What is the epidemiology of cardiovascular disease globally and in specific locations according to the World Health Organization (WHO) and local health departments?

Global and Regional Epidemiology of Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, responsible for approximately 19.2 million deaths in 2023 and 437 million disability-adjusted life years (DALYs), with the burden disproportionately affecting low- and middle-income countries where 88% of CVD-related deaths occur. 1, 2

Global Burden Overview

Magnitude and Trends:

• CVD deaths increased from 13.1 million in 1990 to 19.2 million in 2023, representing a 1.5-fold increase 1
• Prevalent CVD cases more than doubled from 311 million (1990) to 626 million (2023) globally 1
• CVD accounts for 437 million DALYs globally as of 2023, up from 320 million in 1990 1
• Nearly 80% of all CVD-related deaths occur in low- and middle-income countries 3

Leading CVD Subtypes:

• Ischemic heart disease and stroke together account for 85% of the total age-standardized death rate from CVD 4
• The four leading cardiovascular causes of DALYs globally are: ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease 1

Regional Variations in CVD Burden

High-Income vs. Low-Income Countries:

• Age-standardized CVD DALY rates are highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings 1
• High SDI regions experienced more than 50% decline in age-standardized death rates from 1990 to 2017, while low-income regions showed minimal improvement 4
• Hypertension prevalence is now higher in low- and middle-income countries than in high-income countries 2

Geographic Distribution by CVD Type:

• Ischemic heart disease predominates in the Americas, Europe, Eastern Mediterranean, Eastern Europe, Middle East, and Southeast Asia (representing 60% of heart failure etiology in these regions) 2, 5
• Stroke is more common in Africa, Southeast Asia, and the Western Pacific 5
• Rheumatic heart disease (RHD) remains a major burden in Sub-Saharan Africa and low-income countries, accounting for up to 40% of heart failure cases in these populations 2
• In Sub-Saharan Africa specifically, symptomatic RHD incidence is 24.7 per 100,000 population per year in adults 2

European Context:

• CVD remains the main cause of premature death in European women (42% of all deaths below 75 years) and men (38% of deaths at 75 years) 2
• Age-standardized CHD and CVD mortality declined in many European countries between the 1970s and 1990s, with earliest and most prominent decreases in affluent countries 2
• Eastern European countries continue to show persistently high CVD and CHD mortality rates 2
• Mortality rates in Europe vary substantially, ranging from 21.6% to 36.5% in acute heart failure patients across different countries 2

Major Risk Factors Contributing to CVD Burden

Modifiable Risk Factors Account for 79.6% of Global CVD Burden:

• High systolic blood pressure (leading risk factor globally) 1
• Dietary risks (particularly diets low in whole grains and high in sodium) 1, 4
• High LDL cholesterol 1
• Air pollution 1
• Tobacco use 4
• High body mass index 1
• High fasting plasma glucose 1
• Low physical activity 1

Regional Risk Factor Variations:

• Hypertension is the heart failure etiology in 35% of patients in Africa, 21% in South America, and 15% in India, Southeast Asia, and China 2
• In 2015,8.5 million deaths were attributable to systolic blood pressure >115 mmHg, with 88% occurring in low- and middle-income countries 2

Drivers of Increasing CVD Burden

Three Primary Drivers Since 1990:

• Population aging added 139 million CVD DALYs to the global burden 1
• Population growth added 128 million CVD DALYs 1
• Increased exposure to metabolic risk factors (high BMI, high fasting plasma glucose, low physical activity) offset gains from reduced tobacco usage 1

Age and Sex Disparities

Age-Related Burden:

• People over age 50 account for more than 90% of CVD cases and deaths across all age groups 4
• Cardiovascular risk begins developing at very young ages, with evidence that exposure to risk factors before birth influences lifetime CVD risk 2

Sex Differences:

• Age-standardized death rate and DALY rate from CVD are 1.5 times greater in men compared with women 4
• CVD is underappreciated as the main cause of premature death in women 2

Clinical Implications and Prevention Priorities

Critical Prevention Gaps:

• Large variations exist in CVD burden even among countries at similar development levels, explained substantially by inadequately controlled modifiable risk factors 1
• Treatment coverage and effectiveness of hypertension management vary substantially globally and remain particularly low in low- and middle-income countries 2
• Despite decades of awareness, CVD burden continues to increase, requiring urgent yet carefully planned prevention and control efforts 3

Common Pitfall: The WHO Global Health Observatory database provides current mortality data, but standardized Europe-wide CVD morbidity data remain unavailable, limiting comprehensive surveillance 2