2023 Global Burden of Cardiovascular Disease Report Published

December 11, 2023—The American College of Cardiology announced the publication of the new Global Burden of Disease (GBD) special report, which provides an update of health estimates for the global, regional, and national burden and trends of cardiovascular disease (CVD) from 1990 to 2022 by analyzing the impact of cardiovascular conditions and risk factors across 21 global regions.

The report was published by George A. Mensah, MD; Valentin Fuster, MD; Christopher J.L. Murray, MD; and Gregory A. Roth, MD, on behalf of the Global Burden of Cardiovascular Diseases and Risks Collaborators in Journal of the American College of Cardiology (JACC) (2023;82:2350-2473).

The Global Burden of Cardiovascular Diseases Collaboration was launched in 2020. It is an alliance between JACC, the Institute for Health Metrics and Evaluation at the University of Washington, and the National Heart, Lung, and Blood Institute.

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. The new publication is an update to the 2022 GBD study.

According to ACC, research from this study reflects an urgent need for countries to establish public health strategies aimed at preventing CVDs by underscoring the global action needed to disseminate information and implement health programs, especially in hard-to-reach countries. Although CVD rates are high globally, regions of Asia, Europe, Africa, and the Middle East were estimated to have the highest burden of CVD mortality. High blood pressure, high cholesterol, dietary risks, and air pollution remain its leading causes.

The ACC press release noted that the report breaks down mortality rates by location, age, sex, and time categories. It identifies disability-adjusted life years (DALYs), years of life lost due to premature mortality, and years lived with disability. The results presented include several updates to previously published estimates, reflecting new data and new disease modeling methods.

The paper specifically addresses 18 cardiovascular conditions and provides estimates for 15 leading risk factors for CVD: environmental (air pollution, household air pollution, lead exposure, low temperature, high temperature), metabolic (systolic blood pressure, low-density lipoprotein cholesterol, body mass index, fasting plasma glucose, kidney dysfunction), and behavioral (dietary, smoking, secondhand smoke, alcohol use, physical activity).

As summarized by ACC, key takeaways from the report include:

• Ischemic heart disease remained 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 DALYs at 2,564.9 per 100,000 globally.
• 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 to 2022, age-standardized CVD mortality increased in 27 out of 204 locations.
• Global death counts due to CVD increased from 12.4 million in 1990 to 19.8 million in 2022, reflecting global population growth, aging, and contributions from preventable metabolic, environmental, and behavioral risks.
• Eastern Europe had the highest age-standardized total CVD mortality at 553 deaths per 100,000.
• Countries in Australasia had the lowest age-standardized total CVD mortality at 122.5 deaths per 100,000 people.
• Central Asia, Eastern Europe, North Africa, and the Middle East had the highest age-standardized mortality rate per 100,000 people attributable to high systolic blood pressure.
• The regions with the highest rates of CVD burden attributable to dietary risk were Central Asia, Oceania, and parts of North Africa and the Middle East.

“CVDs are a persistent challenge that leads to an enormous number of premature and preventable deaths,” commented Dr. Roth in the ACC press release. “There are many inexpensive, effective treatments. We know what risk factors we need to identify and treat. 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 CVDs.” Dr. Roth is Associate 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 in Seattle, Washington.

Dr. Fuster stated in the press release, “We formed the Global Burden of Cardiovascular Diseases Collaboration 3 years ago to help bring state-of-the-art research to the forefront of the global cardiovascular community. 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.” Dr. Fuster is President of Mount Sinai Fuster Heart Hospital and Physician-in-Chief of The Mount Sinai Hospital in New York, New York, as well as Editor-in-Chief of JACC.

Dr. Mensah added, “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. The 2023 almanac represents an important resource for using locally relevant data to inform local-level actions for heart-healthy and thriving communities.” Dr. Mensah is Director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute.