European Journal of Cardiovascular Medicine

Non-communicable diseases (NCDs), particularly cardiovascular diseases (CVDs), have emerged as the leading cause of morbidity and mortality worldwide. According to the World Health Organization (WHO), NCDs account for nearly 74% of global deaths, with cardiovascular diseases alone contributing to over 17.9 million deaths annually.^1,2 Unlike high-income regions where substantial progress has been made in reducing cardiovascular mortality, South Asia continues to face an alarming epidemiological shift, characterized by an earlier onset of NCDs, higher mortality in productive age groups, and a rapidly escalating economic burden. ³ The region home to nearly a quarter of the world’s population—is projected to carry a disproportionate share of global NCDs in the coming decades, posing a significant threat to sustainable development and health equity.^4,5

South Asia, comprising Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka, is undergoing a rapid demographic and epidemiological transition. Traditionally, the region faced a high burden of communicable diseases, maternal and child health issues, and nutritional deficiencies. However, with urbanization, rising incomes, and lifestyle changes, the health profile has dramatically shifted toward NCDs^6. Current estimates suggest that NCDs contribute to more than 60% of all deaths in South Asia, with cardiovascular diseases accounting for nearly half of this burden.^7,8 Alarmingly, South Asians tend to develop CVD nearly a decade earlier than Western populations, with higher case fatality rates and poorer treatment outcomes.⁹

This premature and disproportionate burden is closely linked with multiple determinants, including high prevalence of hypertension, diabetes mellitus, dyslipidaemia, tobacco consumption, sedentary lifestyles, and dietary risk factors.¹⁰ Air pollution, both ambient and household, further exacerbates cardiovascular risk, particularly in urban centers with poor environmental regulation.¹¹ Compounding these challenges are weak health systems, limited financial protection, and fragmented policy responses, which have restricted the effectiveness of preventive strategies. ¹²

The South Asian region is characterized by a large and youthful population, rapid urbanization, and substantial socioeconomic disparities. More than 40% of the population resides in urban areas, often in environments conducive to unhealthy lifestyles and high pollution exposure.¹³ Economic growth has fueled a nutrition transition, marked by declining traditional diets and rising consumption of calorie-dense, ultra-processed foods.¹⁴ Simultaneously, physical inactivity has become increasingly common, particularly among urban middle-class populations.¹⁵

Poverty and inequity remain persistent barriers to effective NCD prevention and treatment. Out-of-pocket expenditure for healthcare is among the highest in the world in South Asia, often leading to catastrophic health spending and deepening poverty cycles.¹⁶ Moreover, gender disparities, cultural practices, and limited health literacy contribute to late diagnosis and poor adherence to treatment, particularly for women and marginalized groups.¹⁷ These social determinants significantly influence disease progression and outcomes, highlighting the need for context-specific interventions.

Projections indicate a steep rise in NCD-related morbidity and mortality in South Asia over the next two decades. By 2035, India alone is expected to witness over 60 million cases of ischemic heart disease and diabetes combined, while Pakistan and Bangladesh are projected to experience similar surges in hypertension and obesity prevalence.¹⁸ Cardiovascular mortality is anticipated to increase by 25–30% in the region by 2040 if current trends persist.¹⁹ This anticipated shift is likely to strain already fragile health systems, exacerbate workforce productivity losses, and undermine regional economic development goals.²⁰ The growing burden of NCDs also intersects with other public health challenges such as infectious diseases, maternal and child health concerns, and climate change impacts. For instance, air pollution—a leading risk factor for CVD contributes to more than 1.5 million deaths annually in India alone, making environmental health policies inseparable from NCD prevention strategies.²¹

At the global level, the WHO’s Global Action Plan for the Prevention and Control of NCDs (2013–2020, extended to 2030) set a target of reducing premature NCD mortality by 25% by 2025, later aligned with the United Nations Sustainable Development Goal (SDG) 3.4, which aims for a one-third reduction in premature mortality from NCDs by 2030.²² While most South Asian countries have adopted national NCD action plans, their implementation has been slow, underfunded, and fragmented.²³

India, for example, has launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), which seeks to strengthen primary healthcare responses and promote lifestyle interventions.²⁴Pakistan, Bangladesh, and Nepal have similar frameworks, but operational challenges, workforce shortages, and weak monitoring systems continue to limit impact.²⁵ Despite these efforts, the region remains far from achieving the global NCD targets, underscoring the need for renewed political commitment and cross-sectoral collaboration.²⁶

Rationale for Systematic Review

Given the magnitude and complexity of the challenge, synthesizing existing evidence on projected epidemiological shifts and preventive strategies for CVDs and NCDs in South Asia is both timely and necessary. Previous reviews have largely focused on single risk factors (e.g., tobacco or diabetes) or specific countries, with limited attempts to integrate regional perspectives.²⁷ Moreover, rapidly evolving research on digital health, community-based interventions, and health system reforms in South Asia necessitates an updated, comprehensive synthesis.

A systematic review allows for a structured examination of available literature, identification of knowledge gaps, and evaluation of policy and programmatic interventions. Importantly, it can inform national and regional strategies by highlighting evidence-based approaches tailored to South Asia’s unique epidemiological and socio-cultural context.

Objectives

The primary objectives of this systematic review are:

1. To examine projected epidemiological shifts in cardiovascular diseases and non-communicable diseases in South Asia over the next two decades.
2. To identify and critically evaluate preventive strategies implemented or proposed in the region, including policy-level, community-based, and health system interventions.
3. To provide evidence-based recommendations for regional policymakers, healthcare providers, and researchers to strengthen NCD prevention and control in alignment with SDG 3.4.

By addressing these objectives, this review aims to contribute to the regional and global discourse on NCD prevention and control, while providing a roadmap for building healthier tomorrows in South Asia.

Study Design

This systematic review was designed and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure transparency, reproducibility, and scientific rigor in both search and synthesis processes. ¹² The review aimed to synthesize current and projected epidemiological patterns of cardiovascular diseases (CVDs) and other major non-communicable diseases (NCDs) in South Asia, alongside preventive strategies being implemented or proposed in the region. The protocol was prospectively developed and included explicit eligibility criteria, structured search strategies, and pre-defined data extraction methods.

Information Sources

A comprehensive search strategy was implemented across five major electronic databases to capture relevant literature. PubMed/MEDLINE was used for biomedical and clinical studies, Scopus provided multidisciplinary global research coverage, and Web of Science was consulted for high-impact peer-reviewed studies. Additionally, country-level health statistics and epidemiological indicators were obtained from the WHO Global Health Observatory (GHO), while population demographics, socioeconomic determinants, and health expenditure data were sourced from World Bank Open Data. To complement these sources, grey literature was also reviewed, including governmental health reports from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan; policy briefs from the WHO South-East Asia Regional Office (SEARO); reports from international organizations such as the World Heart Federation and NCD Alliance; and regional academic repositories. The search focused on studies published between January 2000 and June 2025, thereby encompassing contemporary epidemiological transitions and preventive initiatives across the region.

Search Strategy

The search was designed using Medical Subject Headings (MeSH) and free-text keywords. Boolean operators (AND, OR) and truncations were applied to maximize retrieval. The following search string (adapted for each database) was used:

(“cardiovascular diseases” OR “coronary artery disease” OR “hypertension” OR “diabetes mellitus” OR “obesity” OR “stroke” OR “non-communicable diseases”) AND (“epidemiology” OR “prevalence” OR “incidence” OR “burden” OR “DALY” OR “mortality” OR “risk factors”) AND (“prevention” OR “public health” OR “primary prevention” OR “screening” OR “health promotion” OR “lifestyle modification” OR “digital health”) AND (“South Asia” OR “India” OR “Pakistan” OR “Bangladesh” OR “Nepal” OR “Sri Lanka” OR “Bhutan” OR “Maldives” OR “Afghanistan”). For example, in PubMed, the MeSH terms used included: “cardiovascular diseases/epidemiology” [MeSH], “Noncommunicable Diseases/prevention & control” [MeSH], “Risk Factors” [MeSH], “South Asia” [MeSH]. The search was cross-validated by two independent reviewers to ensure comprehensiveness.

Table 1: MeSH Terms and Search Strategy for Systematic Review

Eligibility Criteria

Inclusion criteria encompassed studies involving adults (≥18 years) from South Asian countries, including India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan. Eligible study types included observational designs (cohort, case-control, cross-sectional), interventional trials, systematic reviews, and meta-analyses. Outcomes of interest were prevalence, incidence, mortality, morbidity, disability-adjusted life years (DALYs), projections, and preventive strategies for cardiovascular diseases (CVDs) and major non-communicable diseases (NCDs). Studies published between 2000 and 2025 in English were considered.

Exclusion criteria involved studies focusing exclusively on pediatric populations, non-human/animal studies, non-peer-reviewed commentaries, editorials, or opinion papers (unless policy reports relevant to South Asia), and studies with insufficient epidemiological data or those conducted outside South Asia. This rigorous approach ensured a comprehensive synthesis of evidence on the epidemiology and prevention of CVDs and major NCDs in South Asia, facilitating informed policy-making and targeted interventions.

Study Selection Process

All retrieved citations were imported into EndNote X9 reference manager, and duplicates were removed using a combination of automated functions and manual verification. The study selection process involved multiple stages to ensure rigor and minimize bias. Initially, titles and abstracts were screened independently by two reviewers to exclude irrelevant studies. Articles that met the preliminary criteria were then subjected to a full-text review for detailed assessment. Only studies that satisfied all eligibility criteria were included in the final synthesis. Any discrepancies between reviewers were resolved through discussion with a third reviewer to reduce the risk of selection bias. The entire screening and selection process, including the number of records identified, screened, excluded, and included in the qualitative synthesis, is summarized in the PRISMA flow diagram (Figure 1).

Data Extraction

A standardized data extraction form was developed and piloted to systematically capture relevant study information. Extracted data included author(s), year of publication, and country; study design and sample size; population characteristics such as age, sex, and urban or rural setting; epidemiological outcomes including prevalence, incidence, mortality, DALYs, and projections; major risk factors assessed; and preventive interventions evaluated, encompassing policy, clinical, behavioral, and digital strategies. Key findings and study limitations were also recorded. To ensure accuracy and reliability, two reviewers independently performed data extraction, and any discrepancies were reconciled through consensus.

Quality and Risk of Bias Assessment

Risk of bias was evaluated using standardized assessment tools appropriate to study design. The Cochrane Risk of Bias Tool was applied to randomized controlled trials, the Newcastle-Ottawa Scale (NOS) was used for observational studies, and AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) was employed for included systematic reviews and meta-analyses. Quality appraisal was conducted independently by two reviewers, and studies were categorized as low, moderate, or high risk of bias. Any disagreements between reviewers were resolved through consensus to ensure consistency and reliability in the evaluation process.

Table 2 : Quality and Risk of Bias Assessment

The adapted Newcastle–Ottawa Scale (NOS) was used for scoring observational studies based on three domains. The Selection domain (0–4 points) assessed representativeness, sample size justification, sampling method, and non-response. The Comparability domain (0–2 points) evaluated control for key confounders, including age, sex, and socioeconomic status. The Outcome/Exposure domain (0–3 points) considered the validity of outcome or exposure assessment, completeness of follow-up, and appropriateness of statistical analysis. Studies were classified according to total scores as low risk of bias (7–9 points), moderate risk (5–6 points), or high risk (<5 points).

Data Synthesis

Given the heterogeneity in study designs, populations, and outcomes, a narrative synthesis was prioritized for this review. Quantitative measures, including prevalence and incidence rates, were tabulated and compared across South Asian countries, and where feasible, trend projections were integrated from WHO and national datasets. Key findings were organized into three overarching themes: epidemiological shifts, highlighting rising prevalence, incidence, and projections of major NCDs; risk factor transitions, encompassing tobacco use, dietary patterns, obesity, hypertension, diabetes, and air pollution; and preventive strategies, including policy interventions, community-based programs, digital health innovations, and broader health system reforms.

Statistical Considerations

Although this review did not conduct a meta-analysis due to substantial heterogeneity, descriptive epidemiological trends were compiled. Age-standardized prevalence and mortality rates from the Global Burden of Disease (GBD) Study were cross-checked against national health surveys. In addition, projections from modeling studies were compared to WHO Global Health Estimates.

Where appropriate, relative risks, odds ratios, and hazard ratios reported in primary studies were highlighted to contextualize the magnitude of associations between risk factors and outcomes.

Ethical Considerations

Since this review utilized secondary data from published sources and publicly available databases, no ethical approval was required. However, adherence to academic integrity and citation standards was strictly maintained

India

India bears the largest share of South Asia’s NCD burden, with cardiovascular diseases (CVDs) contributing to nearly 28% of all deaths nationwide.³⁰ The age-standardized mortality rate for CVDs ranges between 270 and 400 per 100,000 population.³¹.Hypertension prevalence is estimated at 30–35% in urban areas and 20–25% in rural communities, with poor awareness and treatment adherence.³² Diabetes has emerged as a major public health challenge, with the latest national survey indicating a prevalence of 11.8%, affecting more than 100 million adults³³. Obesity, especially among women, is rising rapidly approximately 23% of women are overweight or obese³⁴. Urban lifestyle changes, dietary shifts, and pollution are major contributors. Preventive programs such as Ayushman Bharat’s Health and Wellness Centres now integrate NCD screening, but coverage remains limited.

Pakistan

Pakistan is experiencing a rapid rise in NCD-related morbidity and mortality. CVD mortality rates are estimated at 275 per 100,000, among the highest in the region.³⁵ Hypertension prevalence ranges between 26% in rural and 33% in urban areas.³⁶ Diabetes affects nearly 19 million adults, corresponding to a prevalence of 17.1%, one of the highest globally.³⁷ Obesity and metabolic syndrome are increasingly common, particularly among women in urban centers. Tobacco use is a critical risk factor, with more than 23.9 million active smokers in the country³⁸. Preventive efforts include salt-reduction campaigns and limited tobacco taxation, but weak enforcement undermines effectiveness. Mobile health programs for diabetes management and community health worker–based hypertension screening have shown promise in pilot projects.

Bangladesh

Bangladesh faces a heavy NCD burden, with 67% of all deaths attributed to chronic diseases, mainly CVDs and diabetes.³⁹ High dietary salt intake (>10g/day) contributes to hypertension prevalence, which affects about 30% of adults.⁴⁰ Obesity and metabolic syndrome are increasing, especially in urban areas undergoing rapid industrialization and lifestyle transitions.⁴¹ Diabetes prevalence is projected to rise substantially, with urban men being the most affected group. Preventive interventions include pictorial tobacco warnings and dietary awareness programs, but fragmented implementation hinders impact. Digital health pilots such as SMS reminders for blood pressure control have shown effectiveness but lack large-scale integration into the public health system.

Nepal

In Nepal, NCDs account for 66% of total deaths, with CVDs, hypertension, and diabetes leading.⁴² Hypertension prevalence is around 29%, while diabetes prevalence is estimated at 8–10%.⁴³ The widespread use of biomass fuels contributes to high levels of indoor air pollution, an under-recognized risk factor for CVD and respiratory disease.⁴⁴ The mountainous geography limits healthcare access, and rural populations remain underserved. Preventive programs include community health worker led NCD screening and salt-reduction campaigns. Despite strong policy commitments, resource limitations and health workforce shortages pose major barriers.

Sri Lanka

Sri Lanka demonstrates a relatively advanced public health system, yet NCDs are a growing challenge, responsible for about 30% of all deaths.⁴⁵ Diabetes prevalence is 10.3%, while hypertension affects nearly one-third of adults.⁴⁶ Obesity rates, particularly among women, have risen to over 34%, one of the highest in South Asia.⁴⁷ Unlike other countries, Sri Lanka has established school-based interventions targeting childhood obesity and wellness programs. Tobacco use is moderately high, though salt-reduction initiatives and hypertension screening programs have been relatively successful. Preventive care integration into primary healthcare has been more consistent compared to neighbouring countries, though rising lifestyle-related risks remain concerning.

Bhutan

Bhutan has made significant strides in tobacco control, including a national ban on tobacco sales, yet NCDs account for nearly 69% of all deaths.⁴⁸ Hypertension and dietary risk factors, particularly high salt intake, are leading contributors. Obesity prevalence is rising, particularly among youth in urban areas adopting sedentary lifestyles. Diabetes prevalence remains lower than in larger South Asian nations, but trends indicate steady growth. Preventive strategies emphasize school health education and community-based nutrition programs. However, reliance on imports and changing food patterns are undermining traditional healthy diets.

Maldives

In the Maldives, CVDs and diabetes are the leading causes of morbidity and mortality, driven by rapid urbanization and dietary changes linked to tourism and imported foods.⁴⁹ Diabetes affects around 8% of the adult population, and hypertension prevalence is estimated at 25–28%.⁵⁰ Obesity, particularly among young adults, has become a growing concern. Preventive health programs include wellness screening at workplaces and school-based lifestyle education, but capacity constraints in island-based health services hinder widespread impact.

Afghanistan

Afghanistan faces unique challenges due to prolonged conflict and instability, which disrupt health systems and complicate reliable data collection. WHO estimates that NCDs account for 35% of deaths, with CVDs and diabetes as the leading contributors.⁵¹ Tobacco use is high, and ambient plus household air pollution remain severe health risks.⁵² Preventive care is minimal, with weak infrastructure and limited access to essential medicines. International organizations have initiated small-scale projects on hypertension screening and community awareness, but nationwide implementation is not yet feasible

Table 3: Summary of Results of Included Studies

Fig.2 Mortality by Country, Age, and Gender in South Asia (CVD & NCDs)

Fig.2. A.  Mortality by Country, Age, and Gender in South Asia (CVD & NCDs)

Legends X-axis: Countries (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, Afghanistan), Y-axis: Mortality rate (per 100,000 population). Stratification: Age groups: 20–39, 40–59, 60+, and Gender: Male, Female

This systematic review highlights the profound epidemiological transition underway in South Asia, where cardiovascular diseases (CVDs) and other non-communicable diseases (NCDs) have become the leading causes of morbidity and mortality. Across India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan, NCDs now account for 60-74% of deaths, underscoring an alarming acceleration compared to two decades ago. These findings confirm global predictions that South Asia will become the epicenter of the NCD epidemic by 2035, driven by urbanization, demographic aging, and lifestyle risk exposures.^72,73

While the absolute burden differs by country, the underlying risk factor transitions are remarkably consistent: widespread tobacco use, high dietary salt and trans fat consumption, increasing obesity and diabetes, and pervasive air pollution. These patterns demonstrate the “double jeopardy” unique to South Asia—persisting infectious disease burdens alongside surging NCDs, straining already fragile health systems.⁷⁴

Comparison with Global Trends

Globally, NCDs account for 71% of deaths, with high-income countries showing declining CVD mortality due to preventive and clinical advances.⁷⁵ In contrast, South Asia displays persistently high and, in some cases, rising CVD mortality rates, with age-standardized rates significantly higher than in regions such as Europe and North America.⁷⁶ This divergence reflects disparities in policy implementation, healthcare infrastructure, and socioeconomic conditions.

For example, while tobacco prevalence has declined substantially in many high-income countries following strong fiscal and legal measures, South Asia remains home to over 250 million tobacco users, including widespread use of smokeless forms.⁷⁷ Similarly, while salt reduction programs have succeeded in Japan, Finland, and the UK, South Asian countries are still in early phases of implementing national dietary modification strategies.⁷⁸

A distinctive feature of South Asia is the younger age of onset of CVDs compared to Western populations. Studies consistently report first myocardial infarction occurring 5–10 years earlier in South Asian adults.⁷⁹ This has profound economic consequences, as it disproportionately affects the working-age population, amplifying productivity losses and perpetuating cycles of poverty.

Health System Challenges

The findings reveal systemic barriers undermining effective NCD control in South Asia:

1. Fragmented Health Systems – Most countries still prioritize communicable disease control and maternal-child health, leaving NCD programs underfunded and poorly integrated.⁸⁰
2. Weak Primary Care Infrastructure – Limited capacity for early screening of hypertension and diabetes leads to late-stage presentation and higher complication rates.⁸¹
3. Low Health Literacy – Poor awareness of NCD risk factors reduces adherence to preventive behaviors and long-term treatment.⁸²
4. Limited Workforce Capacity – Shortages of cardiologists, endocrinologists, and specialized nurses exacerbate service gaps.⁸³
5. Financial Barriers – High out-of-pocket expenditure prevents many from accessing lifelong treatment for hypertension, diabetes, and dyslipidaemia.⁸⁴

These challenges emphasize that without systemic reforms, preventive strategies will remain fragmented and insufficient.

Preventive Strategies: Promise and Gaps

Evidence from included studies suggests several preventive strategies are showing promise: Tobacco control measures (taxation, bans, pictorial warnings) have demonstrated efficacy but require stricter enforcement.⁸⁵ Community health worker–based screening for hypertension and diabetes has expanded access in rural India and Nepal.⁸⁶ Digital health and mHealth interventions, such as SMS reminders for medication adherence in Pakistan and India, improved treatment compliance.⁸⁷ School- and workplace-based wellness programs in Sri Lanka and Bangladesh reduced obesity and improved physical activity.⁸⁸ However, scalability remains limited. Few interventions have been evaluated beyond pilot projects, and most lack long-term sustainability funding. Additionally, preventive programs often fail to address broader social determinants of health, such as poverty, education, and gender inequities, which shape NCD risk exposure.⁸⁹

Multi-sectoral Policy Implications

Addressing the NCD epidemic requires moving beyond the health sector to whole-of-society approaches. The WHO Global Action Plan on NCDs (2013–2020) and Sustainable Development Goal (SDG) 3.4 call for reducing premature NCD mortality by one-third by 2030^90. For South Asia, achieving this target demands:

1. Fiscal Policies – Higher taxation on tobacco, alcohol, and sugar-sweetened beverages to reduce consumption and generate revenue for health^91.
2. Urban Planning – Creating walkable cities, green spaces, and safe cycling infrastructure to promote physical activity^92.
3. Agricultural and Food Policy – Subsidizing fruits and vegetables, regulating trans fats, and reducing salt in processed foods^93.
4. Air Quality Regulation – Strengthening enforcement of emission standards and expanding clean cooking fuel programs to reduce household air pollution^94.
5. Universal Health Coverage (UHC) – Integrating NCD prevention and management into primary care under schemes like India’s Ayushman Bharat and Sri Lanka’s public health service^95.

These actions require political will, cross-sector collaboration, and sustained investment.

Strengths and Limitations of the Review

A strength of this review is its comprehensive inclusion of studies across eight South Asian countries, spanning diverse epidemiological, behavioral, and policy domains. The use of multiple databases, grey literature, and WHO/World Bank data enhances reliability. Country-wise analysis allows contextual insights that pooled statistics might obscure.

However, limitations exist. First, restricting to English-language publications may have excluded relevant local evidence. Second, heterogeneity in diagnostic criteria and survey methodologies complicates direct comparisons. Third, some countries (Bhutan, Maldives, Afghanistan) have limited epidemiological data, reducing precision of burden estimates. Fourth, this review prioritized narrative synthesis due to heterogeneity, and did not conduct meta-analysis. Despite these limitations, the findings provide a robust regional overview aligned with global health frameworks.

Future Research Priorities

Further research is essential in several domains:

1. Longitudinal Cohorts – To track incidence and risk trajectories of CVDs and diabetes in South Asian populations.⁹⁶
2. Implementation Science – To evaluate scalability and cost-effectiveness of community and digital interventions.⁹⁷
3. Health Economics – To model economic costs of NCDs and the return on investment of preventive strategies.⁹⁸
4. Equity-Focused Research – To understand how gender, caste, rural-urban divides, and socioeconomic status affect NCD risk and access to care.⁹⁹
5. Policy Evaluation Studies – To assess the impact of national NCD action plans in South Asia.¹⁰⁰

Overall Synthesis

The results of this systematic review demonstrate that South Asia is at a critical juncture. Without decisive interventions, the region faces a steep rise in premature mortality from NCDs, undermining economic growth and sustainable development. At the same time, emerging strategies particularly community-based screening, digital health innovations, and fiscal policies offer opportunities for scalable and cost-effective prevention. The challenge lies not in identifying solutions, but in implementing them at scale, ensuring equity, and aligning them with broader development goals.

This systematic review highlights the escalating burden of cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) across South Asia, emphasizing the urgent need for coordinated preventive strategies. Evidence from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan demonstrates that NCDs now account for a significant proportion of morbidity and mortality, with cardiovascular conditions, diabetes, and obesity emerging as major contributors. The early onset of these diseases in South Asian populations not only poses a critical public health challenge but also exerts a substantial socio-economic burden, affecting productivity and straining already limited healthcare resources.

Behavioral and lifestyle factors, including tobacco use, unhealthy diets, physical inactivity, and alcohol consumption, remain the dominant risk determinants, often compounded by metabolic conditions such as hypertension, dyslipidemia, and obesity. Environmental factors, such as air pollution and urbanization, further exacerbate disease prevalence, highlighting the complex interplay between lifestyle, genetics, and socio-environmental determinants in this region. Despite the recognition of these challenges, the implementation of preventive and management strategies remains fragmented. Policy interventions such as tobacco control, salt reduction programs, dietary and physical activity promotion, and community-based screening initiatives show promise but require scaling, integration, and rigorous monitoring to achieve meaningful population-level impact. Digital health platforms and mHealth interventions offer innovative avenues for disease prevention and health promotion, especially in resource-limited settings, yet their deployment remains inconsistent across countries. This review underscores the necessity of multi-sectoral, evidence-based approaches to reduce the NCD burden in South Asia. Strengthening health systems, improving access to primary care, enhancing health literacy, and adopting equity-focused interventions are essential to ensure effective prevention and management. Additionally, regional collaboration, knowledge sharing, and investment in sustainable, culturally tailored interventions can enhance outcomes and reduce disparities across populations.

In conclusion, South Asia stands at a critical juncture where decisive policy action, robust preventive strategies, and health system strengthening can substantially mitigate the rising NCD epidemic. Failure to implement evidence-based interventions risks continued escalation of premature mortality and economic burden. Coordinated, scalable, and sustainable strategies focusing on lifestyle modification, early detection, treatment access, and policy support are imperative to achieve healthier tomorrows for South Asian populations.

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