Bangladesh must urgently shift its healthcare focus from treating advanced cardiovascular disease to prevention, early detection and timely risk assessment, according to Associate Consultant in Cardiac Surgery at Square Hospital Dr Md Mesbah Uddin.
In an interview with TIMES ahead of the World Heart Day, observed this year under the global campaign theme “Don’t Miss a Beat”, Dr Mesbah said too many patients reach specialist care only after their conditions have progressed to a critical stage requiring major surgical intervention.
“One of the biggest gaps in our current system is that we often initiate treatment when the disease is already far advanced, missing crucial opportunities to identify and manage risk early,” he said.
“As a surgeon, I regularly perform bypasses and valve replacements on patients who lived with undetected or unmanaged conditions for years. While surgery is life-saving and essential, preventing or controlling disease before it reaches that stage is always the better path.”
Cardiovascular risks in Bangladesh are driven by widespread lifestyle and metabolic factors, including tobacco use, hypertension, diabetes, unhealthy diets and physical inactivity.
Data from Bangladesh’s national STEPS survey, conducted under the World Health Organization’s standardised framework for monitoring non-communicable disease risk factors, shows the scale of the challenge. It found that 70.9% of adults aged 18–69 had at least one major non-communicable disease risk factor, while 26.2% had three or more.
Non-communicable diseases now account for roughly seven out of every 10 deaths in Bangladesh, according to World Health Organization estimates.
Dr Mesbah said the primary clinical concern was not only individual risk factors but their cumulative impact on patients.
“What concerns me most is the clustering of multiple risk factors in the same individual,” he said.
“It is common to see patients presenting simultaneously with hypertension, diabetes, high cholesterol, obesity, and a sedentary lifestyle, often compounded by tobacco exposure.”
While clinicians are seeing severe coronary artery disease in increasingly younger patients, Mesbah cautioned that comprehensive, long-term national data is still needed to establish broader age-related trends conclusively across Bangladesh.
For patients experiencing acute cardiac events, delays in recognising symptoms and accessing appropriate care remain major hurdles to survival and recovery.
A study of 385 patients with acute myocardial infarction, or heart attack, in Bangladesh found that only 22% reached a hospital within six hours of symptom onset, while just 13% arrived within the critical two-hour window. The study identified lack of symptom recognition, geographical distance and transport barriers among the key causes of delay.
“Many people mistake chest pressure or pain for routine gastric discomfort,” Mesbah said.
“They lose precious time taking antacids at home, waiting for symptoms to subside, or consulting local pharmacies before seeking hospital care.”
He urged the public to recognise key heart attack symptoms, including chest pain or tightness accompanied by shortness of breath, cold sweats, nausea, unexplained fatigue, or pain radiating to the arm, shoulder, back or jaw, and to seek emergency medical care immediately.
To support rapid intervention, he stressed the need for streamlined emergency medical pathways nationwide so that patients presenting with chest pain can receive an immediate ECG, rapid diagnosis and timely restoration of blood flow to minimise permanent damage to the heart muscle.
Mesbah said national efforts to address the rising burden of cardiovascular disease should focus on three areas: prevention, early detection and emergency response.
Prevention should include stronger tobacco control policies, promotion of healthy diets and regular physical activity, as well as community-based weight management programmes.
At the primary-care level, routine screening for blood pressure, blood glucose and lipid profiles should be strengthened to identify people at risk before disease becomes advanced.
He also called for faster triage systems and greater public awareness so that patients experiencing heart attacks can reach appropriate emergency cardiac care as quickly as possible.
He stressed that effective cardiovascular health policy cannot rely solely on individual choice or hospital-based care.
“Cardiovascular health is shaped by our broader environment,” Mesbah said. “Achieving lasting progress requires coordinated action across healthcare, education, workplace safety, food regulation, urban planning, and policy enforcement.”
His message is straightforward: “We should not wait until someone develops advanced heart disease before taking cardiovascular health seriously. The ultimate goal must be early identification and intervention so that fewer lives require major surgical rescue.”
