Introduction and methods

Cardiovascular diseases (CVDs), predominately ischemic heart disease (IHD) and stroke, remain a leading cause of mortality and rising health care costs [1,2].

This article reviews the magnitude of total CV burden and addresses underlying causes of CV death and related risk factors at global, regional, and national levels from 1990 to 2019 using estimates from the Global Burden of Disease (GBD) Study 2019.

The GBD is an annually updated multinational collaborative research study that estimates population health over time and is designed to make consistent comparative analyses by age and sex, and across regions. The research study uses standard epidemiological data on incidence, prevalence, mortality and health risk to produce estimates for 204 countries and territories from 1990 to 2019 [3].

Main results

CARDIOVASCULAR DISEASES:

Total CVDs

• The prevalence of total CVD globally increased from 271 million cases (95% UI: 257-285 million) in 1990 to 523 million cases (95% UI: 497-550 million) in 2019.
• CV mortality increased from 12.1 million cases (95% UI: 11.4-12.6 million) in 1990 to 18.6 million cases (95% UI: 17.1-19.7 million) in 2019.
• The number of disability-adjusted life years (DALYs) increased significantly between 1990 and 2019. However, age-standardized rates of death and DALYs decreased largely over that period, suggesting that population growth and aging are major contributors to the global increase in CVDs.
• In 2019, DALYs were highest in men between the age of 30-60 years and in women at >80 years.
• Among men, the age-standardized rates for DALYs were highest in Central Asia, Eastern Europe, and Oceania. Lowest age-standardized DALYs were observed in high-income Asia Pacific, Australasia, Western Europe, and Andean Latin America.
• Age-standardized DALYs among women were highest in Central Asia, Eastern Europe, Oceania, North Africa and the Middle East, and lowest in high-income Asia Pacific, Australasia, and Western Europe.

Ischemic Heart Disease (IHD)

• The prevalence of IHD in 2019 increased to 197 million cases (95% UI: 178-220 million).
• IHD mortality increased to 9.14 million (95% UI: 8.40-9.74 million) in 2019.
• In 2019, the number of DALYs reached 182 million (95% UI: 170-194 million).
• Age-standardized rates of DALYs due to IHD were substantially higher in men compared to women with a steep incline in cases beginning around the age of 30. Men between 45-49 years experienced as many DALYs as women aged 65-69 years.
• The age-standardized DALYs among men were highest in Central Asia, Eastern Europe, Oceania, and North Africa and the Middle East. The lowest age-standardized rates of DALYs were observed in high-income Asia Pacific, Australasia, Western Europe, and Andean Latin America.
• Among women, age-standardized DALYs were highest in Central Asia, Eastern Europe, Oceania, North Africa and the Middle East, and lowest in high-income Asia Pacific, Australasia, and Western Europe.

Stroke

• The prevalence rate of stroke, increased to 101 million cases (95% UI: 93.2-111 million).
• 6.55 Million individuals (95% UI: 6.00-7.02 million) died due to stroke.
• Total number of DALYs caused by a stroke increased to 143 million cases (95% UI: 133-134 million) in 2019.
• There were 12.2 million incident stroke cases (95% UI: 11.0-13.6 million). Of those, 7.63 million (95% UI: 6.57-8.96 million) suffered from an ischemic stroke, 3.41 million (95% UI: 2.97-3.91 million) from intracerebral hemorrhages, and 1.18 million (95% UI: 1.01-1.39 million) from subarachnoid hemorrhages.
• Age-standardized mortality and DALYs due to stroke decreased from 1990 to 2019 globally. Death and DALYs was substantially higher in men compared to women.
• The age-standardized rates of DALYs and death were highest in Oceania, Central Asia, East Asia, Eastern Europe, and sub-Saharan Africa and lowest in Australasia, high-income Asia Pacific, Western Europe, and high-income North America.

Hypertensive Heart Disease (HHD)

• The prevalence of HHD in 2019 increased to 18.6 million cases (95% UI: 13.5-24.9 million).
• 1.16 Million individuals (95% UI: 0.86-1.28 million) died due to HHD.
• The total number of HHD induced DALYs in 2019 was 21.5 million (95% UI: 16.4-23.9 million).
• The number of DALYs was similar between men and women up to the age of 70. Women experienced more DALYs after the age of 70.
• The age-standardized DALYs due to HHD were highest in Central sub-Saharan Africa followed by most of Africa and the Middle East, Oceania, and Central Asia and lowest in Australasia, and high-income Asia Pacific, and Western Europe.

Atrial fibrillation (AF) and atrial flutter (AFL)

• The estimated prevalence of AF and AFL was 59.7 million (95% UI: 45.7-75.3 million) in 2019.
• The prevalence for AF and AFL was unchanged between 1990 and 2019, when adjusted for age and population size (775.9 per 100,000 [95% UI: 592.4-990.8 per 100,000] in 1990 vs. 743.5 per 100,000 [95% UI: 571.2-938.3 per 100,000] in 2019).
• The estimated death rates were similar in 1990 (4.3 per 100,000 [95% UI: 3.7-5.1 per 100,000]) and 2019 (4.4 per 100,000 [95% UI: 3.7-5.0 per 100,000]).
• The total number of DALYs caused by AF and AFL increased from 3.79 million (95% UI: 2.96-4.83 million) in 1990 to 8.39 million (95% UI: 6.69-10.5 million) in 2019. The DALY rates during this period were similar (110.0 per 100,000 [95% UI: 87.7-139.2 per 100,000] in 1990 vs. 107.1 per 100,000 [95% UI: 86.2-133.7 per 100,000] in 2019).
• The DALY rates were highest in high-income North-America, Australasia, Central Asia, and Europe and lowest in the Asia Pacific region.

MODIFIABLE FACTORS:

Systolic Blood pressure (SBP)

Theoretical minimum risk exposure level TTMREL) is defined by the GBP 2019 as the level of exposure that minimizes risk at the population level. For SBP, this value is set at ≥110 to 115 mm Hg.

• There were 4.06 billion adults (95% UI: 3.96-4.15 billion) with an high SBP in 2019 worldwide.
• The prevalence rate for high SBP increased from 84,481.1 per 100,000 persons (95% UI: 81,641.5-87,579.2 per 100,000) in 1990 to 88,971.1 per 100,000 persons (95% UI: 86,950.0-91,028.8 per 100,000) in 2019.
• Adjusted-standardized prevalence, death, and DALY rates for high SBP declined from 1990 to 2019.
• DALY rates for men and women due to high SBP were highest in Central Asia and lowest in the high-income Asia Pacific region.
• Death rates for men due to high SBP were highest in Central Asia and Eastern Europe, and in Central Asia, North Africa and the Middle East, and Central sub-Saharan Africa for women.

Fasting plasma glucose

High fasting plasma glucose is defined as plasma glucose concentration above a TMREL of 4.8-5.4 mmol/L.

• The age-standardized mortality rate for high plasma glucose was 84.2 deaths per 100,000 (95% UI: 65.9-111.1 per 100,000) in 1990, 89.2 deaths per 100,000 (95% UI: 70.2-115.9 per 100,000) in 2005 and 83.0 deaths per 100,000 (95% UI: 64.5-107.1 per 100,000) in 2019.
• The age-standardized DALY rates due to high fasting glucose levels were 1,959.6 per 100,000 (95% UI: 1,638.7-2,362.4 per 100,000) in 1990 and increased to 2,104.3 per 100,000 (95% UI: 1,740.7-2,520.7 per 100,000) in 2019. This is the result of a sharp significant increase in age-standardized years lived with disabilities (YLDs).
• The number of high glucose induced DALYs gradually increased with age, peaked for both sexes at the age of 65-69 and declined afterwards.
• The rate of DALYs from high plasma glucose was highest in Oceania and Central Asia and lowest in Australasia and high-income Asia Pacific. There were large variations observed between and even within countries.

Low-density lipoprotein cholesterol (LDL-c)

High LDL-c is defined by a TMREL of LDL-c above 0.7-1.3 mmol/L.

• The global number of DALYs and death due to high LDL-c increased to 98.6 million DALYs (95% UI: 80.3-119 million) and 4.40 million deaths (95% UI: 3.30-5.65 million) in 2019. However, the age-standardized rates declined, indicating that some progress has been made in reducing LDL-c related diseases.
• Men in the age group 40-44 years experienced the same number of DALYs caused by high LDL-c compared to woman in the group of 60-64 years or 80-84 years.
• Age-standardized DALY rates from high LDL-C was highest in Central Asia, Eastern Europe, Oceania, and North Africa and the Middle East. The lowest DALY rates were observed in high-income Asia Pacific, Australasia, Western Europe, and Andean Latin America.

Body Mass Index (BMI)

High BMI is defined by a TMREL as above 20-25 kg/m² for adults and an above normal weight for children.

• The total number of deaths caused by a high BMI increased from 1990 to 2019 to 5.02 million (95% UI: 3.22-7.11 million) worldwide.
• The number of DALYs rose to 160 million (95% UI: 106-219 million) in 2019.
• When adjusted for population growth and age, deaths rates and DALYs increased modestly from 1990 to 2019. However, YLDs were increased with 60.2% (95% UI: 41.3%-90.2%).
• Age-standardized DALYs attributable to high BMI were most common in Oceania, Central Asia, North Africa and the Middle East, Southern sub-Saharan Africa, and Eastern and Central Europe. The lowest DALY rates were in high-income Asia Pacific.

Conclusion

References

Find this article online at J Am Coll Cardiol