Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023
Journal article, 2025
Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. Objectives: We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. Methods: The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. Results: CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. Conclusions: CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.
epidemiology
global health
cardiovascular disease
Author
Benjamin A. Stark
University of Washington
Nicole K. DeCleene
University of Washington
Emily C. Desai
University of Washington
Johnathan M. Hsu
University of Washington
Catherine O. Johnson
University of Washington
Laura Lara-Castor
University of Washington
Kate E. LeGrand
University of Washington
Prof Bhoomadevi A
Amity University
Mohammad Amin Aalipour
Shahid Beheshti University of Medical Sciences
Hasan Aalruz
Al Zaytoonah University of Jordan
Bedru J. Abafita
University of Tasmania
Ukachukwu O. Abaraogu
University of the West of Scotland
University of Nigeria
Mohammad Abavisani
Mashhad University of Medical Sciences
Nasir Abbas
Chinese Academy of Sciences
City University of Hong Kong
Madineh Akram Abbasi
Tabriz University of Medical Sciences
Mohammadreza Abbasian
Shahid Beheshti University of Medical Sciences
Sidney Kimmel Medical College
Hedayat Abbastabar
Tehran University of Medical Sciences
Abdallah H.A. Abd Al Magied
Ajman University
Samar Abd ElHafeez
Alexandria University
Prof Ahmed Abdelalim
Cairo University
Omar M. Abdelfattah
Morristown Medical Center
Prof Reda Abdel-Hameed
Al-Azhar University
University of Hail
Mahmoud Abdelnabi
Mayo Clinic
Prof Wael M Abdel-Rahman
University of Sharjah
Parsa Abdi
Memorial University of Newfoundland
Wakgari Mosisa Abdisa
Jimma University
Daba Abdissa
Jimma University
Arman Abdous
Islamic Azad University
Mujahid Abdullah
RADS
Auwal Abdullahi
Bayero University
Federal University Wukari
Kulmira Abdykerimova
Kazakh National Medical University
Mesfin Abebe
Dilla University
Aidin Abedi
University of Southern California
Armita Abedi
Zanjan University of Medical Sciences
Asrat Agalu Abejew
Bahar Dar University
E.S. Abhilash
Sree Narayana Guru College Chelannur
Olugbenga Olusola Abiodun
Federal Medical Centre
Prof Olumide Abiodun
Babcock University
Rahim Abo Kasem
University of Louisville
Damascus University
Richard Gyan Aboagye
University of New South Wales (UNSW)
University of Health and Allied Sciences
Shady Abohashem
Massachusetts General Hospital
Harvard Medical School
Hassan Abolhassani
Tehran University of Medical Sciences
Karolinska Institutet
Ulric Sena Abonie
Northumbria University
Abdullahi Tunde Aborode
Healthy Africans Platform
Nagah M. Abourashed
University of Hail
Benha University
Dmitry Abramov
Loma Linda University Medical Center
Lucas Guimarães Abreu
Universidade Federal de Minas Gerais
Dariush Abtahi
Shahid Beheshti University of Medical Sciences
Rana Kamal Abu Farha
Applied Science Private University
Aminu Kende Kende Abubakar
St Luke's International University
National Cancer Center Tokyo
Abubakar Ibrahim Jatau
University of Tasmania
Nermeen Abu-Elala
King Salman International University
Cairo University
Eman Abu-Gharbieh
University of Jordan
University of Sharjah
Hana Jihad Jihad Abukhadijah
Hamad Medical Corporation
Salahdein Aburuz
United Arab Emirates University
University of Jordan
Dina Abushanab
Hamad Medical Corporation
Anirudh Balakrishna Acharya
University of Sharjah
Apurba Acharya
Karnali Academy of Health Sciences
Swetha Acharya
JSS Academy of Higher Education and Research
Meshack Achore
Hofstra University
Ousman Adal
Bahar Dar University
Lisa C. Adams
Technical University of Munich
Stanford University
Lawan Hassan Adamu
Bayero University
Federal University Dutse
Rui Adão
University of Porto
Complutense University
Isaac Yeboah Addo
University of New South Wales (UNSW)
University of Sydney
Oladimeji M. Adebayo
University of Ibadan
University College Hospital
Tajudeen Adesanmi Adebisi
Ladoke Akintola University
Independent Consultant
David Adedia
University of Health and Allied Sciences
Kamoru Ademola Adedokun
Roswell Park Comprehensive Cancer Center
Oluwatobi E. Adegbile
East Tennessee State University
Oyelola A. Adegboye
Charles Darwin University
Nurudeen A. Adegoke
The University of Sydney
Victor Adekanmbi
University of Texas
Olumide Thomas Adeleke
Bowen University
Charles Oluwaseun Adetunji
Edo University Iyamho (EUI)
Olorunsola Israel Adeyomoye
University of Medical Sciences
Rishan Adha
National Chengchi University
Muhammadiyah University of Mataram
Kishor Adhikari
Tribhuvan University
Himalayan Environment and Public Health Network (HEPHN)
Ripon Kumar Adhikary
Jashore University of Science and Technology
Australian National University
Wirawan Adikusuma
Muhammadiyah University of Mataram
Tanin Adl Parvar
Tehran University of Medical Sciences
Mohd Adnan
University of Hail
Qorinah Estiningtyas Sakilah Adnani
Padjadjaran University
Prince Owusu Adoma
University of Education, Winneba
Leticia Akua Adzigbli
University of Health and Allied Sciences
David Adzrago
National Institutes of Health (NIH)
Ahmed M. Afifi
University of Toledo
Habeeb Abiodun Afolabi
Osun State University
Fatemeh Afrashteh
Iran University of Medical Sciences
Arya Afrooghe
Tehran University of Medical Sciences
Muhammad Sohail Afzal
University of Management and Technology
Saira Afzal
Public Health Institute
King Edward Medical University (KEMU)
Suneth Buddhika Agampodi
International Vaccine Institute (IVI)
Dhiraj Motilal Agarwal
KEM Hospital
Gina Agarwal
McMaster University
Prerna Agarwal
Banaras Hindu University
Temesgen Anjulo Ageru
Wolaita Sodo University
Navidha Aggarwal
Maharishi Markandeshwar University
Sepehr Aghajanian
Alborz University of Medical Sciences
César Agostinis Sobrinho
Polytechnic Institute of Guarda
Klaipeda University
Jakub Morze
Nicolaus Copernicus University (SGMK)
Chalmers, Life Sciences, Food and Nutrition Science
Journal of the American College of Cardiology
0735-1097 (ISSN) 15583597 (eISSN)
Vol. 86 22 2167-2243Subject Categories (SSIF 2025)
Public Health, Global Health and Social Medicine
Cardiology and Cardiovascular Disease
DOI
10.1016/j.jacc.2025.08.015
PubMed
40990886