Premature atherosclerotic cardiovascular disease in the MENA region: economic impact, barriers to care, and policy recommendations for an escalating crisis

PURPOSE OF THE REVIEW: Premature atherosclerotic cardiovascular disease (ASCVD) is increasingly recognized as a major public health challenge in the Middle East and North Africa (MENA) region, where cardiovascular events occur at younger ages than in Western populations. Despite ongoing policy reforms and improvements in healthcare infrastructure, premature ASCVD remains underrecognized and insufficiently addressed. This review summarizes the epidemiology, economic burden, policy initiatives, and current barriers related to premature ASCVD in MENA, while proposing targeted interventions to support policymakers and improve health outcomes. RECENT FINDINGS: Recent evidence demonstrates that premature ASCVD occurs approximately 10-12 years earlier in MENA populations than in Western countries. The high prevalence of traditional risk factors, including dyslipidemia, obesity, diabetes, hypertension, smoking, and physical inactivity, together with genetic predisposition and familial hypercholesterolemia, contributes substantially to earlier disease onset. Available economic data indicate a considerable burden associated with ischemic heart disease, stroke, and acute coronary syndromes across the region. Multiple initiatives have focused on cardiovascular risk reduction through screening programs, tobacco taxation, trans-fat elimination policies, and strengthening acute care systems. However, significant barriers persist, including healthcare inequities, fragmented health-information systems, workforce limitations, financing constraints, and insufficient implementation of preventive strategies. SUMMARY: Premature ASCVD represents an underrecognized and growing challenge in the MENA region. Addressing this burden requires integrated policy reforms emphasizing early screening, aggressive risk-factor management, strengthened primary healthcare systems, improved digital health infrastructure, expanded workforce capacity, and sustainable financing strategies. Coordinated regional efforts are essential to reduce the long-term clinical and economic consequences of premature ASCVD.