Background: Cardiovascular disease (CVD) remains the primary cause for death and disability in Pakistan, yet consistent data estimating its impact is limited. Method: Utilizing the Global Burden of Disease tool, we analyzed CVD metrics like prevalence, incidence, DALYs, mortality, and associated risk factors spanning from 1990-2019, categorized by age, gender, year, and region. Results are shown in both absolute numbers and age-standardized rates (ASR) per 100,000 person-years. Results: From 1990-2019, the annual percentage change (APC) witnessed a rise in prevalence by 106% (from 4.1 to 8.6 million), deaths by 98% (from 172,525 to 341,108), and DALYs by 119% (from 4.5 to 9.8 million). When assessed through age-standardized rates (ASR), incidence rates grew by 8% (from 852 to 918), deaths by 9% (from 329 to 357), and DALYs by 9% (from 7326 to 7988). In 2019, ischemic heart disease dominated as the top cause of CVD deaths, constituting 53.76% (183,409 out of 341,108). Over the past 30 years, Balochistan emerged as the most adversely affected state. The age bracket of 70-74 saw the maximum CVD fatalities at 41,848, while the 60-64 age group recorded the highest incidence at 135,376. Men experienced a more pronounced CVD impact than women over these three decades. High blood pressure stood out as the primary cause of CVD-related deaths in Pakistan, trailed by elevated LDL cholesterol levels. Conclusion: CVD accounted for 22.74% deaths amongst all cause of deaths in Pakistan in 2019. From a clinician's perspective, the escalating prevalence and incidence of CVD emphasize the need for early detection, intervention, and tailored treatments, especially in high-risk demographics like older males. From a public health standpoint, these findings underscore the urgency to implement broad-based preventive strategies, focusing on modifiable risk factors such as high blood pressure and LDL cholesterol, and to bolster healthcare infrastructure, particularly in severely affected regions like Balochistan.