Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023

Abstract

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 sub-diseases 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) Study 2023, a multinational collaborative research study, quantified burden due to 376 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

Cardiovascular diseases were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (401 to 465) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344). 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-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (12.2 to 14.0) in 1990 to 19.2 million (17.4 to 20.4) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (294 to 333) prevalent cases of CVD in 1990 and 626 million (591 to 672) prevalent cases in 2023 globally. 79.6% [75.7 to 82.5] of cardiovascular disease burden is attributable to modifiable risk factors (347.3 million [318.4 to 372.8] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high LDL 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 (115 to 139) and 139 million (126 to 151) 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.

Note:
Gates Foundation Grant Number(s): OPP1152504

Data Availability Statement: GBD is performed in compliance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).2 Further details are provided in Appendix 1 (Section 3). All data and results reported in this publication will be made publicly available at time of publication via the Global Health Data Exchange (GHDx) at https://ghdx.healthdata.org/record/ihme-data/cvd-1990-2023. The analytic code written to produce this analysis will be available at the time of publication at https://github.com/ihmeuw/CVD_JACC_1990-2023. Further details are provided in Appendix 1 (Section 3).


© 2025 The Authors. This preprint is posted by SSRN.

Keywords: cardiovascular disease, burden, epidemiology