Cardiovascular diseases (CVD) continues to cause one in three deaths worldwide as a new report was described as a “wake up call” to take the threat seriously.

The latest Global Burden of Disease (GBD) special report published by the American College of Cardiology concluded the rise in CVD was a result of population growth, population aging and exposure to a broad range of risks, including increasing rates of obesity and diabetes. However, it said swift action to combat some of the major causes had the potential to save millions of lives each year.

“This research provides countries with a clear view of where progress is being made and where urgent action is needed,” said Gregory Roth, senior author of the paper, professor in the Division of Cardiology, and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation, University of Washington. “By targeting the most important and preventable risks, with effective policies and proven, cost-effective treatments, we can work to reduce premature mortality from non-communicable diseases. Each country can find reliable evidence and a kind of policy prescription for better cardiovascular health in our results.”

The updated report shows wide global, regional and national variation in CVD risks, even among countries with similar economies. Researchers estimated the impact of 376 diseases including CVD from 1990 to 2023 in 204 countries using all available data and statistical models. They identified potential drivers including population growth, population aging and risk factor exposure.

CVD remains the leading cause of disability-adjusted life years (DALYs) and deaths estimated globally. There were 437 million CVD DALYs in 2023, with a 16-fold difference between the countries with the lowest and highest CVD DALY rates. This is a 1.4-fold increase from the 320 million CVD DALYs in 1990. CVDs were responsible for 19.2 million deaths in 2023, an increase from 13.1 million in 1990. The leading cardiovascular causes of DALYs were ischemic heart disease, intracerebral haemorrhage, ischemic stroke and hypertensive heart disease.

In 2023, 79.6% of all CVD DALYs globally were attributable to modifiable risk factors, which has increased globally by 97.4 million since 1990 largely due to population growth and aging. The top risk factors include metabolic, like high body mass index (BMI) and high fasting plasma glucose, followed by behavioural and environmental/occupational,  such as air pollution, lead exposure and higher temperatures. Metabolic, behavioural and environmental/occupational risk factors contributed to 67.3%, 44.9% and 35.8% of all CVD DALYs, respectively.

In contrast, decreases in exposure to tobacco and air pollution, specifically household air pollution, have counteracted some of the rising CVD burden.

Ischemic heart disease affected an estimated 240 million people in 2023, while lower extremity peripheral arterial disease impacted 122 million; stroke remained a leading cause of death and disability across all regions.

Men had higher cardiovascular mortality rates than women in most regions, and risk increased steeply after age 50. High body mass index and high fasting plasma glucose were the fastest-growing metabolic contributors between 2018 and 2023, mirroring global trends in obesity and diabetes.

“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 Roth. “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 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, Harold H. Hines Jr professor of Medicine, Yale University School of Medicine. “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.”