Cardiovascular disease (CVD) remains the leading cause of death, as well as disease burden, according to an analysis of worldwide data over the past 30 years. The Global Burden of Cardiovascular Disease and Risks 2023 Collaborators reported these data in a manuscript published Wednesday online in the Journal of the American College of Cardiology. “This report is a wake-up call: heart disease remains the world’s leading cause of death, and the burden is rising fastest in places least equipped to bear it,” said Harlan Krumholz, MD, Editor-in-Chief of JACC, and Harold H. Hines Jr, Professor of Medicine at Yale University School of Medicine, New Haven, in a news release by the American College of Cardiology (ACC) on Wednesday. "The good news is we know the risks and how to address them; if countries act now with effective health policies and systems, millions of lives can be saved.” Most countries have seen an uptick in CVD since 1990 due to increasing rates of harmful risk factors. Some risk factors include an aging population, that is also growing, as well as limited access to health care. The investigators in this study reported the international estimates of CVD burden, including the risk factors driving the increase in CVD. All available data were used in this multinational, collaborative research study: the Global Burden of Disease (GBD) 2023. The investigation took place across 204 countries and territories between 1990 and 2023. Disability-adjusted life years (DALYs) were mostly caused by CVDs during this study period. CVD was also the leading cause of mortality. In 2023, 437 million CVD DALYs were recorded globally, compared with 320 million in 1990. Leading CVDs were ischemic heart disease, intracerebral hemorrhage, ischemic stroke and hypertensive heart disease. Low and low-middle socio-demographic inddex (SDI) settings had the highest rates of CVD DALYs, and high SDI areas had the lowest rates. Most regions showed that men had higher rates of CVD death compared with women. From 1990 to 2023, CVD death rates rose from 13.1 million to 19.2 million. Prevalant cases of CVD also increased by more than double during this time (311 million vs 626 million). Modifiable risk factors contribute to 79.6% of the global CVD burden, namely high systolic blood pressure, poor diet, high alcohol consumption, high low-density lipoprotein cholesterol and air pollution. Exposure to modifiable risk factors has some mixed effects. Since 1990, increases in body mass index, high fasting plasma glucose and inactivity worsen the burden of CVD. Simultaneously, ceasing or reducing tobacco use and smoking have lowered some of these effects. Finally, growth of the worldwide population, as well as aging, added 128 million and 139 million CVD DALYs to the CVD burden since 1990, playing a significant role in the rates of CVD. Risk for CVD death sharply increased after age 50. “The finding that CVD burden is substantially greater outside of the most developed settings even after accounting for differences in population age, remains among the most important messages of this analysis,” said Gregory A. Roth, MD, MPH, lead author of the paper and Director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, during the ACC news release. “Our analysis shows wide geographic differences in CVD burden that can’t be explained by income level alone. Given this kind of variation, our findings offer the opportunity to tailor local health policies to target the most relevant risks for specific populations.” This research was funded by the Bill and Melinda Gates Foundation and the American College of Cardiology Foundation. Source: Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, regional, and national burden of cardiovascular diseases and risk factors in 204 countries and territories, 1990-2023. J Am Coll Cardiol. 2025 September 24 (Article in press). Image Credit: Sunset Paper’s – stock.adobe.com