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. 2025 May 8;25(1):1704.
doi: 10.1186/s12889-025-22702-7.

Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data

Xing-Yu Zhu #  1 , Miao-Qian Shi #  2 , Zhi-Meng Jiang  1 , Xiao-Li  1 , Jian-Wei Tian  3 , Fei-Fei Su  4
Affiliations

Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data

Xing-Yu Zhu et al. BMC Public Health. .

Abstract

Objective: The objective is to evaluate the temporal trends in the burden of cardiovascular diseases attributable to metabolic risk factors from 1990 to 2021 and to project the burden over the subsequent 30 years.

Methods: A joinpoint regression model was employed to estimate the annual percentage change in cardiovascular disease mortality attributable to metabolic risk factors, utilizing data from the Global Burden of Disease (GBD) 2021. An age-period-cohort analysis was conducted to evaluate the effects of age, period, and cohort. A frontier analysis was employed to investigate the correlation between the prevalence of cardiovascular disease attributable to metabolic risk factors and socio-demographic trends. An autoregressive integrated moving average (ARIMA) model was subsequently constructed to forecast future cardiovascular disease burden.

Results: Between 1990 and 2021, the global age-standardized mortality rate (ASMR) of cardiovascular diseases attributable to metabolic factors exhibited a consistent decline (Average Annual Percent Change (AAPC) = -1.28, 95% CI [-1.42, -1.14], P < 0.01). However, the absolute number of deaths increased from 8.326 million to 13.595 million. The most substantial reduction in ASMR was observed in the High Socio-Demographic Index (SDI) region (AAPC = -2.98, 95% CI [-3.10, -2.86], P < 0.01), whereas the reductions were relatively smaller in the Low-middle SDI and Low SDI regions. The ARIMA model predicts a decline in global cardiovascular disease mortality over the next three decades, with the most pronounced decrease anticipated in the high-middle SDI region and smaller declines expected in the middle SDI and low SDI regions.

Conclusion: Notwithstanding a global decline in age-standardized mortality and disability-adjusted life year (DALY) rates, the burden of cardiovascular diseases attributable to metabolic factors remains significant worldwide. Targeted interventions must be implemented without delay, particularly for males and populations in low and middle SDI regions, to mitigate the impact of metabolic factors on public health.

Keywords: Age-standardized mortality rate; Autoregressive integrated moving average; Average Annual Percent Change; Cardiovascular disease; Global Burden of Disease.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The GBD data are de-identified and publicly accessible, exempting the study from institutional ethics board review. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Age-standardized mortality rates of cardiovascular diseases attributable to metabolic risk factors in 204 countries, 2021
Fig. 2
Fig. 2
Global burden of cardiovascular diseases attributable to metabolic risks in 2021. A Age-specific number of deaths; B Age-standardized mortality rates (ASMR); C Age-specific disability-adjusted life years (DALYs); D Age-standardized DALY rates; E Trends in deaths and ASMR (1990–2021); F Trends in DALYs and age-standardized DALY rates (1990–2021). The black bars in Figure E and F represent the 95% confidence intervals (CIs) for the respective data points
Fig. 3
Fig. 3
Joinpoint regression analysis of age-standardized mortality rates (ASMR) for cardiovascular diseases attributable to metabolic risks (1990–2021). A Global ASMR; B High SDI Region; C High-middle SDI Region; D Middle SDI Region; E Low-middle SDI Region; F Low SDI Region
Fig. 4
Fig. 4
Age-Period-Cohort (APC) model analysis for cardiovascular disease mortality attributable to metabolic risks. A Longitudinal Age Curve (Age Effect); B Cohort Relative Mortality (Cohort Effect); C Local Drifts with Net Drift (Temporal Trends); D Period Effect on Mortality (Period Effect)
Fig. 5
Fig. 5
Relationship between cardiovascular disease burden attributable to metabolic risks and socio-demographic index (SDI). A Global and 21 Regions: ASMR vs. SDI Relationship (1990–2021); B Global and 204 Countries: ASMR vs. SDI Relationship (2021)
Fig. 6
Fig. 6
Frontier analysis of the relationship between socio-demographic index (SDI) and Age-Standardized Mortality Rate (ASMR). A SDI and ASMR Trends (1990–2021); B 2021 Frontier Analysis for SDI and ASMR
Fig. 7
Fig. 7
Forecasted trends in cardiovascular disease mortality attributable to metabolic risks over the next 30 Years (Global and Five SDI Regions)
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