CVD tops disease burden, death cause worldwide

The leading cause of disease burden and death across the globe is still cardiovascular disease (CVD), with low, low-middle, and middle sociodemographic index (SDI) regions carrying the heaviest burden, according to a study.

“The decades-long increase in CVD burden was the result of population growth, population ageing, and increased exposure to a subset of risk factors led by metabolic risks,” the investigators said. “Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.”

In the Global Burden of Disease (GBD) 2023 study, a team of investigators assessed burden due to 375 diseases and identified drivers of change from 1990 to 2023 using available data and statistical models. They also estimated population-level burden of diseases in 204 countries and territories.

CVD was the leading cause of disability-adjusted life years (DALYs) and deaths worldwide. As of 2023, a total of 437 million CVD DALYs were quantified globally, indicating a 1.4-fold increase from 320 million in 1990. [J Am Coll Cardiol 2025;86:2167-2243]

In 2023, the leading cardiovascular causes of DALYs globally were ischaemic heart disease, intracerebral haemorrhage, ischaemic stroke, and hypertensive heart disease. Low and low-middle SDI regions had the highest age-standardized CVD DALY rates, while high SDI regions showed the lowest.

The number of CVD deaths also rose worldwide from 13.1 million in 1990 to 19.2 million in 2023. The number of prevalent CVD cases more than doubled, from 311 million in 1990 to 626 million in 2023.

A major proportion (79.6 percent) of CVD burden could be attributed to modifiable risk factors (347 million DALYs in 2023). CVD burden across the globe could be attributed to high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution.

“Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high BMI, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases,” the investigators said.

Some of the major drivers of the increasing CVD burden since 1990 were population growth and ageing, adding 128 million and 139 million CVD DALYs, respectively.

Policies

“Investment in cardiovascular health policies will be challenging in the current political and economic climate,” according to the investigators.

In 2025, development assistance for health has declined to its lowest level in over 15 years as several countries (eg, Finland, France, Germany, UK, and US) have slashed their funding. Only a small part of this funding was allotted to noncommunicable diseases. [https://www.healthdata.org/research-analysis/library/financing-global-health-2025-cuts-aid-and-future-outlook]

Furthermore, the 78th World Health Assembly approved in May a resolution affirming their commitment to universal health coverage and urging increases in domestic investments to enhance financial protections and lower out-of-pocket expenses. [https://apps.who.int/gb/ebwha/pdf_files/EB156/B156_(16)-en.pdf]

“Policies should also support the eradication of rheumatic heart disease, which remains a persistent health threat in the poorest countries,” the investigators said. [BMC Glob Public Health 2025;3:1:62]