TOPLINE:

In an analysis spanning 33 years, cardiovascular diseases (CVDs) remained the leading cause of disease burden and deaths globally, with nearly 80% of the burden being attributable to modifiable risk factors, such as high systolic blood pressure, poor diet, high levels of low-density lipoprotein (LDL) cholesterol, and air pollution.

METHODOLOGY:

• Researchers reviewed updates from a multinational collaborative study that quantified the global burden of over 300 diseases across 204 countries and territories from 1990 to 2023.
• They reported findings regarding the burden of 18 CVDs and their modifiable risk factors, showing how burden, trends, and key drivers evolved over a period of 33 years.
• The report drew on 6447 source‐years of data on mortality and nonfatal cases, over 55,000 source‐years of data on exposure to risk factors, and 3814 source-years of estimates for the relative risk.
• The cumulative disease burden was represented as disability-adjusted life years (DALYs), which was a combined measure of years of life lost due to premature deaths and years lived with a disability.
• Researchers assessed social and economic conditions using the sociodemographic index (SDI), which grouped regions as low, low-middle, middle, high-middle, and high SDI regions.

TAKEAWAY:

• Results highlighted CVDs as the leading cause of DALYs and deaths globally in 2023, resulting in 437 million DALYs, a 1.4-fold increase since 1990, and 19.2 million deaths. Leading CVD causes of DALYs included ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive disease. The number of prevalent cases of CVD more than doubled over the 33 years.
• Modifiable risk factors accounted for 79.6% of all CVD DALYs. High systolic blood pressure was the leading factor, followed by dietary risks, high levels of LDL cholesterol, and air pollution.
• The number of CVD DALYs attributable to combined metabolic, behavioral, and environmental/occupational risks increased by 39%, largely due to population growth and aging. The growing prevalence of high BMI, high levels of fasting plasma glucose, and low physical activity contributed to the burden, whereas the reduced use of tobacco partly curbed the burden.
• Rates of CVD DALYs were higher in regions with low, low-middle, and middle SDIs than in those with a high SDI, even after accounting for differences in population age. Risk factors varied across regions, with some areas being more affected by household air pollution and others by alcohol or sodium intake.

IN PRACTICE:

“This research provides countries with a clear view of where progress is being made and where urgent action is needed,” said senior author of the paper in a press release.

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

SOURCE:

This study was led by the Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators and Gregory A. Roth, MD, MPH, professor in the Division of Cardiology and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle. It was published online on September 24, 2025, in the Journal of the American College of Cardiology.

LIMITATIONS:

The quality and availability of input data varied widely across regions, with 56 countries lacking studies on vital registration or verbal autopsy for estimating CVD mortality. Certain conditions such as myocarditis and atrial fibrillation relied on country-level covariates due to sparse data. Information on how certain risk factors mediated other risks remained limited.

DISCLOSURES:

This study was funded by the Bill and Melinda Gates Foundation and the American College of Cardiology Foundation. This work is part of a partnership between the Journal of the American College of Cardiology; the National Heart, Lung, and Blood Institute; and the Institute for Health Metrics and Evaluation at the University of Washington.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.