The latest update from the Global Burden of Disease (GBD) Study, covering data from 1990 to 2023, not only reveals the current state of cardiovascular disease on a global scale, but also points to the interventions that can help accelerate progress. A JACC focus issue, published Nov. 24, reflects on how these findings can guide the future of cardiovascular care.

"The GBD is sometimes viewed as a mirror: a detailed reflection of where we are," writes JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, in an accompanying Editor's Page. "But its real power is as a compass, pointing us toward where we must act. A mirror reflects; a compass directs."

Viewpoints from the issue explore the critical role of implementation science, with George A. Menash, MD, FACC; Cara C. Lewis, PhD; and Jagat Narula, MD, DM, PhD, MACC, emphasizing the need for proven dissemination and implementation strategies to make full use of the evidence-based interventions and resources available to combat cardiovascular disease. "Too often, implementation science is treated as an afterthought, considered only after clinical or public health initiatives are conceptualized, designed, and tested in clinical trials," they write. "This linear approach undermines effectiveness, widespread adoption, and sustainability. Instead, implementation science must be embedded from the start – informing intervention development, effectiveness testing, guiding clinical and public health implementation, and bridging the gap between research and real-world impact."

The integration of primary and community-based care is also explored. Lijing L. Yan, PhD, MPH, et al., highlight common myths and barriers to effective integration and share five opportunities for global action. "Integrated [primary and community-based care] represents such a scalable innovation to sustainably tackle the massive global challenge of [cardiovascular diseases]. It deserves a central place in our collective efforts to improve cardiovascular health," they write.

Other features in this issue address clinical topics and call out gaps in GBD estimates. For example, Behnood Bikdeli, MD, FACC, et al., note the absence of venous thromboembolic (VTE) disease from the report and offer both immediate and long-term strategies to improve VTE estimates on a global scale. In another viewpoint, Erica Sarah Spatz, MD, FACC, shares how the "GBD data deliver a stark warning" that the window for prevention is closing when it comes to obesity. "Curbing obesity will require political will, community engagement and policies that make healthy choices the easiest and most cost-effective choices," she writes. "And for countries where obesity is already prevalent, we need generic drugs and equitable access now. There is no time to waste."

The focus issue also presents how digital health tools and artificial intelligence (AI) promise to move the field of cardiovascular disease surveillance forward. Rohan Khera, MD, FACC, calls out emerging mobile technologies, wearable sensors and AI as factors contributing to a new paradigm that will "help societies and communities improve cardiovascular health but requires a major shift from retrospective, model-based estimation to continuous, data-driven monitoring rooted in communities." Chris T. Longenecker, MD, also tackles this topic, spotlighting the unknowns now associated with the future of cardiovascular surveillance and calling on clinicians and others to "embrace uncertainty with open arms." He writes: "The more we do so, the greater our chance to grow, innovate, and build healthier global communities."

Other viewpoints from the issue consider other risk factors like medication adherence and provide an up-close look at understanding GBD models, cardiovascular disease estimates and risk-deleted disability-adjusted life years. They also dive into challenges and solutions from different countries and regions of the world, including South America, Japan, Pakistan, India, Canada and Sub-Saharan Africa.

In a recent JACC Leadership Page, ACC President Christopher M. Kramer, MD, FACC, shares ACC's ongoing commitment to addressing cardiovascular health across the globe. "We remain steadfast in breaking down disease-based silos, championing more integrated, patient-centered care, and solving the global workforce crisis," he writes. "Together, we must continue to engage directly with communities affected by [noncommunicable diseases] to ensure equitable access to prevention, treatment, and lifelong care." For more on this topic, watch a REMARKable Conversations episode on ACC's global strategy in action.

Clinical Topics: Cardiovascular Care Team, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine

Keywords: Cardiovascular Diseases, Global Burden of Disease, Implementation Science, Global Health, Noncommunicable Diseases, Venous Thromboembolism, Risk Factors, ACC International