Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023.
Level 3 - non-randomized controlled study
Level by design analogy (multinational longitudinal epidemiological modeling and risk attribution).
PubMed 40990886 · doi:10.1016/j.jacc.2025.08.015
What was done
The Global Burden of Disease (GBD) 2023 study estimated the burden of cardiovascular diseases (CVDs) across 204 countries and territories from 1990 to 2023 using statistical models on multinational surveillance and epidemiological data. The analysis quantified global, national, and subnational burden (deaths, disability-adjusted life years [DALYs], and prevalence) across 18 CVD subdiseases and 12 modifiable risk factors, decomposing trends into drivers including population growth, population aging, and risk factor exposures.
What was found
CVDs remained the leading cause of DALYs and deaths globally in 2023: - **DALYs and Deaths:** CVD DALYs increased 1.4-fold from 320 million (95% UI: 292 to 344 million) in 1990 to 437 million (95% UI: 401 to 465 million) in 2023. CVD deaths rose from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. - **Prevalence:** Prevalent CVD cases more than doubled from 311 million (95% UI: 294 to 333 million) in 1990 to 626 million (95% UI: 591 to 672 million) in 2023. - **Leading Causes & Disparities:** Leading cardiovascular causes of DALYs were ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease. Age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) regions. - **Risk Factors:** Modifiable risk factors accounted for 79.6% (95% UI: 75.7% to 82.5%) of CVD burden (347 million DALYs). Top risks were high systolic blood pressure, dietary risks, high LDL cholesterol, and air pollution. Increasing high BMI, fasting plasma glucose, and physical inactivity worsened burden, whereas reduced tobacco use mitigated it. - **Demographic Drivers:** Population aging added 139 million DALYs (95% UI: 126 to 151 million) and population growth added 128 million DALYs (95% UI: 115 to 139 million) to the increase since 1990.
Why it matters
This study provides definitive benchmark estimates showing that cardiovascular disease burden continues to accelerate globally, driven by demographic aging, population growth, and worsening metabolic risks, with the heaviest impact falling on low- and middle-income regions.
Limits
Estimates depend heavily on statistical modeling and imputation in regions where vital registration and health surveillance data are sparse or absent. Measurement quality and diagnostic criteria for specific cardiovascular subdiseases vary significantly across nations and over time. Comparative risk assessment models assume independent causal relationships and may not fully reflect complex interactions among multiple co-occurring risk factors.
Cited by
- supports Cardiovascular disease is the leading cause of death worldwide and is the leading cause of death among women.