Vietnam's cardiovascular disease landscape reveals a striking demographic paradox: while age-standardized mortality rates are projected to decline by 51% through 2050, absolute CVD deaths will surge 43% to nearly 300,000 annually. Population aging accounts for 140% of mortality increases, overwhelming epidemiological improvements that have prevented over 102,000 deaths. High systolic blood pressure remains the dominant risk factor, while rising BMI and alcohol use show alarming rank escalations. This demographic transformation mirrors patterns emerging across rapidly aging Asian economies, where healthcare systems designed for younger populations face unprecedented chronic disease burdens. The findings underscore a critical shift needed from acute care models to preventive frameworks targeting hypertension management and lifestyle interventions in older adults. Vietnam's experience offers a preview of challenges facing other middle-income countries entering demographic transition. However, the reversal of declining CVD incidence trends during 2019-2023 suggests pandemic-era disruptions may have lasting cardiovascular consequences. As a preprint awaiting peer review, these projections require validation, particularly the ARIMA modeling assumptions spanning three decades of socioeconomic change.