Pakistan's growing burden of heart disease has often been seen as a problem of middle and older age. A new study published in Progress in Cardiovascular Diseases challenges that view, arguing that the roots of heart, kidney, and metabolic conditions often begin much earlier: during adolescence and young adulthood.
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'Longitudinal study of cardiovascular-kidney-metabolic syndrome risk assessment among adolescents and young adults (10–45 years) in Pakistan (LIFECARD)', the article outlines the design of Pakistan's first large, community-based study to track heart and metabolic health over time. The research is led by Aga Khan University (AKU) researchers in collaboration with national and international partners.
Participant enrolment for the study began in November 2024 at the Karachi (peri-urban) site, where nearly 2,000 adolescents and adults have already joined the cohort. A second site in Matiari (rural) began enrolling participants in December 2025, extending the study beyond major urban centres. Full enrolment is expected by the third quarter of 2026.
Pakistan has one of the highest rates of heart disease in South Asia, yet most local evidence comes from studies that capture only a single snapshot in time. LIFECARD aims to change this by following two groups: adolescents aged 10–20, and adults aged 21–45, over at least a 10-year period. This long-term approach will help researchers understand how risk factors develop, interact, and worsen across key stages of life.
Importantly, enrolment at the Karachi site has been evenly balanced between males and females across both age groups, strengthening the study's ability to examine how risks may differ by sex as young people transition into adulthood.
Focusing on younger age groups fills a major gap in existing research. Pakistan is a young country, with a median age of about 21 years, and as this population grows older, rates of chronic disease are expected to rise sharply. Studying risk early creates a critical opportunity for prevention, when lifestyle changes and early treatment can have the greatest impact, rather than responding once disease is already advanced.
What makes LIFECARD distinctive is its integrated approach. Instead of studying heart disease, diabetes, obesity, or kidney problems separately, the study examines how these conditions are closely linked and together form what is known as cardiovascular kidney metabolic syndrome. In Pakistan, health risks are shaped by a mix of factors, including unhealthy diets, low physical activity, air pollution, stress, and early-life conditions. Looking at these risks together provides a clearer and more realistic picture of how disease develops.
By following participants over many years, the study will do more than show how common these risks are. Regular check-ups will help researchers see how health changes over time, identify when risks such as high blood pressure or poor diet begin to cause the most harm, and determine which combinations of risks are most dangerous.
The study will also explore areas that have received little attention in Pakistan. These include early signs of artery damage detected through simple ultrasound scans of the neck, exposure to air pollution at home and outdoors, the effects of anxiety and depression, health risks linked to pregnancy in women, and how a person's genetic makeup may interact with their environment to influence disease risk.
As Principal Investigator, Dr Salim S. Virani, Professor of Medicine at AKU, notes in the article, the aim is not just to document risk but to guide action. By tracking how health risks evolve over time, the study seeks to identify the right interventions at the right stages of life, when prevention can make the biggest difference.
The implications extend beyond research. Findings from LIFECARD are expected to inform early screening strategies, age-specific risk assessment in clinics, community-based prevention programmes, and policy decisions, including those related to air quality. The study also offers a practical model for other low- and middle-income countries facing similar demographic and lifestyle changes.
By shifting attention from late-stage disease to early risk, LIFECARD reframes Pakistan's heart health challenge: not just as a looming crisis, but as a chance to act early and improve outcomes for an entire generation.
Illustration: LIFECARD study design showing participant criteria and data collection timeline
