Comparative analysis of atherosclerotic cardiovascular disease burden between ages 20-54 and over 55 years: insights from the Global Burden of Disease Study 2019

Abstract

Background: To systematically analyze differences in atherosclerotic cardiovascular disease (ASCVD) burden between young and older adults.

Methods: We estimated the prevalence, mortality, and disability-adjusted life years (DALYs) of ASCVD, including ischemic heart disease (IHD), ischemic stroke (IS), and peripheral artery disease (PAD), in individuals aged 20-54 and > 55 years from 1990-2019, utilizing data from the 2019 Global Burden of Disease Study. The annual percentage changes (EAPCs) for age-specific prevalence, mortality, or DALY rates were calculated to quantify the temporal trends of ASCVD burden. We also analyzed population attribution fractions (PAF) of premature ASCVD mortality and DALYs for different risk factors and compared the burden of extremely premature, premature, and non-premature ASCVD cases based on clinical classifications.

Results: From 1990-2019, the global prevalence rates of IHD, IS, and PAD in the 20-54 years age group increased by 20.55% (from 694.74 to 837.49 per 100,000 population), 11.50% (from 439.48 to 490.03 per 100,000 population), and 7.38% (from 384.24 to 412.59 per 100,000 population), respectively. Conversely, the ASCVD prevalence in > 55years age group decreased. Adverse outcome burdens, including mortality and DALYs, varied among ASCVD subtypes. The decrease in the mortality/DALY burden of IHD and IS was lower in the 20-54 years group than in the > 55 years group. For PAD, DALYs among those aged 20-54 increased but decreased among those aged > 55 years. When grouped according to socio-demographic index (SDI) values, lower SDI regions exhibited a higher proportion of young ASCVD burden. The prevalence of young IHD, IS, and PAD in low SDI regions reached 20.70%, 40.05%, and 19.31% in 2019, respectively, compared with 12.14%, 16.32%, and 9.54%, respectively, in high SDI regions. Metabolic risks were the primary contributors to the ASCVD burden in both age groups. Increased susceptibility to ambient particulate matter pollution and inadequate control of high body-mass index and high fasting plasma glucose in young individuals may partially explain the differing temporal trends between young and older individuals.

Conclusions: The ASCVD burden in young individuals may become a growing global health concern, especially in areas with lower socioeconomic development levels that require more effective primary prevention strategies.

Keywords: Extremely premature atherosclerotic cardiovascular disease; Global disease burden; Ischemic heart disease; Ischemic stroke; Peripheral artery disease; Premature atherosclerotic cardiovascular disease.

Fig. 1

Global burden of ASCVD in the younger and the older. A Proportion of people aged 20–54 in total IHD burden. B Proportion of people aged 20–54 in total IS burden. C Proportion of people aged 20–54 in total PAD burden. D The rates of global IHD burden in people aged 20–54 and older than 55 during 1990 and 2019. E The rates of global IS burden in people aged 20–54 and older than 55 during 1990 and 2019. F The rates of global PAD burden in people aged 20–54 and older than 55 during 1990 and 2019.ASCVD: atherosclerotic cardiovascular disease; IHD: ischemic heart disease; IS: ischemic stroke; PAD: peripheral artery disease; SDI: socio-demographic index; DALYs: disability-adjusted life years

Fig. 2

The rate of ASCVDs burden by SDI during 1990–2019. A The rate of IHD burden in people aged 20–54 during 1990–2019. B The rate of IHD burden in people older than 55 during 1990–2019. C The rate of IS burden in people aged 20–54 during 1990–2019. D The rate of IS burden in people older than 55 during 1990–2019. E The rate of PAD burden in people aged 20–54 during 1990–2019. F The rate of PAD burden in people older than 55 during 1990–2019. SDI: socio-demographic index; IHD: ischemic heart disease; IS: ischemic stroke; PAD: peripheral artery disease; DALYs: disability-adjusted life years

Fig. 3

The change of IHD burden by countries and territories during 1990–2019. A The change of IHD prevalence cases in people aged 20–54 by countries and territories in 2019. B The change of IHD prevalence cases in people older than 55 by countries and territories in 2019. C The change of IHD death cases in people aged 20–54 by countries and territories in 2019. D The change of IHD death cases in people older than 55 by countries and territories in 2019. E The change of IHD DALYs cases in people aged 20–54 by countries and territories in 2019. F The change of IHD DALYs cases in people older than 55 by countries and territories in 2019. IHD: Ischemic heart disease. DALYs: disability-adjusted life years

Fig. 4

The man to women ratio of the rate of global ASCVDs burden during 1990–2019. A The man to women ratio of the rate of global IHD prevalence during 1990–2019. B The man to women ratio of the rate of global IHD death during 1990–2019. C The man to women ratio of the rate of global IHD DALYs during 1990–2019. D The man to women ratio of the rate of global IS prevalence during 1990–2019. E The man to women ratio of the rate of global IS death during 1990–2019. F The man to women ratio of the rate of IS DALYs during 1990–2019. G The man to women ratio of the rate of PAD prevalence during 1990–2019. H The man to women ratio of the rate of PAD death during 1990–2019. I The man to women ratio of the rate of PAD DALYs during 1990–2019. ASCVD: atherosclerotic cardiovascular disease; IHD: ischemic heart disease; IS: ischemic stroke; PAD: peripheral artery disease; SDI: socio-demographic index; DALYs: disability-adjusted life years

Fig. 5

PAF of risk factor for IHD death for different gender. A PAF of risk factor for IHD death for both genders. B PAF for risk factor of IHD death for women. C PAF of risk factor for IHD death for male. PAF: population attribution fractions