Global death counts due to cardiovascular disease (CVD) increased from 12.4 million in 1990 to 19.8 million in 2022, reflecting global population growth and aging and the contributions from preventable metabolic, environmental and behavioral risks, according to the newest Global Burden of Disease (GBD) special report published in JACC.

The report provides an update of health estimates for the global, regional and national burden and trends of CVD from 1990-2022 by analyzing the impact of cardiovascular conditions and risk factors across 21 global regions. It specifically addresses 18 cardiovascular conditions and provides estimates for mortality and disability-adjusted life years as they relate to 15 leading risk factors for cardiovascular disease, including air pollution, household air pollution, lead exposure, low temperature, high temperature, systolic blood pressure, LDL-C, body mass index, fasting plasma glucose, kidney dysfunction, dietary, smoking, secondhand smoke, alcohol use and physical activity.

"We formed the Global Burden of Cardiovascular Diseases Collaboration three years ago to help bring state-of-the-art research to the forefront of the global cardiovascular community," said Valentin Fuster, MD, PhD, MACC, an author of the paper and editor-in-chief of JACC. "We are excited to publish this 2023 Almanac as a dedicated issue of the Journal to inform the realities of CVD risk and inspire strategies for a heart-healthy world."

Key takeaways from the report, include:

• An increasing, disproportionate burden of CVD was observed in low- and middle-income countries (LMICs). More than 75% of the global CVD burden is found in the LMICs in Oceania, Eastern and Central Europe, sub-Saharan Africa, North Africa and the Middle East, the Caribbean, and East and South Asia.
• Ischemic heart disease remains the leading cause of global CVD mortality with an age-standardized rate per 100,000 of 108.8 deaths, followed by intracerebral hemorrhage and ischemic stroke.
• High systolic blood pressure accounted for the largest contribution to attributable age-standardized CVD disability-adjusted life years (DALYs) at 2,564.9 per 100,000 globally.
• There was a dramatic 65.1% decline in attributable age-standardized CVD DALYs for household air pollution from solid fuels from 1990 through 2022.

• Dietary risks were the leading contributor to age-standardized CVD DALYs among the behavioral risks, while ambient particulate matter pollution led the environmental risks.
• Between 2015-2022, age-standardized CVD mortality increased in 27 of 204 locations.
• Eastern Europe had the highest age-standardized total CVD mortality at 553 deaths per 100,000. In contrast, countries in Australasia had the lowest age-standardized total CVD mortality at 122.5 deaths per 100,000 people.
• Regions of Asia, Europe, Africa and the Middle East were estimated to have the highest burden of CVD mortality, largely due to high blood pressure, high cholesterol, dietary risks and air pollution.

The findings from the report highlight the urgent need for global action to establish public health strategies, disseminate information and implement health programs in countries around the world – especially those in hard-to-reach areas of the world.

"Extreme geographic variation … indicates a need for increased research to leverage insights from regions with low burden to inform actions in high-burden locales," the report states.

Early intervention programs are also key, with the authors noting that an estimated 34% of CVD deaths in 2022 alone occurred before age 70. These deaths underscore that "CVD is not a necessary feature of human aging but instead almost entirely the result of modifiable risk factors," the authors write.

"We know what risk factors we need to identify and treat," says Gregory A. Roth, MD, MPH, FACC, senior author of the paper and associate professor in the Division of Cardiology and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "There are many inexpensive, effective treatments. There are simple healthy choices that people can make to improve their health. This atlas provides detailed information on where countries stand in their efforts to prevent and treat cardiovascular diseases."

Launched in 2020, the Global Burden of Cardiovascular Diseases Collaboration is an alliance between the Journal of the American College of Cardiology, the IHME, and the National Heart, Lung, and Blood Institute (NHLBI). Serving as an update to 2022's GBD Study, the 2023 publication includes data from 204 countries and territories, highlighting the leading global modifiable cardiovascular risk factors, their contribution to disease burden and recent prevention advancements.

"Identifying sustainable ways to work with communities to take action to prevent and control modifiable risk factors for heart disease is essential for reducing the global burden of heart disease," said George A. Mensah, MD, FACC, director of the Center for Translation Research and Implementation Science at the NHLBI. "The 2023 Almanac represents an important resource for using locally relevant data to inform local-level actions for heart-healthy and thriving communities."

Clinical Topics: Cardiovascular Care Team

Keywords: Cardiovascular Diseases, Data Curation, International, ACC Publications, Cardiology Magazine, ACC International, Global Burden of Disease, Heart Disease Risk Factors

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