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

Roth, G. A., Mensah, G. A., Johnson, C. O. , Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J., Criqui, M. H., DeCleene, N., Eagle, K. A., Emmons-Bell, S., Feigin, V. L., Fernández-Solà, J., Fowkes, G., Gakidou, E., Grundy, S. M., He, F. J., Howard, G., Hu, F., Inker, L., Karthikeyan, G., Kassebaum, N. J., Koroshetz, W., Lavie, C., Lloyd-Jones, D., Lu, H. S., Mirijello, A., Temesgen, A. M., Mokdad, A. H., Moran, A. E., Muntner, P., Narula, J., Neal, B., Ntsekhe, M., Moraes de Oliveira, G., Otto, C.A., Owolabi, M. O., Pratt, M., Rajagopalan, S., Reitsma, M. B., Ribeiro, A. L. P., Rigotti, N., Rodgers, A., Sable, C., Shakil, S., Sliwa-Hahnle, K., Stark, B. A., Sundström, J., Timpel, P., Tleyjeh, I. M., Valgimigli, M., Vos, T., Whelton, P. K., Yacoub, M., Zuhlke, L., Murray, C., Fuster, V., Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. A., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J. R., Catapano, A. L., Chugh, S., Cooper, L. T., Coresh, J., Criqui, M. H., DeCleene, N. K., Eagle, K. A., Emmons-Bell, S., Feigin, V. L., Fernández-Sola, J., Fowkes, F. G. R., Gakidou, E., Grundy, S. M., He, F. J., Howard, G., Hu, F., Inker, L., Karthikeyan, G., Kassebaum, N. J., Koroshetz, W. J., Lavie, C., Lloyd-Jones, D., Lu, H. S., Mirijello, A., Misganaw, A. T., Mokdad, A. H., Moran, A. E., Muntner, P., Narula, J., Neal, B., Ntsekhe, M., Oliveira, G. M. M., Otto, C. M., Owolabi, M. O., Pratt, M., Rajagopalan, S., Reitsma, M. B., Ribeiro, A. L. P., Rigotti, N. A., Rodgers, A., Sable, C. A., Shakil, S. S., Sliwa, K., Stark, B. A., Sundström, J., Timpel, P., Tleyjeh, I. I., Valgimigli, M., Vos, T., Whelton, P. K., Yacoub, M., Zuhlke, L. J., Abbasi-Kangevari, M., Abdi, A., Abedi, A., Aboyans, V., Abrha, W. A., Abu-Gharbieh, E., Abushouk, A. I., Acharya, D., Adair, T., Adebayo, O. M., Ademi, Z., Advani, S. M., Afshari, K., Afshin, A., Agarwal, G., Agasthi, P., Ahmad, S., Ahmadi, S., Ahmed, M. B., Aji, B., Akalu, Y., Akande-Sholabi, W., Aklilu, A., Akunna, C. J., Alahdab, F., Al-Eyadhy, A., Alhabib, K. F., Alif, S. M., Alipour, V., Aljunid, S. M., Alla, F., Almasi-Hashiani, A., Almustanyir, S., Al-Raddadi, R. M., Amegah, A. K., Amini, S., Aminorroaya, A., Amu, H., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, T., Andrei, C. L., Ansari-Moghaddam, A., Anteneh, Z. A., Antonazzo, I. C., Antony, B., Anwer, R., Appiah, L. T., Arabloo, J., Ärnlöv, J., Artanti, K. D., Ataro, Z., Ausloos, M., Avila-Burgos, L., Awan, A. T., Awoke, M. A., Ayele, H. T., Ayza, M. A., Azari, S., B, D. B., Baheiraei, N., Baig, A. A., Bakhtiari, A., Banach, M., Banik, P. C., Baptista, E. A., Barboza, M. A., Barua, L., Basu, S., Bedi, N., Bejot, Y., Bennett, D. A., Bensenor, I. M., Berman, A. E., Bezabih, Y. M., Bhagavathula, A. S., Bhaskar, S., Bhattacharyya, K., Bijani, A., Bikbov, B., Birhanu, M. M., Boloor, A., Brant, L. C., Brenner, H., Briko, N. I., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Cahuana-Hurtado, L., Camera, L. A., Campos-Nonato, I. R., Cantu-Brito, C., Car, J., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cerin, E., Charan, J., Chattu, V. K., Chen, S., Chin, K. L., Choi, J-Y. J., Chu, D-T., Chung, S-C., Cirillo, M., Coffey, S., Conti, S., Costa, V. M., Cundiff, D. K., Dadras, O., Dagnew, B., Dai, X., Damasceno, A. A. M., Dandona, L., Dandona, R., Davletov, K., De La Cruz-Gongora, V., De la Hoz, F. P., De Neve, J-W., Denova-Gutierrez, E., Derbew Molla, M., Derseh, B. T., Desai, R., Deuschl, G., Dharmaratne, S. D., Dhimal, M., Dhungana, R. R., Dianatinasab, M., Diaz, D., Djalalinia, S., Dokova, K., Douiri, A., Duncan, B. B., Duraes, A. R., Eagan, A. W., Ebtehaj, S., Eftekhari, A., Eftekharzadeh, S., Ekholuenetale, M., El Nahas, N., Elgendy, I. Y., Elhadi, M., El-Jaafary, S. I., Esteghamati, S., Etisso, A. E., Eyawo, O., Fadhil, I., Faraon, E. J. A., Faris, P. S., Farwati, M., Farzadfar, F., Fernandes, E., Fernandez Prendes, C., Ferrara, P., Filip, I., Fischer, F., Flood, D., Fukumoto, T., Gad, M. M., Gaidhane, S., Ganji, M., Garg, J., Gebre, A. K., Gebregiorgis, B. G., Gebregzabiher, K. Z., Gebremeskel, G. G., Getacher, L., Obsa, A. G., Ghajar, A., Ghashghaee, A., Ghith, N., Giampaoli, S., Gilani, S. A., Gill, P. S., Gillum, R. F., Glushkova, E. V., Gnedovskaya, E. V., Golechha, M., Gonfa, K. B., Goudarzian, A. H., Goulart, A. C., Guadamuz, J. S., Guha, A., Guo, Y., Gupta, R., Hachinski, V., Hafezi-Nejad, N., Haile, T. G., Hamadeh, R. R., Hamidi, S., Hankey, G. J., Hargono, A., Hartono, R. K., Hashemian, M., Hashi, A., Hassan, S., Hassen, H. Y., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Herteliu, C., Holla, R., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Huang, J., Humayun, A., Iavicoli, I., Ibeneme, C. U., Ibitoye, S. E., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Islam, R. M., Iso, H., Iwagami, M., Jain, V., Javaheri, T., Jayapal, S. K., Jayaram, S., Jayawardena, R., Jeemon, P., Jha, R. P., Jonas, J. B., Jonnagaddala, J., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, A., Kahlon, T., Kalani, R., Kalhor, R., Kamath, A., Kamel, I., Kandel, H., Kandel, A., Karch, A., Kasa, A. S., Katoto, P. D. M. C., Kayode, G. A., Khader, Y. S., Khammarnia, M., Khan, M. S., Khan, M., Khan, M., Khan, E. A., Khatab, K., Kibria, G. M. A., Kim, Y. J., Kim, G. R., Kimokoti, R. W., Kisa, S., Kisa, A., Kivimaki, M., Kolte, D., Koolivand, A., Korshunov, V. A., Koulmane Laxminarayana, S. L., Koyanagi, A., Krishan, K., Krishnamoorthy, V., Kuate Defo, B., Kucuk Bicer, B., Kulkarni, V., Kumar, G. A., Kumar, N., Kurmi, O. P., Kusuma, D. ORCID: 0000-0002-1909-9341, Kwan, G. F., La Vecchia, C., Lacey, B., Lallukka, T., Lan, Q., Lasrado, S., Lassi, Z. S., Lauriola, P., Lawrence, W. R., Laxmaiah, A., LeGrand, K. E., Li, M-C., Li, B., Li, S., Lim, S. S., Lim, L-L., Lin, H., Lin, Z., Lin, R-T., Liu, X., Lopez, A. D., Lorkowski, S., Lotufo, P. A., Lugo, A., M, N. K., Madotto, F., Mahmoudi, M., Majeed, A., Malekzadeh, R., Malik, A. A., Mamun, A. A., Manafi, N., Mansournia, M. A., Mantovani, L. G., Martini, S., Mathur, M. R., Mazzaglia, G., Mehata, S., Mehndiratta, M. M., Meier, T. B., Menezes, R. G., Meretoja, A., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Miller, T. R., Mirrakhimov, E. M., Mirzaei, H., Moazen, B., Moghadaszadeh, M., Mohammad, Y., Mohammad, D. K., Mohammed, S., Mohammed, M. A., Mokhayeri, Y., Molokhia, M., Montasir, A. A., Moradi, G., Moradzadeh, R., Moraga, P., Morawska, L., Moreno Velásquez, I., Morze, J., Mubarik, S., Muruet, W., Musa, K. I., Nagarajan, A. J., Nalini, M., Nangia, V., Naqvi, A. A., Narasimha Swamy, S., Nascimento, B. R., Nayak, V. C., Nazari, J., Nazarzadeh, M., Negoi, R. I., Neupane Kandel, S., Nguyen, H. L. T., Nixon, M. R., Norrving, B., Noubiap, J. J., Nouthe, B. E., Nowak, C., Odukoya, O. O., Ogbo, F. A., Olagunju, A. T., Orru, H., Ortiz, A., Ostroff, S. M., Padubidri, J. R., Palladino, R., Pana, A., Panda-Jonas, S., Parekh, U., Park, E-C., Parvizi, M., Pashazadeh Kan, F., Patel, U. K., Pathak, M., Paudel, R., Pepito, V. C. F., Perianayagam, A., Perico, N., Pham, H. Q., Pilgrim, T., Piradov, M. A., Pishgar, F., Podder, V., Polibin, R. V., Pourshams, A., Pribadi, D. R. A., Rabiee, N., Rabiee, M., Radfar, A., Rafiei, A., Rahim, F., Rahimi-Movaghar, V., Ur Rahman, M. H., Rahman, M. A., Rahmani, A. M., Rakovac, I., Ram, P., Ramalingam, S., Rana, J., Ranasinghe, P., Rao, S. J., Rathi, P., Rawal, L., Rawasia, W. F., Rawassizadeh, R., Remuzzi, G., Renzaho, A. M. N., Rezapour, A., Riahi, S. M., Roberts-Thomson, R. L., Roever, L., Rohloff, P., Romoli, M., Roshandel, G., Rwegerera, G. M., Saadatagah, S., Saber-Ayad, M. M., Sabour, S., Sacco, S., Sadeghi, M., Saeedi Moghaddam, S., Safari, S., Sahebkar, A., Salehi, S., Salimzadeh, H., Samaei, M., Samy, A. M., Santos, I. S., Santric-Milicevic, M. M., Sarrafzadegan, N., Sarveazad, A., Sathish, T., Sawhney, M., Saylan, M., Schmidt, M. I., Schutte, A. E., Senthilkumaran, S., Sepanlou, S. G., Sha, F., Shahabi, S., Shahid, I., Shaikh, A. A., Shamali, M., Shamsizadeh, M., Shawon, M. S. R., Sheikh, A., Shigematsu, M., Shin, M-J., Shin, J. I. l., Shiri, R., Shiue, I., Shuval, K., Siabani, S., Siddiqi, T. J., Silva, D. A. S., Singh, J. A., Mtech, A. S., Skryabin, V. Y., Skryabina, A. A., Soheili, A., Spurlock, E. E., Stockfelt, L., Stortecky, S., Stranges, S., Suliankatchi Abdulkader, R., Tadbiri, H., Tadesse, E. G., Tadesse, D. B., Tajdini, M., Tariqujjaman, M., Teklehaimanot, B. F., Temsah, M-H., Tesema, A. K., Thakur, B., Thankappan, K. R., Thapar, R., Thrift, A. G., Timalsina, B., Tonelli, M., Touvier, M., Tovani-Palone, M. R., Tripathi, A., Tripathy, J. P., Truelsen, T. C., Tsegay, G. M., Tsegaye, G. W., Tsilimparis, N., Tusa, B. S., Tyrovolas, S., Umapathi, K. K., Unim, B., Unnikrishnan, B., Usman, M. S., Vaduganathan, M., Valdez, P. R., Vasankari, T. J., Velazquez, D. Z., Venketasubramanian, N., Vu, G. T., Vujcic, I. S., Waheed, Y., Wang, Y., Wang, F., Wei, J., Weintraub, R. G., Weldemariam, A. H., Westerman, R., Winkler, A. S., Wiysonge, C. S., Wolfe, C. D. A., Wubishet, B. L., Xu, G., Yadollahpour, A., Yamagishi, K., Yan, L. L., Yandrapalli, S., Yano, Y., Yatsuya, H., Yeheyis, T. Y., Yeshaw, Y., Yilgwan, C. S., Yonemoto, N., Yu, C., Yusefzadeh, H., Zachariah, G., Zaman, S. B., Zaman, M. S., Zamanian, M., Zand, R., Zandifar, A., Zarghi, A., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z-J., Zhang, Y., Zhang, W., Zhong, C., Zou, Z., Zuniga, Y. M. H., Murray, C. J. L. & Fuster, V. (2020). Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), pp. 2982-3021. doi: 10.1016/j.jacc.2020.11.010

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.

Publication Type: Article
Additional Information: ©2020 TheAuthors. Published by Elsevier on behalf of the American College of Cardiology Foundation . This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords: cardiovascular diseases, global health, health policy, population health
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
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