Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study

Gregory A Roth, George A Mensah, Catherine O Johnson, Giovanni Addolorato, Enrico Ammirati, Larry M Baddour, Noël C Barengo, Andrea Z Beaton, Emelia J Benjamin, Catherine P Benziger, Aimé Bonny, Michael Brauer, Marianne Brodmann, Thomas J Cahill, Jonathan Carapetis, Alberico L Catapano, Sumeet S Chugh, Leslie T Cooper, Josef Coresh, Michael Criqui, Nicole DeCleene, Kim A Eagle, Sophia Emmons-Bell, Valery L Feigin, Joaquim Fernández-Solà, Gerry Fowkes, Emmanuela Gakidou, Scott M Grundy, Feng J He, George Howard, Frank Hu, Lesley Inker, Ganesan Karthikeyan, Nicholas Kassebaum, Walter Koroshetz, Carl Lavie, Donald Lloyd-Jones, Hong S Lu, Antonio Mirijello, Awoke Misganaw Temesgen, Ali Mokdad, Andrew E Moran, Paul Muntner, Jagat Narula, Bruce Neal, Mpiko Ntsekhe, Glaucia Moraes de Oliveira, Catherine Otto, Mayowa Owolabi, Michael Pratt, Sanjay Rajagopalan, Marissa Reitsma, Antonio Luiz P Ribeiro, Nancy Rigotti, Anthony Rodgers, Craig Sable, Saate Shakil, Karen Sliwa-Hahnle, Benjamin Stark, Johan Sundström, Patrick Timpel, Imad M Tleyjeh, Marco Valgimigli, Theo Vos, Paul K Whelton, Magdi Yacoub, Liesl Zuhlke, Christopher Murray, Valentin Fuster, GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group

Abstract

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

Keywords: cardiovascular diseases; global health; health policy; population health.

Conflict of interest statement

Author Disclosures This study was funded by the Bill and Melinda Gates Foundation. Dr. Benjamin has received funding from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) (R01HL092577, 1R01HL128914) and American Heart Association (18SFRN34110082). Dr. Brauer has received a grant from the Bill and Melinda Gates Foundation. Dr. Catapano has received support from Fondazione Cariplo 2015-0524 and 2015-0564, H2020 REPROGRAM PHC-03-2015/667837-2, ERA NET ER-2017-2364981, GR-2011-02346974, Ministry of Health - Ricerca Corrente Multimedica; has received research grant/support from Sanofi, Sanofi Regeneron, Amgen, Mylan, Menarini, and Eli Lilly; has served on the speakers bureau for Akcea, Amgen, Sanofi, Esperion, Kowa, Novartis, Ionis Pharmaceuticals, Mylan, Menarini, Merck, Recordati, Regeneron, Daiichi-Sankyo, AstraZeneca, Aegerion, Amryt, and Sandoz; has received honoraria from Akcea, Amgen, Sanofi, Esperion, Kowa, Novartis, Ionis Pharmaceuticals, Mylan, Menarini, Merck, Recordati, Regeneron Daiichi-Sankyo, AstraZeneca, Aegerion, Amryt, and Sandoz; and has served as a consultant/on the Advisory Board for Akcea, Amgen, Sanofi, Esperion, Kowa, Novartis, Ionis Pharmaceuticals, Mylan, Menarini, Merck, Recordati, Regeneron Daiichi-Sankyo, Genzyme, Aegerion, and Sandoz. Dr. Coresh has received funding from the NIH and National Kidney Foundation; and has served as an advisor to Healthy.io. Dr. Fowkes has served on the Advisory Board for AstraZeneca. Dr. Muntner has received grants and personal fees from Amgen Inc. Dr. Ribeiro has received partial support by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (PPM-00428-17). Dr. Zuhlke has received funding by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and the National Research Foundation of South Africa. Dr. Rigotti has served as a consultant to Achieve Life Sciences; and has received royalties from UpToDate, Inc. Dr. Rodgers is employed by The George Institute for Global Health (TGI) and seconded part time to George Medicines Pty Ltd (GM); TGI has submitted patent applications with respect to low-fixed-dose combination products for the treatment of cardiovascular or cardiometabolic disease and is listed as one of the inventors; George Health Enterprises Pty. Ltd. (GHE) and its subsidiary, GM, have received investment funds to develop fixed-dose combination products, including combinations of blood pressure-lowering drugs; GHE is the social enterprise arm of TGI (Dr. Rodgers does not have a direct financial interest in these patent applications or investments). Dr. Sundström holds ownership in companies providing services to Itrim, Amgen, Janssen, Novo Nordisk, Eli Lilly, Boehringer Ingelheim, Bayer, Pfizer, and AstraZeneca, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Central Illustration
Central Illustration
Cardiovascular Disease Burden Across Time, Location, Cause, and Risk Factor Percent Change in Age-Standardized CVD Death Rate from 2010-2019. Map of the percent change in age-standardized CVD mortality rate from 2010 to 2019.Number of CVD Deaths. Total number of deaths due to CVD by sex, 1990 to 2019; total number of deaths due to CVD in 2010 and 2019 among the countries with the highest number of CVD deaths in 2019. Proportion of CVD Deaths by Cause (2019). Proportion of total CVD deaths in 2019 by underlying causes. CVD Burden Attributable to Modifiable Risk Factors. Comparison of the rankings of CVD DALYs attributable to modifiable risk factors in 1990 and 2019. CVD = cardiovascular disease; DALYs = disability-adjusted life years; LDL = low-density lipoprotein.
Figure 1
Figure 1
Total Numbers and Rates of Cardiovascular Diseases (A) Total number of DALYs, deaths, prevalent cases, YLDs, and YLLs due to cardiovascular diseases, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, prevalence, YLD, and YLL rates of cardiovascular diseases, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. DALYs = disability-adjusted life years; YLDs = years lived with disability; YLLs = years of life lost.
Figure 2
Figure 2
Total Numbers and Rates of Ischemic Heart Disease (A) Total number of DALYs, deaths, prevalent cases, YLDs, and YLLs due to ischemic heart disease, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, prevalence, YLD, and YLL rates of ischemic heart disease, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 3
Figure 3
Map of Age-Standardized Prevalence of Stroke Survivors in 2019
Figure 4
Figure 4
Map of Age-Standardized DALYs Due to Hypertensive Heart Disease in 2019 DALYs = disability-adjusted life years.
Figure 5
Figure 5
Total Numbers and Rates of Congenital Heart Anomalies (A) Total number and number among children younger than 1 year of DALYs, deaths, prevalent cases, YLDs, and YLLs due to congenital heart anomalies, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, prevalence, YLD, and YLL rates of congenital heart anomalies, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 6
Figure 6
Map of Age-Standardized DALYs Due to Rheumatic Heart Disease in 2019 DALYs = disability-adjusted life years.
Figure 7
Figure 7
Map of Age-Standardized DALYs Due to Cardiomyopathy and Myocarditis in 2019 DALYs = disability-adjusted life years.
Figure 8
Figure 8
Map of Age-Standardized DALYs Due to Alcoholic Cardiomyopathy in 2019 DALYs = disability-adjusted life years.
Figure 9
Figure 9
Map of Age-Standardized DALYs Due to Atrial Fibrillation and Flutter in 2019 DALYs = disability-adjusted life years.
Figure 10
Figure 10
Total Numbers and Rates of Aortic Aneurysm (A) Total number of deaths and YLLs due to aortic aneurysm, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages death and YLL rates of aortic aneurysm, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. YLLs = years of life lost.
Figure 11
Figure 11
Age-Standardized DALYs Due to Nonrheumatic Calcific Aortic Valve Disease in 2019 by Region Age-standardized DALY rate of nonrheumatic calcific aortic valve disease by region and sex with 95% uncertainty intervals, 2019. DALYs = disability-adjusted life years.
Figure 12
Figure 12
DALYs Due to Nonrheumatic Degenerative Mitral Valve Disease in 2019 by Age Number of DALYs due to nonrheumatic degenerative mitral valve disease by age and sex with 95% uncertainty intervals, 2019. Ages younger than 15 years were removed from the figure because they are not modeled for this cause. DALYs = disability-adjusted life years.
Figure 13
Figure 13
Total Numbers and Rates of Endocarditis (A) Total number of DALYs, deaths, incident cases, YLDs, and YLLs due to endocarditis, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, incidence, YLD, and YLL rates of endocarditis, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 14
Figure 14
Map of Age-Standardized DALYs Due to Peripheral Artery Disease in 2019 DALYs = disability-adjusted life years.
Figure 15
Figure 15
DALYs Due to High Systolic Blood Pressure in 2019 by Age Number of DALYs due to high systolic blood pressure by age and sex with 95% uncertainty intervals, 2019. Ages younger than 15 years were removed from the figure because they are not modeled for this risk. DALYs = disability-adjusted life years.
Figure 16
Figure 16
Total Numbers and Rates of High Fasting Plasma Glucose (A) Total number of DALYs, deaths, YLDs, and YLLs due to high fasting plasma glucose, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, YLD, and YLL rates of high fasting plasma glucose, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 17
Figure 17
Map of Age-Standardized DALYs Due to High LDL Cholesterol in 2019 DALYs = disability-adjusted life years; LDL = low-density lipoprotein.
Figure 18
Figure 18
Total Numbers and Rates of High Body Mass Index (A) Total number of DALYs, deaths, YLDs, and YLLs due to high body mass index, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, YLD, and YLL rates of high body mass index, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 19
Figure 19
Map of Age-Standardized DALYs Due to Impaired Kidney Function in 2019 DALYs = disability-adjusted life years.
Figure 20
Figure 20
Map of Age-Standardized DALYs Due to Ambient Particulate Matter Pollution in 2019 DALYs = disability-adjusted life years.
Figure 21
Figure 21
Total Numbers and Rates of Tobacco (A) Total number of DALYs, deaths, YLDs, and YLLs due to tobacco, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, YLD, and YLL rates of tobacco, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 22
Figure 22
Total Numbers and Rates of Dietary Risks (A) Total number of DALYs, deaths, YLDs, and YLLs due to dietary risks, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. (B) Age-standardized and all-ages DALY, death, YLD, and YLL rates of dietary risks, 1990 to 2019. Shaded regions represent 95% uncertainty intervals. Abbreviations as in Figure 1.
Figure 23
Figure 23
Map of Age-Standardized DALYs Due to Low Physical Activity in 2019 DALYs = disability-adjusted life years.
Figure 24
Figure 24
Map of Age-Standardized YLLs Due to Cardiovascular Diseases in 2019 YLLs = years of life lost.

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