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TYPE
Original Research
PAGE NO.
21-31
10.37547/tajmspr/Volume07Issue03-04
OPEN ACCESS
SUBMITED
03 January 2025
ACCEPTED
05 February 2025
PUBLISHED
07 March 2025
VOLUME
Vol.07 Issue03 2025
CITATION
Umar Siddique, Fazal Amin, Faiza Shams, Imran Ali, Muhammad Nouman,
Saad Ahmad khan, Hafiz Fazal Mahmood, & Muhammad Dawood. (2025).
Epidemiology; risk factors and prevention strategies for cardiovascular
disease and obesity in Pakistan. The American Journal of Medical Sciences
and Pharmaceutical Research, 7(03), 21
–
31.
https://doi.org/10.37547/tajmspr/Volume07Issue03-04
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
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, Pakistan
Corresponding author
: Muhammad Dawood
Abstract:
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
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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,
Obesity,
Pakistan,
Recommendations.
Introduction:
The latest evidence has revealed that
globally, cardiovascular disease (CVD) is the leading
cause of death, and around 80% to 86% of these deaths
occur in low- and middle-income countries (LMICs).
From around16 million deaths that occur due to non-
communicable diseases (NCDs), 82% are in LMICs and
37% of these deaths are related to CVD. [1]
However, there is a substantial variation in the
mortality rates, according to sex, age, ethnicity, socio-
economic status (SES), and geographical location. The
worldwide CVD-related death rates for men (age less
than 70 years) are three times higher than for women
and double in low socio-economical areas than in
affluent areas. [2]
Almost all South Asian countries, namely Pakistan, Sri
Lanka, Bangladesh, India, and Nepal, constitute more
than a quarter of the LMICs and are considered to be
at a higher risk of coronary heart diseases (CHD) and
any other part of the globe. A large population-based
cohort study verified the comparatively less incidence
of CVD in South Asian patients than in Chinese and
Canadian patients. [3] Various factors such as social,
biological, and psychological issues raise the CVD
burden of LMICs. The INTERHEART study-case-control
study conducted in 52 countries worldwide across
various regions including Europe, Asia, Middle East,
Australasia, Africa, and North and South America-has
identified nine such modifiable candidates for
triggering acute myocardial infarction (AMI), which
leads to CVD. These modifiable risk factors include blood
pressure, diabetes, cigarette smoking, abdominal
obesity, psychosocial index, physical inactivity, high
intake of fruits and vegetables, Apolipoprotein
B/Apolipoprotein A1 (ApoB/ApoA1) metabolism, and
high intake of alcohol. Figure 1.[4]
Numerous research discussing the risk factors of CVD
have been done, however, there is lack of literature in
Pakistani setting. The Pakistan health research council in
2016 found that in Pakistan, the risk factors for NCDs is
growing. [3] Therefore, this study shows the
epidemiologic transition of CVD in Pakistan; it evaluates
the primary contributors in Pakistan; it focusses on the
contemporary anticipatory services accessible in the
nation. The last portion of the study emphasises the
best feasible approaches of encouraging the
adjustments of risk-factors in the Pakistani population.
METHODOLOGY
Literature was searched from PubMed, Medline and
Google Scholar. Only English language articles from the
2010-2023 period were considered. We included only
published articles with adequate sample size, sampling
technique and relevance to CVD-related risk factors.
Various keywords were used to extract the required
information from the databases, like cardiovascular
disease, cardiac disease, causes, CVD risk factors,
obesity, hypertension, diabetes, and preventive
strategies and recommendations. Overall, 200 abstracts
were read and 46 references were included in the final
review as these were directly related to CVD risk factors.
CVD in Pakistan: An Epidemiologic Transition
Pakistan has been facing a heaving burden of both
communicable and non-communicable diseases.
According to a 2013 report on the global burden of
disease, it is estimated that 30% of worldwide deaths
are due directly to CVD.[5] In this particular disease
changing paradigm, it bears several implications for
capacity and resource allocation for health service
instituted. Some of the estimates about common illness
among the Pakistani adult population consist of 41
percent hypertension, 21 percent tobacco use, 17.3
percent high cholesterol, 21 percent obesity, 10 percent
diabetes mellitus (DM), and dyslipidemia (males, 34%;
females, 49%), and 2.8 percent stroke. [6] Due to rising
estimates, this can be said to be increasing in the
country, where the rates of NCDs and communicable
diseases approximate each other. The distribution of
modifiable risk factors for CVD in Pakistan is changing
due to this epidemiologic transition increases levels of
stress, unhealthy eating habits, sedentary lifestyles, and
increases in smoking rates. [4]
Limited Epidemiological Data on Cardiovascular
Disease Risk Factors in Pakistan
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In Pakistan, data on heart disease prevalence is limited.
Two population studies conducted in 2013 and 2019
estimated the prevalence of heart disease to range
between 0% and 3.7% in rural and urban areas. The
2019 National Health Survey of Pakistan (NHSP)
highlighted a high incidence of cardiovascular disease
(CVD) risk factors in both rural and urban
populations.[7] Other small-scale studies have also
reported a high prevalence of CVD risk factors;
however, these studies are constrained by limited
sample sizes and reliance on self-reported data. A
cross-sectional study conducted in a Karachi hospital
identified key CVD risk factors, including a family
history of ischemic heart disease (IHD), age, div mass
index (BMI), smoking, sedentary lifestyle, total
cholesterol, diabetes mellitus (DM), low-density
lipoprotein (LDL), high-density lipoprotein (HDL), and
triglycerides.[8]
The
study
found
significant
associations between coronary artery disease (CAD)
and high cholesterol [odds ratio (OR) = 1.6 (1.04, 2.24)],
age over 40 years [OR = 4.4 (2.32, 8.5)], BMI over 29.9
kg/m² [OR = 1.7 (1.01, 2.71)], diabetes [OR = 2.03 (1.24,
3.3)], and a positive family history of IHD. However,
due to the cross-sectional design and convenient
sampling methods used, these findings may not be
generalizable to rural populations in Pakistan.
Gender Differences in Cardiovascular Disease Risk
and Management
Cardiovascular disease for men and women differs in
the states of risk factors, presenting symptoms,
diagnosis, and management. While the timeline for
development of cardiovascular disease (CVD) is
affected in women through other risk factors, such as
pregnancy complications, menopause, and polycystic
ovary syndrome (PCOS), men are generally affected by
CVDs at younger age due to inherently high levels of
blood
pressure
and
cholesterol.[9]
Women,
traditionally subjected to atypical heart attack
symptoms of nausea, fatigue, and dizziness, have in
these instances found themselves misdiagnosed and
inappropriately treated. Furthermore, research shows
that women are offered fewer interventions and
medications with equal or greater benefits when
compared to men.[10] Similar challenges are faced in
the case of Pakistani women, who contend with
multifactorial cultural and socioeconomic limitations in
obtaining timely healthcare.
Correcting these imbalances would require gender-
sensitive healthcare policies, better awareness, and
equal access to early diagnosis and treatment.
Identification of gender-specific clinical manifestations
and risk factors of CVD may improve these challenges to
prevention strategies and eventually lead to a reduction
in death. [7]
Economic Disparities and Illiteracy: Overcoming the
Twin Barriers of Poverty
Pakistan faces significant challenges in alleviating
poverty and bridging the socio-economic divide
between different segments of society. The
Multidimensional Poverty Index indicates that the
country's poverty rate declined from 55% in 2004 to
39% in 2015. The literacy rate varies widely, ranging
from 97% in Islamabad to as low as 20% in District
Kohlu.[11] A majority of the population (60%-65%)
resides in rural areas, but there is a growing trend of
migration to urban centers. According to a national
vision report, urbanization is expected to accelerate,
making Pakistan predominantly urban by 2030.[12] This
shift will place considerable pressure on essential
resources, leading to challenges such as inadequate
access to clean drinking water, food insecurity, and a
lack of affordable, quality primary healthcare services.
Additionally,
weak
social
protection
systems,
infrastructure deficits particularly in transportation,
energy, and irrigation
—
and inefficiencies in social
service delivery further exacerbate these issues.
Moreover, ongoing structural adjustments and policy
changes in the healthcare system have contributed to
social inequalities and negatively impacted health
outcomes on a global scale.[13]
Burden of Risk factors in Pakistan
Examination of the risk factors to reduce the CVD
burden and mortality is important to prioritise the CVD
prevention and reduction efforts in countries like
Pakistan, where the CVD burden is increasing. Data
shows that excessive alcohol use, poor diet, physical
inactivity, tobacco use, and psychosocial issues are the
main determinants for CVD. The next section briefly
discusses the burden of the major risk factors for CVD in
the Pakistani context.[14]
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Figure 1. Cardiovascular disease risk factors
Smoking: A Major Risk
The association of smoking with CVD is unequivocal; it
is the major health risk in the world today. In the 2015
report by the World Health Organization (WHO), 22.2%
of males and 2.1% of females in Pakistan smoke.[15]
During the 20th century,100 million individuals died
globally from diseases brought about by the
consumption of excessive tobacco, and it is estimated
that by 2030, one in every six persons will die because
of the fatal impacts of smoking. 50% of these deaths
will occur among the middle-age population (35-
69years). Studies like INTERHEART and others
performed in Pakistan indicated a linear relationship
between cigarette number smoked and CVD. 40 or
more cigarettes day smokers are at nine times risk of
having cardiac issues compared to non-smokers.[16]
Impact of Socioeconomic Status on Education
Thus, socioeconomic status (SES) and illiteracy are
generally recognized as being directly consistent with
risk behaviors and an unhealthy lifestyle. As reported
by Teo et al., 'from the estimated 1.3 billion smokers in
the world, 82% live in LIMCs.' People did not spend
money on education and healthy food but rather on
alcohol and smoking, causing adverse effects on the
cardiovascular system.[17] A study conducted in
Rawalpindi, Pakistan, showed there is a significant
association of literacy with tobacco use, and the
widening gap of tobacco consumption keeps
increasing between the "no formal education" and the
"graduation level of education" groups.
Role of Mental Health in Cardiovascular Disease
Mental health is important in the development and
advancement of cardiovascular disease (CVD).
Psychological disorders like stress, anxiety, and
depression have been associated with heightened CVD
risk through physiological and behavioral pathways.
Chronic stress initiates the overactivation of the
hypothalamic-pituitary-adrenal (HPA) axis, which
results in elevated cortisol levels, heightened blood
pressure, inflammation, and metabolic disturbances, all
of which lead to heart disease.[18]
Depression is specifically linked with unfavorable
cardiovascular outcomes. Patients with depression have
a higher chance of following unhealthy lifestyles like
smoking, lack of physical exercise, unhealthy diets, and
poor adherence to medications, putting them at risk of
developing hypertension, obesity, and diabetes (WHO).
Anxiety disorders are also linked to increased heart rate,
vascular pathology, and increased inflammatory
markers, further contributing to cardiovascular risk.[19]
In
Pakistan,
mental
health
conditions
are
underdiagnosed and undertreated because of stigma,
ignorance, and poor access to psychological services.
The inclusion of mental health screening as part of
standard cardiovascular care, the encouragement of
stress management programs, and the promotion of
mindfulness-based interventions like meditation and
relaxation can decrease the risk of CVD. Public health
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programs must also aim to raise awareness of the close
link between mental health and heart health, so that
CVD prevention and management are addressed in a
comprehensive manner.[20]
Alternative Forms of Tobacco Use in Pakistan
Various forms of tobacco use in Pakistan-these include
cigarettes, beedis, chewing tobacco (paan), and
hookah/shisha (water-pipe smoking)-are right now on
the rise. The place where smokeless use of tobacco is
culturally accepted would be Pakistan and Indian
cultures.[17] In the prevalence of tobacco use,
differences exist among the districts of Pakistan, and
various studies conducted in various locations in
Pakistan have reported that concerning 33% of
Pakistani men and 4.7% of females are reported to be
tobacco users. The generalized view among the
population
is
that
tobacco
consumption
is
complementary to smoking, though studies have
shown that tobacco is harmful. The prevalence rate of
smokeless tobacco use was identified at 40% in a
survey conducted in squatter settlements of
Karachi.[21]
There is very little awareness of the dangers of tobacco
in very general terms; for instance, the AMI patients do
not consider water pipe use to be harmful concerning
AMI recurrence. A cross-sectional study documented
the water pipe smoking practice in students, showing
that 60% of students regard it as less dangerous than
cigarette smoking. The other source that the tobacco
industry has supported Pakistan with is Rs27.5 billion
per annum.[22] In 2010-2011 more than 65.40 billion
cigarettes in production, and of these the government
of Pakistan generated Rs55 billion from the tobacco
industry within this same financial year. The tobacco
use is persistently increasing; tobacco sales show an
upward trend in the first nine months of 2008 showing
an increase of 17% compared to 2007 levels. Out of this
figure, 9.3% increase is attributable to sales increase
while the rest is on account of price rise.[23] Though
Pakistan has an antismoking legislation since 2003, it is
hardly enforced. Nationwide campaigns against the
dangers of tobacco, a ban on cigarette advertising, and
discouragement of tobacco cultivation became the
major strategic interventions. However, these
government-supported strategies have partially
succeeded in implementation due to many political
impediments.[20]
Dietary Patterns and Nutritional Challenges in
Pakistan
Pakistani cooking generally involves curries, and
therein is lot of saturated fat along with it. The foods
mainly consumed by people living below the poverty
line comprise carbohydrates and more saturated fats.
It was found from a cross-sectional descriptive study in
Pakistan that carbohydrate consumption among the
urban population of Pakistan is 51.5% and fat is 36.3%.
This population eats unhealthy food for many reasons:
rising costs of fresh fruits and vegetables, a scarcity of
agricultural opportunities, and cheap availability of very
saturated commercial products (oils and ghee).[24]
This fact has resulted in the subsequent increase of risk
for CVD. A great challenge for the health care system of
Pakistan is, however, changing people from the less
affordable, commercially produced oils to healthier oils.
This then would require a complete revolution of the
agricultural and food policy in the country. Such a
drastic change in the overall systems in Pakistan should
follow very careful consideration regarding people's
reaction in terms of living below the poverty line.[25]
Physical Inactivity and Sedentary Lifestyle
Physical inactivity and a sedentary lifestyle are
significant contributors to the rising burden of
cardiovascular disease (CVD) in Pakistan. Rapid
urbanization, increased reliance on technology, and
evolving work environments have led to reduced
physical activity among the population. Prolonged
sitting, excessive screen time, and a lack of regular
exercise are associated with obesity, high blood
pressure, dyslipidemia, and insulin resistance, all of
which heighten the risk of CVD.[26]
Regular physical exercise has a critical role in preserving
cardiovascular health by boosting blood circulation,
strengthening metabolic function, and lowering
inflammation. Studies show that individuals who engage
in at least 150 minutes of moderate-intensity exercise
per week have a significantly lower risk of heart disease
compared to those who remain inactive (AHA).
However, in Pakistan, limited awareness, a shortage of
recreational spaces, and cultural constraints often
discourage people from adopting an active lifestyle.[27]
Encouraging physical activity by implementing national
policies for health, community programs, and
occupational wellness programs can play an
instrumental role in minimizing the risk of CVD.
Encouragement of walking, cycling, and sports, as well
as the inclusion of physical education in the curriculum,
can counteract the impact of the sedentary lifestyle on
public health. Physical inactivity should be handled as a
modifiable cardiovascular disease risk factor in order to
minimize the cardiovascular disease burden of
Pakistan.[28]
High Blood Pressure
The strong relationship linking CVD and high BP has long
been established. Each year, about 7.6 million people
die globally, accounting for some 13.5% of total deaths
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associated with high blood pressure. Over the years,
the rate of hypertension has been on the rise in South
Asian populations.[29] Though not clearly defined,
some putative causes for primary hypertension such as
obesity, sodium intake, and lack of access to health
care for treatment are major risk factors for causing
high blood pressure. As a study observed, raised blood
pressure is considered one of the classical risk factors
for other CVDs in South Asian as well as Caucasian,
Chinese, and African populations. In Pakistan, the
prevalence of hypertension is on the rise as well. A
2006 health survey in Pakistan10 found that 22% of
adults (aged 15 years and older) and 33% of adults
(aged 45 years and older) were hypertensive (blood
pressure >140 and diastolic >90 mm of Hg), while in
2016, age-standardized prevalence was 17.3%-25.3%
in males and 9.9%-41.4% in females of different ethnic
backgrounds.[30]
Obesity as a Risk Factor for Cardiovascular Disease
Obesity is a substantial risk factor for cardiovascular
disease (CVD), contributing to its development through
different physiological and metabolic pathways.
Excess div weight, particularly central obesity, is
directly associated to illnesses such as hypertension,
dyslipidemia,
insulin
resistance,
and
chronic
inflammation, all of which raise the probability of
developing heart disease.[28]
One of the major ways that fats are involved in CVD is
with hypertension (high blood pressure). Excess div
fat leads to increased vascular resistance and cardiac
output, placing an added burden on the heart. Obesity
is also associated with dyslipidemia, characterized by
rising levels of low-density lipoprotein (LDL)
cholesterol and triglycerides, with declining high-
density lipoprotein (HDL) cholesterol, which promotes
atherosclerosis.[31]
In addition, obesity induces a state of chronic low-
grade inflammation, in which adipose tissue releases
pro-inflammatory cytokines including tumor necrosis
factor-alpha (TNF-
α) and interleukin
-6 (IL-6). Such
inflammatory
markers
promote
endothelial
dysfunction
and
vascular
damage,
further
compounding cardiovascular risk. Insulin resistance,
commonly described in obese individuals, also
contributes to CVD through the enhancement of
hyperglycemia and metabolic derangements that
impair vascular function.[32]
The connection between CVD and obesity highlights
the imminent need for risk-lowering strategies for
obesity. Lifestyle modification, dietary refinement,
and regular exercise can all significantly enhance
cardiovascular outcomes. Treatment of obesity on an
individual and community level continues to remain a
key intervention in the avoidance and control of
CVD.[33]
Limited Awareness and Challenges in Blood Pressure
Control in Pakistan
The research indicates that Pakistani general
practitioners (GPs) do not identify hypertension
appropriately according to guidelines of the Pakistan
Hypertension League. One of the Pakistan studies has
indicated that 28.5% of the GPs lack understanding of
disease and 76.47% of them do not adhere to guidelines
recommended to control hypertensive patients. It was
also revealed in a study in Australia that 61.5% GPs
failed to initiate treatment for hypertension because
they have knowledge gap, unfamiliarity with
recommended guidelines, and unawareness of the drug
therapy.[34] The main reasons for not controlling blood
pressure are the insufficient knowledge of the
healthcare professionals, and non-adherence to
treatment by patients. This issue is truly careful for
geriatric population, which is indeed mounting the
prevalence of diseases concerning hypertension.[35]
One of the research in Pakistan revealed that 28.5% of
the GPs lack understanding regarding disease and
76.47% are not adhering to recommended guidelines to
treat hypertensive patients. In a study in Australia, it has
also been found that 61.5% GPs failed to initiate
treatment for hypertension because they have
knowledge gap, unfamiliarity with recommended
guidelines, and unawareness regarding drug therapy.
The major reasons for failure to control the blood
pressure are healthcare professionals' poor knowledge
and non-compliance with the treatment of patients.
This problem is truly diligent for the aging population,
which is eventually piling up the load of diseases
associated with hypertension.[33]
Challenges in Blood Glucose Regulation and Diabetes
Management
The magnitude of diabetes increases rapidly as
unhealthy diets, sedentary lifestyle, aging of population,
and smoking grow in importance. An assessment of the
situation revealed that 5.1% of individuals were newly
diagnosed to have DM in Pakistan: 5.1% male and 6.8%
female in urban areas, and 5% male and 4.8% female in
rural areas; it was 5.2 million in 2000, with an estimate
of 13.9 million by 2020 and 14.5 million by 2025.
According to the NHSP, around 25% of all DMs occur in
those aged 45 years and above. In addition, during this
study, DM was found to be present in 5.4% of the
population aged above 15 years (95% CI; 4.9-5.9), with
considerable ethnic diversity.[36]
Poor control over blood glucose levels and diagnosis
enhances the prevalence of diabetes. As per NHSP,
about 2.7 million people suffer from diabetes; of these,
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only 0.8 million diagnosed come to know of their
status. Sugar levels are controlled in only 3% of them.
This has worsened with regard to rural areas and
women. This demonstrates the need to have age-
specific data, at both regional and national levels,
regarding blood sugar levels, so that necessary
preventive interventions may be initiated.[37]
Physical activity in LMICs is also declining because of
urbanization and lifestyle changes. This shift has
resulted from the gradual transition of the population
from the rural to urban setup, in which the changes of
diets and often parallel an increased sedentary
lifestyle. For example, in these areas, 40% of women
are inactive in physical activity Swaziland, Namibia, and
South Africa.[38] In China, during urbanization, the
adults' physical activity decreased by 32%, while
sedentary lifestyle activities such as prolonged
television watching surged. A similar situation is
witnessed in Pakistan. A study conducted in Pakistan
on obesity prevalence in persons 15 years or older
reported that 25% of that population consists of
overweight or obese individuals (95% CI 21.8%-28.2%).
Such projections for the health system of Pakistan are
alarming
since
a
large
population
remains
underweight, mostly in school-aged years. Parallelly,
there has been an exponential increase in obesity and
overweight in school-aged children residing in urban
areas in Pakistan.[35]
In summary, the proportion of the risk factors
mentioned above is increasing in Pakistan; on the
other hand, there are limited data available on the
prevalence of CAD and none on the incidence of CAD.
The subsequent section will discuss some of the active
health structures and the available services at primary
and secondary preventive levels in Pakistan.
Healthcare System and Infrastructure in Pakistan
Pakistan comprise a highly hierarchical health system
having both public and private facilities. According to
the National Institute of Population Studies (2006-
2009), around 70% of the total population of the
country has access to private sector health facilities
which are mainly fee for service based.[39] The service-
engineered health care system in Pakistan is inefficient
to cover the demands of a mushrooming kind of
populace and is therefore ill-equipped to deal with the
impending
illness-associated
epidemiological
transitions. Private healthcare has a very critical role in
the provision of health care services, including those
for the armed forces, NGOs, and social security
institutions, which provide their own suppliers and
collect and generate funds for their own use. In most
cases, there would not be a framework of governance
in place, either within the public or private and semi-
private healthcare sector, to monitor clinical practice
and the quality of service. This is how Pakistan continues
to perform poorly on health indicators.[40]
Advanced Technological Approaches in Cardiovascular
Disease Management
Little consideration has been afforded to the area of
prevention against CVD in Pakistan. Most health
resources
are
utilized
to
deal
with
infectious/communicable and reproductive health
issues, and therefore the health system is unable to
grapple with the increasing burden of chronic diseases.
There has, therefore, been development for high-tech
tertiary care facilities for CVD.18 Patients usually
present themselves for medical attention after a
cardiovascular event has occurred. Whether or not the
emphasis is on the importance of tertiary health care,
human resources and technology services are in a bare
minimum state in Pakistan. For the majority of the rural
population, these services remain inaccessible due to
transportation barriers and financial burden. Very few
private institutions have been engaged in developing
CVD
prevention
programs
for
the
Pakistani
population.[28]
Innovative Prevention Strategies and Health Programs
in Pakistan
Some of the private organizations work together with
international organizations in preventing CVD and
promoting health. Due to the fact that modifiable
contributory factors constitute most of the non-
communicable diseases, CVD prevention can be looked
into as NCD prevention. A good health care system must
exist in the country in which prevention programmes at
both primary and secondary levels operate and an
effective coordination of both public and private health
care is undertaken.[35] The prevention and control of
CVDs in Pakistan have essentially been sidelined at
health care discuss. This justifies a multifaceted
approach for the population and high-risk ones. Without
the involvement of several stakeholders, such as the
health and finance ministry, department of education,
and agricultural and other regulatory bodies,
uncoordinated efforts will be insufficient for CVD
prevention and control in the country. A multi-sector
action framework such as that proposed by Fuster and
Kelly may be useful to guide further actions so that
contextually based interventions can be applied in the
country and taking into consideration a full range of
complex determinants of CVD.[41] The integrative
nature of the framework also promotes equal
participation by public and private organizations in
Pakistan focusing on the CVD risk reduction programme.
In this context, the following proposals are made to
address the emergent necessities pertaining to CVD in
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Pakistan.
Preventing Obesity to Reduce Cardiovascular Risk
Preventing obesity is vital for minimizing the risk of
cardiovascular disease (CVD). Effective solutions
include lifestyle modifications, dietary improvements,
frequent physical exercise, and public health
interventions. Adopting a heart-healthy lifestyle, such
as keeping a balanced diet, engaging in regular
exercise, getting appropriate sleep, managing stress,
and avoiding tobacco use, helps to weight control and
better cardiovascular health. Emphasizing a diet rich in
fruits, vegetables, whole grains, lean meats, and
healthy fats optimizes weight control and decreases
obesity-related CVD risks.[42] Regular physical
exercise has a critical role in weight management and
cardiovascular health by lowering obesity-related
problems
and
promoting
general well-being.
Additionally, public health initiatives, such as
regulations supporting access to nutritional meals, safe
venues for physical exercise, and educational
programs about healthy behaviors, aid in avoiding
obesity on a bigger scale. Behavioral counseling
programs have also demonstrated minor but
substantial advantages in encouraging better lives
among those without established CVD risks.
Implementing these methods needs a collective effort
from individuals, healthcare providers, governments,
and community groups.[43] By tackling obesity via
comprehensive lifestyle and public health initiatives,
the incidence of CVD can be considerably lowered.
Recommendations
Prioritizing Chronic Diseases as a National Health
Imperative
It is important that the Pakistani health system adds
chronic illness to its health care agenda. Integrating
existing programmes for the prevention of
communicable diseases with programmes for the
prevention of chronic diseases is a major health goal
for many LMICs. Pakistan can also apply this model to
address the common risk factors, such as smoking,
unhealthy diet, lack of physical activity, high blood
pressure, and obesity.[44]The plan focuses on
identifying risk behaviours and their modification,
which requires change in legislation and policy; for
example, changes in agricultural policies to increase
access to and demand for healthy food, the
development of strategies to utilize open spaces for
physical activity, and the involvement of religious and
community leaders to endorse the participation.
Enhancing Population Data on CVD Risk Factors in
Pakistan
The recent surveillance of Pakistan surveillance is
outdated and fragmented. A national system gathers
records from private and public segment that is not fully
programmed; in addition, the health information
management system is also outdated and may be
unreliable in the present context. At the local and
population level a quality surveillance system is needed
in order to determine the effects of these risk factors on
CVD; it is recommended that the attention on causes of
mortality and morbidity should be provided, primary
determinants of CVD should be identified in the local
context, money should be properly allocated for long-
run, sustainable system of chronic disease-related
surveillance. In low- and middle-income countries, the
surveillance system could be initiated with the presence
of contextual factors.[45]
Contextual Analysis of Risk Factors
To integrate the prevention of CVD in national health
plan, a contextual approach is required. A large number
of patients who attend secondary prevention
programmes do not achieve lifestyle changes such as
smoking cessation, improved eating habits, and more
physical activity. Culturally relevant and context-specific
policies are needed while taking into account the
infrastructure
capacity
and
financial
actuality.
Moreover, it is also crucial to include a system that
comprises of satisfactory communication, proper
planning, flexible decision making, and committed
people.[40]
BP Control Awareness
Public-communication interventions concerning health-
related messages are cost-effective and useful in
changing behaviours at the population level. For
instance, the messages associated with the hazards of
smoking, high level of fat and salt consumption can be
communicated via newspapers and pamphlets and
replicated in other settings where people have access to
newspapers and are literate.[27] However, 70% of
Pakistanis are not able to read newspapers or lack of
access to newspapers, television programmes or radios
that can be broadcasted regularly. The educational
programmes for health should also be included in health
policies.
Society-Based Initiatives
Implementing small community-based programs and
adopting population-based approaches are effective
strategies to raise awareness about the need to address
risk factors. Many health-related community programs
are currently being implemented in urban areas across
various LMICs. These integrated and targeted initiatives,
addressing multiple risk factors, can be incorporated
into healthcare systems and provide access to
individuals in familiar community settings such as
schools, workplaces, mosques, and other community
The American Journal of Medical Sciences and Pharmaceutical Research
29
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
organizations. This approach is both feasible and cost-
effective in Pakistan.[46] However, it is crucial to
remain practical when executing community-based
programs and to be cautious about investing in
initiatives that do not primarily aim to reduce the
burden of cardiovascular disease (CVD). Furthermore,
regardless of the chosen intervention strategy,
considering the local context is essential, as it plays a
significant role in the effectiveness of CVD prevention
and control efforts.
Implementation of Prevention Programmes
According to the research, cardiovascular risks were
first acquired and increased early in life. Unhealthy
habits in childhood and teen enhance the risk which
includes tobacco use, high fat and high-calorie diet,
and lack of physical exercise; as a consequence,
implementation of cardiovascular health promotion
initiatives throughout pregnancy and the early days of
life is of tremendous significance. The efforts for its
prevention should be continued throughout the course
of life.[41] The description of the epidemiological shift
highlights the diverse illness patterns, from
communicable to NCDs, with the large burden of CVD
risk in Pakistan. It is a huge task to decrease these
dangers in Pakistani population. The existing dispersed
and fragmented project requires effective planning
and supervision. The possible cost-effective strategies
of altering these high-risk habits have been identified,
including health promotion campaigns, enhanced
surveillance and exchange activities in the local
environment. Reviewing the dynamics of health
systems and health habits helps to gain important
understanding.[38] Understanding the social and
economical constraints and modifying in the culture,
the unique setting-related capacities and resources
would be needed for population-based interventions
for reaching the aim of CVD risk reduction in Pakistan
Enhancing Economic Well-Being
Income-generating programs for the poor, such as
microfinance or microcredit, require relevant and
transparent institutional support for economic
development projects which are directed towards the
impoverished vulnerable population.[44] Additionally,
there must be a significant change made to the way
funds are allocated, used, and the accuracy of the
amounts allotted.
Disclosure
: The authors report no conflicts of interest
in this work.
Funding
: This study received no financial support from
any organization. All expenses were covered by the
authors themselves.
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