Report: Cardiovascular diseases remain the world's leading cause of disease burden

Today is World Heart Day and, according to the latest Global Burden of Disease (GBD) Study (published last week in JACC), cardiovascular diseases (CVD) remain the world’s leading cause of disease burden, causing one in three deaths worldwide in 2023. This status, the report reveals, is a result of population growth, population aging and exposure to a broad range of risks, including increasing rates of obesity and diabetes.

“This research provides countries with a clear view of where progress is being made and where urgent action is needed,” said Gregory A Roth, MD, MPH — senior author of the report, Professor in the Division of Cardiology and Director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation, University of Washington.

“By targeting the most important and preventable risks, with effective policies and proven, cost-effective treatments, we can work to reduce premature mortality from non-communicable diseases. Each country can find reliable evidence and a kind of policy prescription for better cardiovascular health in our results.”

For the updated report, researchers estimated burden due to 376 diseases — including CVD — from 1990 to 2023 in 204 countries using all available data and statistical models. Showing wide global, regional and national variation in CVD burden, even among countries with similar economies, the researchers identified potential drivers, including population growth, population aging and risk factor exposure.

What they found is that CVD remains the leading cause of disability-adjusted life years (DALYs). There were 437 million CVD DALYs in 2023, with a 16-fold difference between the countries with the lowest and highest CVD DALY rates. This marks a 1.4-fold increase from the 320 million CVD DALYs in 1990. The leading cardiovascular causes of DALYs were ischemic heart disease, intracerebral haemorrhage, ischemic stroke and hypertensive heart disease.

The researchers also confirm that CVD remains the leading cause of deaths estimated in the GBD globally. In 2023, CVDs were responsible for 19.2 million deaths — an increase from the 1990 figure of 13.1 million. It was also found that, in 2023, 79.6% of all CVD DALYs globally were attributable to modifiable risk factors; these have increased by 97.4 million since 1990 largely due to population growth and aging.

The top risk factors include metabolic factors, like high body mass index (BMI) and high fasting plasma glucose, followed by behavioural and environmental/occupational factors, like air pollution, lead exposure and higher temperatures. Metabolic, behavioural and environmental/occupational risk factors contributed to 67.3%, 44.9% and 35.8% of all CVD DALYs, respectively.

“This report is a wake-up call: heart disease remains the world’s leading cause of death, and the burden is rising fastest in places least equipped to bear it,” said Harlan Krumholz, MD, FACC — JACC Editor-in-Chief and Harold H. Hines Jr Professor of Medicine at the Yale School of Medicine.

“The good news is we know the risks and how to address them; if countries act now with effective health policies and systems, millions of lives can be saved.” Indeed, the researchers noted that counteracting some of the rising CVD burden are decreases in exposure to tobacco and air pollution, specifically household air pollution.

The report was published open access in JACC on 24 September. You can read it here.

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