVD, accounting for nearly one in every three globaldeaths[2–5] . More than 500 million individuals were living withCVD that same year almost twice the number reported in1990[6,7] . Beyond its clinical consequences, CVD imposes pro -found social and economicstrain on families, caregivers, commu -nities, and national health systems, driven by both direct medicalexpenses (hospitalizations, outpatient visits, medications) andindirect losses due to long-term disability and reducedproductivity[8–10] . Once viewed as a problem of high-income orWestern settings, this pattern has shifted dramatically over thepast several decades[11,12] . More than three-quarters ofall CVDdeaths now occur in low- and middle-income countries (LMICs),according to the World Health Organization (WHO)[5,6] . Thiswork follows the Transparency in the Reporting of ArtificialIntelligence in Research (TITAN) 2025 guidelines to ensure thatevery stage involving artificial intelligence across analysis, inter -pretation, and manuscript development is conducted andreported with ethical rigor, clarity, and reliability[13] .  \nWithin LMICs, Pakistan is an especially concerning example.Home to over 0.23 billion people and the world’s fifth mostpopulous nation, the country saw its annual CVD deaths risefrom roughly 170 000 in 1990 to 340 000 in 2019[5,6] . The 2019Global Burden of Disease (GBD) study reported an age-standar -dized CVD incidence of 918.18 per 100 000 population inPakistan (Global: 684.33 per 100 000) and an age-standardizedmortality rate of 357.88 per 100 000 (Global: 239.85 per  \naDepartment of Cardiothoracic Imaging, Department of Radiology and Imaging  \nSciences, Emory University Hospital, Atlanta, GA, USA, bISNA HighSchool,Mississauga, Ontario, Canada, cInternational School of Medicine, InternationalUniversity of Kyrgyzstan, Bishkek, Kyrgyzstan and dDivision of CardiothoracicImaging, Department of Radiology, Mayo Clinic, Phoenix, AZ, USASponsorships or competing interests that maybe relevant to content are disclosedatthe end of this article.  \n*Corresponding author. Address: International School of Medicine, InternationalUniversity of Kyrgyzstan, 6, St. April 7, Bishkek 720074, Kyrgyzstan.  \nE-mail: m.noshab2000@gmail.com (M. Noshab).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where itis permissibleto download and share the work provided itis properly cited. The work cannot bechanged in any way or used commercially without permission from the journal.Annals of Medicine & Surgery (2026) 88:59–60  \nReceived 22 November 2025; Accepted 30 November 2025Published online 16 December 2025http://dx.doi.org/10.1097/MS9.0000000000004565  \n100 000)[14] . In the National Socioeconomic Registry Survey of  \n34 million households, 18.9% of respondents self-reportedCVD[15] . Several intertwined risk factors heighten Pakistan’svulnerability. High rates of consanguineous marriage (58%marrying first or second cousins) may concentrate hereditaryrisks; major cardiometabolic conditions such as diabetes(30.8% age-adjusted prevalence), hypertension (37% amongadults), and smoking among men (25%) are widespread[15,16] .As this predominantly young population ages, these risks fore -shadow a substantial rise in CVD burden. Yet Pakistan spendsonly $43 per capita on healthcare, just 1.2% of its GDP andranks in the lowest global decile for universal health coverageperformance[15] . Despite this situation, th","cbCaim5SSki4K7y8","https://ap.wps.com/l/cbCaim5SSki4K7y8","pdf",177870,"English","# Background and global context\n## Pakistan as a high-concern example\n# Modifiable risks driving the burden\n## Metabolic and behavioral factors\n## Environmental exposures\n# Urgent national challenge and needed action","[{\"question\":\"Why is Pakistan highlighted as an especially concerning case for CVD burden?\",\"answer\":\"Pakistan’s CVD deaths and related outcomes have risen substantially since 1990, with incidence and mortality remaining persistently high compared with global averages. The editorial also notes insufficient coordinated national strategy for surveillance, prevention, and long-term management.\"},{\"question\":\"Which modifiable metabolic and behavioral risk factors are emphasized?\",\"answer\":\"The editorial points to high systolic blood pressure, elevated LDL cholesterol, rising body mass index, high fasting plasma glucose, and kidney dysfunction. It also highlights high-sodium and processed-food diets, widespread smoking and second-hand smoke exposure, and low physical activity.\"},{\"question\":\"What role do environmental exposures play in Pakistan’s CVD burden?\",\"answer\":\"Ambient particulate matter–related risk continues to rise, and household air pollution remains above global levels. The editorial also states that risks linked to lead exposure and environmental extremes have shown little meaningful progress.\"}]","Pakistan’s rising cardiovascular disease burden associated with modifiable risk factors: an urgent appeal for evidence-driven action | PDF",1790674779]