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Burden of the Cardiovascular 
Diseases in Central Asia 

 
Altyn Aringazina1, Tleuberdi 
Kuandikov2, Viktor Arkhipov1 
 
1Department of Population Health and 
Social Sciences, Kazakhstan School of 
Public Health, Medical University, 
Almaty, Republic of Kazakhstan;  
2Department of Anesthesiology and 
Intensive Care of National Scientific 
Centre of Surgery, Almaty, Republic of 
Kazakhstan; 
 

 

 

 
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ARINGAZINA 
 

 
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Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.321|http://cajgh.pitt.edu 

 
 

Abstract 

Cardiovascular diseases (CVD) are now the number one cause of death in low- and middle-income countries, including those in 
Central Asia (CA). Low- and middle- income countries (LMICs) bear a disproportionate and growing burden of CVD, which 
constitutes a challenge to national development. CVD account for more than 43% of cases of disability and 9.0% of cases of 
temporary disability in many developing countries. The high burden of CVD oftentimes results from insufficient preventive care 
and a lack of education about the prevention and treatment of these diseases. The rapidly growing burden of CVD and other major 
non-communicable diseases (NCDs) is a global public health threat, especially in Central Asia. Information on cardiovascular risk 
factors, including hypertension, diabetes, tobacco use, and alcohol use, is traditionally obtained from studies conducted in Europe 
and North America, which limits our understanding of these factors in Central Asia. In this review, we collected all published 
information on CVD in Central Asia from 2000 to 2015, which included the websites of the Ministries of Health, the World Health 
Organization, PubMed, and other published sources.This narrative review describes CVD burden, stroke incidence, and common 
CVD risk factors in the five post-Soviet countries of Central Asia (Kazakshstan, Kyrgyzstan, Tajikistan, Turkmenistan, and 
Uzbekistan). 

Keywords: Cardiovascular Diseases; Epidemiology; Central Asia 

 
Burden of the Cardiovascular 
Diseases in Central Asia 

 
Altyn Aringazina1, Tleuberdi 
Kuandikov2, Viktor Arkhipov1 
 
1Department of Population Health and Social 
Sciences, Kazakhstan School of Public 
Health, Medical University, Almaty, Republic 
of Kazakhstan;  
2Department of Anesthesiology and 
Intensive Care of National Scientific Centre 
of Surgery, Almaty, Republic of Kazakhstan; 

 
 
 

Research 

Central Asia (CA) is a region consisting of five 
former Soviet republics, including Kazakhstan (18 
million), Kyrgyzstan (5.7 million), Tajikistan (8.0 
million), Turkmenistan (5.2 million), and Uzbekistan (30 
million), with a total population of approximately 66 
million inhabitants1. Cardiovascular diseases (CVD) are 
the number one cause of death in low- and middle-
income countries (LMICs), such as those in CA2. The 
high burden of these conditions oftentimes results from 
insufficient preventive care and lack of education about 
the prevention and treatment of these diseases. The 
rapidly growing burden of CVD and other major non-
communicable diseases (NCD) is a major public health 
challenge in CA3. 

It is projected that CA countries will experience 
an increase in the total number of deaths due to NCDs by 
20201. The World Health Organization (WHO) estimated 
that 17.5 million people died of CVD in 2012, accounting 
for 46% of all NCD deaths3. Of these deaths, an estimated 
7.4 million were due to coronary heart disease, and 6.7 

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million were due to stroke and hypertension3. More than 
80% of these deaths occurred in low and middle-income 
countries, and CVD are now the number one cause of 
death in CA4. Worldwide, nearly 25.7 million people had 
strokes in 2013 (71% was ischemic stroke), of which 6.5 
million died (51% was ischemic stroke). The mortality 
from CVD in CA countries is generally higher than that 
in Europe5.  

Information on cardiovascular risk factors, 
including hypertension, diabetes, tobacco use, and 
alcohol use are traditionally derived from studies 
conducted in Europe and North America. For this study, 
we reviewed information from a variety of sources on 
CVD in Central Asia from 2000 to 2015 from published 
sources, including the websites of the Ministries of 
Health and the World Health Organization, as well as 
PubMed, and other published sources. The purpose of 
this review is to describe and analyze data on CVD in CA 
for the following reasons. First, the policy makers of CA 
countries face enormous difficulties in reforming 
healthcare in extremely unfavorable economic 
conditions, and during major domestic and political 
transformations. To help these countries rebuild their 
health systems, policymakers need access to reliable 
information about their own health systems and local 
public health indicators. Second, CA countries have an 
interest in discovering initiatives that can be successfully 
adapted from abroad. It should be noted that most data 
regarding CA healthcare systems is limited or not 
available for public access. To our knowledge, reliable 
scientific and statistical publications on CVD in 
Turkmenistan were not available as of 2017. Thus, this 
review does not include the Republic of Turkmenistan.  

Republic of Kazakhstan 

In 2014, the overall mortality rate from CVD in 
Kazakhstan was 232.4 per 100,000; in 2015 it was 219 
per 100,0006. Regionally, the highest rate of CVD was 
reported in the Karaganda region with 368.1 deaths per 
100,000 in 20156. In rural areas, mortality figures were 
significantly lower than in urban areas. Among urban 

residents in 2014, the general mortality rate from CVD 
was 238.3 per 100,000, while in rural areas it was 162.2 
per 100,000. Kazakhstan has the third highest death rate 
from ischemic stroke among the countries of the former 
Soviet Union7.  

During the period between 2011 and 2015, a 
national screening program for CVD and diabetes was 
introduced in Kazakhstan. Screening of CVD in 
Kazakhstan takes place every 2 years through free 
medical care in all district clinics for men and women 
aged 18, 25, 30, 35, and 40-64 years who have not been 
diagnosed with heart disease or diabetes. During the 
screening, patients are given a questionnaire assessing 
risk factors and had their height, weight, blood pressure, 
cholesterol, and blood sugar measured6. Those with a 
high risk of cardiovascular mortality received referrals 
for further care. From 2011 to 2015, over 7.5 million 
adults in Kazakhstan were screened for CVDs. As a 
result, more than 600,000 cases of heart disease were 
identified (7.9% of those screened)8.  

 Arterial hypertension is one of the most 
common diseases in Kazakhstan and poses a serious 
challenge to public health. Between 2009 and 2013 the 
prevalence of hypertension significantly increased from 
10,778 to 13,392 per 100,0008, resulting in 24.3% of 
adults in Kazakhstan having hypertension in 20138,9. 
Mortality rates related to hypertension increased as well 
and now rank first among causes of death. 
Approximately 40% of the deaths were observed in 
working age group (20–64 years), 64% of which were 
males6. To curb this epidemic, the State Health System 
established a screening program for the early detection of 
CVD and its risk factors9-11. Most of the screened patients 
had not previously received any treatment for their 
conditions12.  

According to the WHO Report on the Global 
Tobacco Epidemic (2013), the prevalence of tobacco use 
among the adult population of Kazakhstan (aged 15-65 
years) was 29.8% (48.0% for males and 12.1% for 
females)13. The consumption of smokeless tobacco 

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ARINGAZINA 

 
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among young people was 3.0% (3.4% for males and 2.7% 
for females)11.  

In comparison, the results of five national 
studies on monitoring and surveillance of tobacco 
consumption in Kazakhstan showed a small decrease in 
smoking over the past 14 years13. In 1998, the prevalence 
of smoking among young people over the age of 11 was 
28.0%, 49.8% among men and 12.2% among women. In 
2012 this figure was 26.5%, 41.5% among men and 
11.0% among women13. In 2006, Kazakhstan joined the 
Framework Convention on Tobacco Control, and 
committed itself to implementing measures to protect the 
public from tobacco smoke14. The Chief Sanitary Doctor 
of the Ministry of Health of the Republic of Kazakhstan 
adopted ban on smoking hookah in public places in 
March of 201315. The government supports initiatives 
aimed at the prevention of non-communicable diseases 
by adoption of a healthy lifestyle in the population. 

Kazakhstan is 34th in the world in terms of 
alcohol consumption (10.3 liters of alcohol consumed per 
capita per year) and is the largest consumer of alcohol 
among the CA countries16. From 2008-2012, the volume 
of alcoholic beverages sold in Kazakhstan increased by 
9.6% from 862 million liters to 944.4 million liters. From 
2013 to 2017, the growth in sales of alcoholic beverages 
in Kazakhstan was projected to average 1.7% per year. In 
2017, estimated domestic sales of alcoholic products 
were expected to reach 1.028 million liters. According to 
the 2003 World Health Survey (total sample size of 2894; 
1170 males and 1724 females), the mean value (in grams) 
of pure alcohol consumed per day among drinkers was 
2.9 (total), 4.2 (males) and 2.1 (females). While alcohol 
consumption in general carries additional health risks 
unrelated to CVD, extremely high levels of alcohol 
consumption may increase the risk of CVD in an 
individual. 

In Kazakhstan, stroke treatment is becoming a 
priority with 41 world-class stroke centers opening in 
different regions of the country in the past few years, and 
30 more centers projected to open before 202017. Under 

the Ministry of Health and Social Development of 
Kazakhstan, a coordinating council was formed to 
implement an integrated model of health care delivery for 
socially significant NCDs17. The Ministry of Health 
focused its efforts on conditions like acute myocardial 
infarctions, acute cerebrovascular accidents, malignant 
neoplasms, trauma, and pregnancy complications18. 
Although many health status measures show that  
Kazakhstan is ahead of most nations in the region, it 
continues to lag behind other countries with similarly 
sized economies on several important health indicators7.  

Republic of Kyrgyzstan 

Among countries incuded in the WHO 
European Region report, Kyrgyzstan has the highest 
premature mortality rate from CVD, the second-highest 
death rate from cerebrovascular disease, and the third-
highest death rate from ischemic heart disease19. In 
Kyrgyzstan, mortality from stroke is much higher, and 
ischemic heart disease is moderately lower than in other 
post-Soviet countries. Life expectancy at birth in 
Kyrgyzstan is 75 years for women and 67 years for 
men19. NCDs are estimated to account for 80% of all 
deaths; with half of these deaths attributed to CVD. The 
probability of dying between the ages of 30 and 70 years 
from the main NCDs (ischemic stroke and ischemic heart 
disease) is 28%20,21. Nevertheless, there is a downward 
trend for premature mortality from NCDs (largely driven 
by reductions in CVD mortality), and projections suggest 
that Kyrgyzstan will reach the global NCD target of a 
25% reduction in mortality by 202521. In recent years, 
there has been a reduction in the total mortality rate due 
to CVD, with a decrease from 331.3 in 2012 to 300.9 per 
100,000 in 201522. Mortality rate reduction was also 
observed for stroke and acute myocardial infarction in 
men and women, although the reduction in the latter 
mortality rate was larger in women than men21. In 
contrast, according to the National Statistics, mortality 
for all ages due to ischemic stroke has increased23.  

Apart from the differences in risk factor 
prevalence, other reasons for higher mortality among 

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men relate to lack of awareness of the signs, symptoms, 
and consequences of raised blood pressure and 
underutilization of health-care services24. 

Kyrgyzstan has a relatively low gross domestic 
product compared to other post-Soviet countries and was 
categorized as a low-income country by the World Bank 
until 201425. However, the general government 
expenditure on health as a percentage of total government 
expenditure is relatively high compared to similar 
countries, with total expenditure on health close to that of 
12 post-Soviet median-income countries20. The trends in 
select causes of death are similar to those in other post-
Soviet countries, but are slower to change, which can be 
linked to the health-system’s limited capacity for early 
detection and treatment20. The prevalence of 
cardiovascular risk factors is high; these  include diet, 
high blood pressure, and tobacco use21. A recent WHO 
study describing the nutritional composition of the foods 
sold in Bishkek, Kyrgyzstan, found that the amounts of 
trans-fatty acids and salt in common foods are extremely 
high compared to the developed contries26.  

High blood pressure was always on the top of 
the list of health problems identified during health 
assessments in Kyrgyzstan population. It was the third 
most common disease for women, the second most 
common for men, and exerts a large burden on 
populations living in poverty20,22. Government initiatives 
have been formed to focus on screening programs to 
improve people’s awareness of hypertension. Since 2011, 
an annual “hypertension week” has been held, during 
which Village Health Committees (VHCs) provided 
blood pressure screenings, and explained the dangers of 
elevated blood pressure and CVD27. The Community 
Action for Health (CAH) program 201427 has contributed 
to a significant improvements in the early detection and 
management of hypertension, and the number of people 
undergoing screening is increasing annually. Since 2011, 
a total of 1.75 million people were screened for elevated 
blood pressure, comprising about half of the adult 
population of Kyrgyzstan23. The CAH program had a 

significant nationwide impact on hypertension awareness 
and control. According to WHO calculations from the 
nationally representative Integrated Household Survey, 
hypertension awareness increased from 27% in 2007 to 
45% in 201528. The increase was greater in rural areas, 
where VHCs work. As a result, a large urban–rural gap 
in awareness of hypertension status noted in 2007 had 
disappeared by 201528. Compliance with anti-
hypertensive medication also improved during this 
period. The proportion of people with elevated blood 
pressure who reported having taken their medication in 
the past 24 hours was 33% in 2015, in contrast to 14% in 
200728. 

Nicotine and alcohol consumption are important 
factors contributing to CVD mortality in Kyrgyzstan. The 
prevalence of current tobacco smoking among 
Kyrgyzstan population aged 15 years and older in 2013 
was 3.7% for women, and 50.5% for men21. The total 
annual per capita alcohol consumption among people 
aged 15 years and older was 4.3 liters of pure alcohol per 
year in 201121.   

Additionally, obesity is a problem in 
Kyrgyzstan. In 2014, the percentage of overweight males 
and females aged 18 years and above was 45.2% and 
49.1% respectively 21. The WHO STEPS NCD survey in 
2013 reported that 42.9% of adults aged 25–64 years had 
elevated blood pressure (similar frequency in males and 
females) and 23.6% had an elevated total cholesterol 
levels (more common in females than in males)29. Almost 
one in five (17.4%) adults were identified as being at high 
cardiovascular risk, i.e. the probability of their having a 
cardiovascular event or death in the next ten years was 
30% or more. Over a third of adults aged 25–64 years had 
three or more cardiovascular risk factors; this rate was 
higher among men (39.5%) and older age groups29. 

In Kyrgyzstan, there is an established political 
and legislative framework for the prevention and control 
of CVD. There are a national strategy to combat NCDs 
for 2013-2020, which recently passed a mid-term 
evaluation, and the National Health Reform Program 

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ARINGAZINA 

 
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"Den Sooluk" for 2012-201622, which prioritizes the 
health of the cardiovascular system. The regulatory and 
fiscal framework for tobacco control is underdeveloped, 
but its scope can be expanded, and its enforcement can 
be strengthened22.  

Funding of the CVD Action Plan includes 
implementation of a package of essential NCD (PEN) 
interventions at the primary health-care level (PEN 
protocols) as well as an article that provides free access 
to screening22. “Den Sooluk” was originally planned to 
end in 2016 but because of a delayed start, the 
Government of Kyrgyzstan and donor partners agreed to 
extend it until the end 2018. A mid-term review of “Den 
Sooluk” reported that 25% of the 96 indicators have been 
achieved or exceeded as part of the main goal of reducing 
the burden of  CVD’s30. 

 
Republic of Tajikistan 

The epidemiological situation shows that CVD 
are the leading cause of death in Tajikistan31. Between 
1990 and 2010, Tajikistan had an increase in the burden 
of NCDs, especially coronary heart disease and stroke31. 
In addition, it is estimated that about 40% of the total 
population is overweight and 9% is obese, which 
suggests a low level of physical activity and unhealthy 
dietary habits32. There is limited access to emergency 
medical services for the acute myocardial infarction. The 
most important services are provided at the level of the 
central district hospitals (prescribing aspirin, beta 
blockers, and angiotensin converting enzyme inhibitors), 
but access to thrombolytic therapy is limited33. For the 
treatment of stroke, obsolete methods are used that are 
not based on evidence-based medicine34. The country 
lacks evidence-based clinical guidelines for the 
management of stroke patients34. During 2005-2011, 
CVD mortality increased from 63 to 67 cases per 
100,000, or approximately from 46.8% to 48.82% of the 
total death rate35. 

Hypertension is among the major risk factors for 
CVD. Many Tajik women suffer from hypertension 

without knowing it; hypertension is often termed the 
‘silent killer’ because of the lack of warning signs or 
symptoms. In the 2012, Tajikistan Demographic and 
Health Survey (TjDHS)32 respondents completed several 
questions to determine their history of hypertension, 
including whether they have ever been told by a doctor 
or other health worker that they had high blood pressure 
and, if so, whether they had been told that on two or more 
occasions. If surveyed women reported that on one or 
more occasions they were told that they had high blood 
pressure, they were asked additional questions on actions 
they were taking at the time of the survey to lower their 
blood pressure. Overall, the TjDHS32 results indicate that 
12% of women aged 15-49 reported having been told by 
a doctor or other health worker that their blood pressure 
was high. Seventy-eight percent of women with high 
blood pressure reported that they were diagnosed with 
hypertension on two or more occasions. More than eight 
in ten of those women were taking medication to control 
their blood pressure. A significant percentage of women 
reported not taking other measures to lower their blood 
pressure; only 46% were cutting back on salt in their diet, 
39% were controlling or losing weight, and 29% were 
exercising. As expected, the prevalence of women with 
high blood pressure increased with age, from 3% of 
women aged 15-19 to 29% of women aged 45-49. Also, 
being overweight (BMI >25) was strongly correlated 
with high blood pressure. The proportion of women with 
high blood pressure was slightly higher in rural women 
compared to urban women (30% and 21% respectively). 
This can be explained by the fact that a relatively large 
proportion of women are receiving medical care in urban 
health facilities32. 

Tajikistan made progress in the fight against 
tobacco by amending the Law on Restricting the Use of 
Tobacco Products in early 201136

, and ratifying the WHO 
Framework Convention on Tobacco Control (WHO 
FCTC)37 which was launched on September 19, 201338-

40. Despite these amendments, the laws on tobacco 
control still need improvements. In particular, it is 
necessary to clarify and explain the terminology 

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associated with what is considered to be tobacco 
products38. Nevertheless, youth smoking monitoring and 
control are better in Tajikistan compared to other CA 
countries. The Global Youth Tobacco Survey (GYTS), 
an inter-country study conducted in CA, was conducted 
in Tajikistan in 201441 and showed that in Tajikistan only 
5.9% of students used any tobacco products (6.8% of 
men and 2.8% of women), while the average results in 
other CA countries were reported to be higher (9.6%)41. 

The level of alcohol consumption in Tajikistan 
is relatively low42. The total annual per capita alcohol 
consumption among people aged 15 years and above was 
4.3 liters of pure alcohol per year42. According to the 
recent survey of rural population, only 12.2% of men and 
0.1% of women consumed alcohol38. Among the urban 
population, 39% of men and 6.7% of women consumed 
alcohol38. Advertising alcohol is prohibited in Tajikistan, 
although it can still be found in retail stores.  

Tajikistan has made progress in promoting 
healthy eating and physical activity. In 2011, a 
governmental intersectoral working group was 
established to develop and implement the strategy for 
improving nutrition and physical activity, including an 
action plan for 2013-2020 based on WHO strategies43. 
The strategy defines priority areas, such as reducing 
consumption of salt, trans-fats, and sugar, and promotes 
exclusive breastfeeding, timely and appropriate 
supplementary nutrition, as well as a healthy diet and 
physical activity. Since 2004, Tajikistan has 
implemented a series of comprehensive measures to 
reform the health sector to address the problem of limited 
access to health services. The reforms envision changing 
the organization and provision of medical services by 
moving to the family medicine model and introducing 
appropriate financial mechanisms to reduce the level of 
out-of-pocket cash payments44-46. These efforts still face 
challenges, in particular, the need to expand the coverage 
of basic individual services, strengthen the tobacco 
control, increase the level of state funding, strengthen the 

coordination between providers, and improve the quality 
of medical services at the level of primary health care. 

Republic of Uzbekistan 

Uzbekistan registers more than 1.5 million acute 
and chronic CVD cases on an annual basis, with more 
than half a million of them being newly diagnosed cases. 
Over the past 10 years, the level of primary and general 
morbidity in this population has increased47. Since 2003, 
the primary incidence rate has increased 1.4 times (from 
1,291 to 1,759 per 100,000), and the general prevalence 
increased 1.2 times (from 4,672 to 5,503 per 100,000)48. 
Detection of the primary morbidity and registration of 
general morbidity from CVD among the adult population 
increased 1.3 and 1.1 times (7,154 and 6,053 per 
100,000) respectively48. Morbidity from CVD among 
children (0-14 years) and teens (15-18 years old) has 
decreased 1.2 times (4,586 per 100,000) between 2003 
and 201348. Such a decrease among younger age groups 
is probably associated with a program on maternal and 
child health implemented in 1998. The increase in the 
level of primary and general morbidity from CVD among 
the adult population is probably due to the increase in life 
expectancy in the country from 67 to 73.1 years48. In 
addition, the measures taken in the Republic of 
Uzbekistan to improve the quality of primary health care, 
and the development of healthy lifestyles have increased 
the number of individuals receiving medical care48. The 
level of coverage by preventive examinations of certain  
population groups for the study period increased to 88-
89% for adults and to 99-99.6% for children49. The level 
of access to doctors in polyclinics (primary care 
facilities) and rural medical stations increased 1.3 times 
when compared to 2003 and amounted to 9 visits per 
capita per year in 201349. It is estimated that by 2020 the 
level of the primary and general morbidity from the CVD 
across the Republic will be 2,069 per 100,000 (60% 
increase) and 6,062 per 100,000 (30% increase) 
respectively48.  

CVD traditionally have low-ranking positions 
on the list of morbidity causes, contributing only 6.8% of 

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all causes of morbidity in 2013. This may be explained 
by the relatively young population; 32% of population is 
under 18 years of age. However, in the structure of the 
causes of death in the country, they occupy a leading 
place, and in 2012 their share was 61.6%48. Among all 
leading causes of the overall morbidity 40.4% is 
occupied by diseases characterized by an elevated blood 
pressure, including hypertension with target organ 
damage (14.2%), angina (7.7%), chronic ischemic 
disease heart disease (7.0%), cerebrovascular disease 
(4.1%), acute myocardial infarction (0.54%), and 5.9% 
by chronic rheumatic heart disease48.  

A study aimed at hypertension, the women's and 
men's questionnaires for the Uzbekistan Health 
Examination Survey (UHES), was performed in 2002 
with no more recent data available. Rates of hypertension 
among women aged 15-49 and men aged 15-59 were 7 to 
8% respectively50. 74% of women had a blood pressure 
reading in the optimal range (< 120/80 mmHg) compared 
to 48% of men50. In general, rates of hypertension were 
positively associated with age, education, urban 
residence, and being overweight/obese. More 
hypertensive women than men were aware of their 
condition (62% versus 37%), and higher number of 
women than men managed their condition with 
medication (37% versus 10%)50. 

In Uzbekistan, a study based on the WHO 
STEPS methodology was conducted between January 
and April of 201451. This study suggested that the 
prevalence of smoking among adults (18-64 years) was 
14.4% (26.8% of men and 1.4% of women)51. Smoking 
is prohibited in all enclosed public places except for 
designated smoking areas. However, there are no 
specially allocated funds to enforce this ban, nor is there 
a system for filing and considering citizens' complaints 
about violations of the smoking ban52. In accordance with 
the Law on Advertising, adopted in 1998, which was 
subsequently amended53, and the law on restricting the 
distribution and consumption of alcohol and tobacco 
products adopted in 2011, certain types of direct and 

indirect advertising of tobacco products are banned. 
However, in the event of violation of these prohibitions, 
a penalty in the form of a fine is not enforced52.  

According to the recent rural population survey, 
only 12.2% of men and 0.1% of women used alcohol38. 
These figures were 39% for men and 6.7% for women in 
urban populations37,54. The total annual per capita alcohol 
consumption among people aged 15 years and above was 
4.6 liters of pure alcohol per year51. Prices on alcohol are 
quite low and may stimulate an increase in alcohol 
consumption. 

Conclusions 

NCDs, and particularly CVD, present a 
challenge for the CA. Ischemic heart disease and stroke 
are major causes of premature mortality, and the 
prevalence of cardiovascular risk factors is high within 
the CA population. Some of the regional governments 
have committed themselves to tackling the problem, as 
evidenced by the policy framework and some of the 
measures already in place. In CA countries stroke and 
ischemic heart disease are more prominent among NCDs. 
This is most likely due to a higher prevalence of CVD 
risk factors in CA countries. Reduction in salt 
consumption in CA countries is important for the 
reduction of CVD, especially for stroke. The high 
prevalence of elevated blood pressure is of great concern 
due to the fact that some with elevated blood pressure 
may be unaware of their condition. Such persons should 
be followed up and advised to utilize existing primary 
and secondary prevention opportunities. Secondly, those 
who were previously diagnosed with high blood pressure 
and were not effectively treated need to be followed up 
with by health care providers.  

Prevention of smoking is also an important 
strategy for reducing CVD in most CA countries, 
especially for men. Smoking increases the risk of 
developing CVD by approximately 30%55. The STEPS 
survey will provide invaluable information needed to 
inform policy and planning. Tobacco smoking is an 

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important modifiable behavioral risk factor in CA. 
Second hand smoking is something that has been rarely 
evaluated in CA and needs to be considered in future 
research. 

Heavy alcohol consumption remains an 
important risk factor for global burden of CVD56. Nearly 
all the data on humans exploring the relationship between 
alcohol consumption and CVD risk, including some 
indications of potential CVD benefits associated with 
low-to-moderate alcohol consumption, are derived from 
epidemiologic studies. Therefore, because there are no 
randomized controlled trials, health care professionals 
should not recommend alcohol consumption as a primary 
or secondary lifestyle intervention. Instead, clinicians 
should continue to recommend strategies such as a 
healthy diet and exercise. For example, certain levels of 
alcohol consumption that lower risk for CHD may 
increase it for other CV conditions, such as stroke. In 
addition, data from studies using new research methods, 
including Mendelian randomization, suggest that the 
relationship between low-to-moderate alcohol 
consumption and cardioprotection merits more critical 
appraisal56. 

The prevalence of obesity is also increasing in 
the region, potentially leading to the increased prevalence 
of diabetes, impaired glucose control, and metabolic 
syndrome. Since these conditions influence 
cardiovascular health, we will focus on these conditions 
in our future research. As of 2017, there were no major 
studies focusing on these problems in the region. We 
believe that the problem of obesity and diabetes deserves 
close attention from the regional institutions, WHO, and 
other international organizations. 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
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	Burden of the Cardiovascular Diseases in Central Asia
	Abstract
	Keywords: Cardiovascular Diseases; Epidemiology; Central Asia
	Burden of the Cardiovascular Diseases in Central Asia
	Research

