Cardiometabolic disease has become the dominant noncommunicable health challenge of the 21st century, with its burden increasingly centered in Asia. Rising obesity, type 2 diabetes mellitus, hypertension, and dyslipidemia now account for more than one-third of cardiovascular mortality. This escalation reflects the interaction of biological susceptibility with rapid urbanization, digitalized food environments, physical inactivity, and persistent tobacco exposure. Health-system limitations, including low diagnosis rates, poor risk-factor control, and uneven access to essential therapies, further amplify vulnerability across South, East, and Southeast Asia. Environmental pressures such as air pollution and extreme heat compound these risks, while migrant data illustrate how biological predisposition is magnified in obesogenic settings. This review synthesizes evolving epidemiology, biological diversity, behavioral and environmental drivers, and health-system gaps shaping cardiometabolic risk across Asia. It also outlines policy and therapeutic strategies, including strengthened primary care, prevention-focused interventions, and emerging therapeutics needed to reduce cardiometabolic disease in the region.