The Present and Future
JACC State-of-the-Art Review
Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study

https://doi.org/10.1016/j.jacc.2020.11.010Get rights and content
Under a Creative Commons license
open access

Highlights

  • The burden of CVD, in number of DALYs and deaths, continues to increase globally.

  • CVD burden attributable to modifiable risk factors continues to increase globally.

  • Countries should invest in existing cost-effective public health programs and clinical interventions to target modifiable risks, promote healthy aging across the lifespan, and reduce disability and premature death due to CVD.

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.

Key Words

cardiovascular diseases
global health
health policy
population health

Abbreviations and Acronyms

AC
alcoholic cardiomyopathy
AF
atrial fibrillation
AFL
atrial flutter
BMI
body mass index
CAVD
calcific aortic valve disease
CHA
congenital heart anomalies
CKD
chronic kidney disease
CVD
cardiovascular disease
DALYs
disability-adjusted life years
GBD
Global Burden of Diseases, Injuries, and Risk Factors Study
HAP
household air pollution
HHD
hypertensive heart disease
HICs
high-income countries
ICD
International Classification of Diseases
IHD
ischemic heart disease
IKF
impaired kidney function
IS
ischemic stroke
LDL
low-density lipoprotein
LMICs
low- and middle-income countries
LPA
low physical activity
MV
mitral valve
PAD
peripheral artery disease
PM
particulate matter
RHD
rheumatic heart disease
SBP
systolic blood pressure
SDI
sociodemographic index
TMREL
theoretical minimum risk exposure level
UI
uncertainty interval
YLDs
years lived with disability
YLLs
years of life lost

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

A complete list of the the GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group is available in the Supplemental Appendix.