Cardiovascular and respiratory diseases remain two of the leading contributors to morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) undergoing rapid epidemiological transitions. The World Health Organization (WHO) estimates that cardiovascular diseases (CVDs) account for approximately 32% of global deaths, with ischemic heart disease and stroke comprising the majority of these deaths [1]. Chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD) and asthma, are major public health burdens, causing an estimated 7% of all deaths globally [2]. These conditions share overlapping risk factors, such as smoking, obesity, hypertension, diabetes, and air pollution, which often coexist and compound disease outcomes [3,4]. In South Asia, particularly in Bangladesh, the epidemiological landscape has shifted significantly over the past two decades. While communicable diseases once dominated, noncommunicable diseases (NCDs), especially CVDs and CRDs, have emerged as the leading causes of hospitalization and premature mortality [5]. According to national data, nearly one-third of Bangladeshi adults have hypertension, and approximately 25% have diabetes or prediabetes [6]. Concurrently, COPD affects an estimated 12–13% of adults, making it one of the most prevalent chronic diseases in the country [7, 8]. Urbanization, dietary changes, sedentary lifestyles, and persistent exposure to tobacco smoke and biomass fuels have accelerated these trends. Hospital-based studies in Bangladesh have revealed a predominance of ischemic heart disease and hypertensive disorders among middle-aged and older adults, particularly in men [9]. Similarly, COPD and asthma are more prevalent among individuals with a history of smoking or occupational exposure to dust and biomass fuel [7]. However, the co-occurrence of CVDs and CRDs in the same individuals, an increasingly recognized pattern termed “multimorbidity”, remains underexplored in Bangladeshi hospital cohorts. Understanding this overlap is crucial for clinical management and health system planning, as patients with combined cardiopulmonary disease experience worse outcomes, longer hospital stays, and higher mortality rates [10]. Although several community-based surveys and disease-specific studies have described the individual patterns of CVD or CRD in Bangladesh, few have systematically examined their concurrent distribution in a single adult hospital cohort. Furthermore, existing evidence is fragmented across studies focusing separately on cardiovascular or respiratory conditions, often with limited sample sizes or restricted geographic coverage of the studies. This highlights a gap in the integrated epidemiological understanding of these disorders in real-world hospital settings, where the dual burden is most evident [11]. Therefore, this study aimed to describe the epidemiological trends of cardiovascular and respiratory disorders among adults attending a tertiary care hospital in Bangladesh.

This hospital-based cross-sectional observational study was conducted at the Department of Cardiology, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh, from January 2024 to December 2024. A total of 280 adult inpatients and outpatients presented with cardiovascular or respiratory complaints during this period are included in this study. Selection criteria Inclusion criteria: • Age ≥ 18 years at presentation • Documented primary diagnosis of cardiovascular or respiratory disease (or both) • At least one recorded comorbidity or risk factor (e.g. hypertension, diabetes, smoking) Exclusion criteria: • Exclusive acute respiratory infections without a chronic respiratory diagnosis • Presentations for non-cardiopulmonary conditions Data Collection and Study Procedure Data were collected from adult patients attending the outpatient and inpatient departments of Medicine, Cardiology, and Pulmonology. A structured data collection form was used to record relevant variables, including sociodemographic characteristics, lifestyle factors, anthropometric measurements (height, weight, and BMI), and clinical parameters related to cardiovascular and respiratory health. Clinical diagnoses were made by attending physicians based on clinical examination and relevant investigations, such as electrocardiography, echocardiography, chest radiography, and spirometry, according to standard diagnostic criteria. Data collectors reviewed the participants' hospital records on the day of consultation or admission. Data were analyzed using SPSS version 25.0. Informed consent was obtained from all participants before their inclusion in the study. Confidentiality was maintained throughout the study period.

Table 1: Baseline Characteristics of the Study Participants (n = 280) Variable Category Frequency (n) Percentage (%) Age (years) 18–40 46 16.4 41–60 148 52.9 >60 86 30.7 Sex Male 165 58.9 Female 115 41.1 BMI (kg/m²) Normal (18.5–24.9) 122 43.6 Overweight (25.0–29.9) 101 36.1 Obese (≥30.0) 57 20.3 Smoking Status Current 121 43.2 Former 39 13.9 Never 120 42.9 Comorbidities Hypertension 129 46.1 Diabetes mellitus 80 28.6 Dyslipidemia 54 19.3 Table 1 presents the baseline characteristics of the study population. Most participants were aged 41–60 years, with a male predominance. Overweight and obesity were common, and nearly half had hypertension. Table 2: Distribution of Major Cardiovascular Disorders among Participants (n = 176) Cardiovascular Diagnosis Frequency (n) Percentage (%) Ischemic heart disease 67 38.2 Hypertensive heart disease 47 26.8 Heart failure 26 14.6 Rheumatic heart disease 14 8 Arrhythmia 12 6.8 Other cardiac conditions 10 5.6 Table 2 summarizes the pattern of cardiovascular diseases. Ischemic heart disease was the most prevalent diagnosis, followed by hypertensive heart disease and heart failure. Table 3: Distribution of Major Respiratory Disorders among Participants (n = 104) Respiratory Diagnosis Frequency (n) Percentage (%) Chronic obstructive pulmonary disease 57 31.4 Bronchial asthma 31 17.1 Pneumonia 17 9.3 Interstitial lung disease 7 3.9 Other respiratory diseases 5 2.8 Table 3 outlines the respiratory disease profile. COPD was the predominant condition, followed by asthma and pneumonia. Table 4: Distribution of Comorbidities and Risk Factors among Study Participants (n = 280) Risk Factor / Comorbidity Frequency (n) Percentage (%) Hypertension 129 46.1 Diabetes mellitus 80 28.6 Obesity (BMI ≥ 30 kg/m²) 57 20.3 Dyslipidemia 54 19.3 Smoking (current/former) 160 57.1 Sedentary lifestyle 133 47.5 Family history of CVD 71 25.4 Table 4 presents major comorbidities and risk factors. Hypertension and smoking were the most common, frequently coexisting with metabolic abnormalities such as diabetes and obesity.

This hospital-based cross-sectional observational study in Mymensingh, Bangladesh, demonstrated the prominent burden of cardiovascular disorders accompanied by a non-negligible share of respiratory morbidity among adults. The predominance of cardiovascular disease aligns with national projections showing that ischemic and hypertensive cardiovascular conditions are major contributors to Bangladesh’s non-communicable disease (NCD) burden [12]. In the Global Burden of Disease analyses, Bangladesh has seen a sustained rise in the proportion of mortality and disability attributable to CVD and respiratory diseases over recent decades [2,3]. In this study, ischemic heart disease accounted for over one-third of cardiovascular cases, followed by hypertensive heart disease and heart failure. This distribution mirrors the patterns observed in hospital-based studies in Bangladesh, including Dhaka and other tertiary centers, where coronary artery disease consistently dominates the cardiovascular case mix [13]. In the diabetic population in Dhaka, CAD accounted for approximately 32% of cardiovascular diagnoses [13]. The comparatively higher proportion of heart failure in our study population may reflect later-stage presentation and limited access to early intervention, which is common in resource-constrained settings. The respiratory disease profile, led by COPD and asthma, concurs with previous hospital- and community-based prevalence data. A seminal hospital-based study in urban Bangladesh (aged ≥35 years) reported a COPD prevalence of 11.4% using spirometric criteria [5]. Community data suggest the prevalence of COPD ence in Bangladesh ranges between 10% and 14%, especially among older adults with tobacco exposure [7]. The higher proportion in our cohort likely reflects the selection of more symptomatic patients in tertiary hospitals. The intersection of cardiovascular and respiratory diseases, that is, comorbidity, underscores the dynamics of multimorbidity. In this study, conditions such as hypertension, diabetes, obesity, and smoking co-occurred frequently, reflecting shared pathophysiological mechanisms. Exposure to smoking and household air pollution is common in Bangladesh, and studies have documented strong associations between respiratory diseases and biomass fuel exposure and ambient particulate matter [14]. These risk factors also increase cardiovascular risk, creating a substantial overlap. Multimorbidity is well described in Bangladesh’s aging population: a community-based survey among adults aged ≥50 years found that ~39% had ≥2 chronic conditions, with hypertension being the most common [15]. Among elderly Bangladeshis, hypertension, diabetes, and ischemic heart disease are the most frequent coexisting diseases [16]. Gender differences in disease presentation are also informative. Our finding of male predominance (58.9%) reflects sex differences in risk exposure: men in Bangladesh have markedly higher smoking rates, occupational exposures, and patterns of sedentary lifestyles [6]. However, the substantial representation of females (41.1%) mirrors evolving trends in NCD epidemiology, including rising female obesity and indoor air pollution exposure from biomass cooking [14]. Age-wise, most patients were clustered in the middle to older age groups, consistent with the burden of chronic NCDs accumulating with advancing age. This trend aligns with the national GBD estimates, which indicate a shift in age-specific disease burdens toward older adults [2]. The co-occurrence of obesity and overweight status in almost half of the participants reinforces a higher BMI with both cardiac and respiratory pathology; obesity is an independent risk factor for COPD, asthma, and cardiovascular disease [6]. The dual burden of CVD and CRD, combined with multimorbidity clustering, has implications for clinical care and health-system design. In settings such as Bangladesh, vertical disease-focused programs may overlook important overlaps. Integrated screening for hypertension, diabetes, and respiratory symptoms during general outpatient visits could enhance early diagnosis and reduce service duplication. Integrated care models in LMICs have shown promise when combining chronic respiratory and cardiovascular services in one clinic [3]. Moreover, population-level prevention targeting smoking cessation, improved cooking fuels, diet, and physical activity can address shared upstream drivers. In summary, this study provides updated evidence on the epidemiological patterns of overlapping cardiovascular and respiratory diseases in tertiary hospitals in Bangladesh. These findings underscore the need for integrated clinical pathways, shared prevention strategies, and longitudinal studies to elucidate outcomes and inform policy.

This study demonstrated that cardiovascular and respiratory disorders constitute a major health burden among adults, with ischemic heart disease and COPD emerging as the predominant conditions. Most affected individuals were middle-aged men who frequently exhibited comorbidities such as hypertension, diabetes mellitus, and obesity. The findings emphasize the convergence of cardiometabolic and respiratory risk factors and the need for integrated screening and management approaches within hospitals and primary care systems to reduce the morbidity and mortality associated with chronic diseases.

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