Gender Bias in Ischemic Heart Disease Mortality: More in Women —Asian Study, More in Pakistan, Least in Bhutan, JACC Asia, February 2026
Ischemic Heart Disease (IHD) mortality remains alarmingly high across South Asia, yet women in Pakistan face the highest annual death risk of 4.4% compared to 3.1% in men, and Bhutan has the lowest, with 2.35% for women and 2.65% for men, a disparity tied to metabolic and dietary stressors, as a recent study has shown.
The study was published in the Journal of the American College of Cardiology (JACC): Asia in February 2026.
Bridging the Gender-Specific Data Gap of IHD Mortality Across South Asians.
South Asia currently experiences the most significant global impact of IHD. While established literature from developed nations suggests a female survival disadvantage, a lack of comprehensive data exists for Low- and Middle-Income Countries (LMICs). Addressing the lack of data, the study aimed to evaluate sex-specific trends in IHD prevalence and mortality across South Asia.
Study Overview:
The cross-sectional investigation analyzed data from Bangladesh, Bhutan, India, Nepal, and Pakistan between 2005 and 2021 to assess Age-Standardized Mortality Rates (ASMRs) and Age-Standardized Prevalence Rates (ASPRs). The researchers calculated the ASMR-to-ASPR index to determine the annual percentage of deaths among the IHD-affected population, excluding subnational variations to focus on national trends. The primary endpoint focused on identifying sex-specific mortality disparities and their correlation with modifiable dietary and metabolic risk factors across varying economic statuses.
Key Clinical Findings of the Study Include:
- Escalating Burden: Research-wise, between 2005 and 2021, the absolute ASMR across South Asia rose by 13.7% in men and 10.3% in women, with men maintaining higher overall rates of 848 deaths per 100,000 population.
- Pakistan's Female Disadvantage: Specifically, Pakistan was the only nation where women faced a 43% higher mortality burden relative to prevalence compared to men in 2021.
- Metabolic Drivers: Analytically, high systolic blood pressure emerged as a critical mortality driver in Pakistani women (Z-score 3.30), a trend not observed in their male counterparts.
- Nutritional Deficits: Comparatively, inadequate intake of fiber (Z-score 2.00) and vegetables (Z-score 2.02) significantly contributed to the excess mortality seen in the Pakistani female demographic.
- Economic Impact: Statistically, a strong negative correlation (r = -0.77) was found between Gross National Income (GNI) per capita and mortality risk across the region.
Clinical Preventative Priorities
For practicing physicians, these findings suggest that reducing the excess IHD mortality gap in South Asia requires shifting focus toward preventative dietary strategies and aggressive blood pressure management specifically tailored to female patients. Clinicians should prioritize the promotion of fiber-rich foods and vegetable intake to mitigate sex-based disparities in cardiovascular outcomes.
Reference
Rahaman T, Cenko E, Manfrini O, et al. Sex Disparities in Ischemic Heart Disease in South Asia: The Role of Dietary Factors. JACC Asia. 2026;6(2):161–174.
