Global, regional, and national burden of cardiovascular disease attributable to high body mass index from 1990 to 2021 and projection to 2045

Abstract

Background: High body mass index (HBMI) is strongly associated with cardiovascular disease (CVD), but the global burden of CVD attributable to HBMI remains poorly defined. This study aims to elucidate the current burden and temporal trends of CVD attributable to HBMI.

Methods: We used data from the Global Burden of Disease Study (GBD) 2021 to estimate CVD deaths and disability-adjusted life years (DALYs) attributable to HBMI. Our analysis examines trends in deaths and DALYs by age, gender, and Socio-demographic Index (SDI) across global, regional, and national levels from 1990 to 2021. We used health inequality and decomposition analyses to quantify the influencing factors of disease burden and a Bayesian age-period-cohort (BAPC) model to predict the potential trend of HBMI on CVD burden.

Results: In 2021, HBMI-related CVD resulted in approximately 1.9 million deaths and 45.43 million DALYs among urban and rural populations, with an age-standardized mortality rate (ASMR) of 22.77 (95% UI, 12.87-34.24) and an age-standardized disability rate (ASDR) of 529.00 (95% UI, 277.28-808.64) per 100,000 people. Over the study period, the overall CVD burden attributable to HBMI decreased significantly, while the burden of atrial fibrillation and flutter increased. The disease burden was closely tied to socioeconomic development and was unevenly distributed, with middle SDI regions experiencing a heavier burden. The highest burden was observed in individuals aged 84 and older, with a significant increase in the 20-44 age group. Decomposition analysis revealed that the increase in DALYs was driven by population growth. Projections from the BAPC model suggest that by 2045, global DALYs of CVD attributable to HBMI may continue to increase.

Conclusions: This study provides a comprehensive epidemiological assessment of the CVD burden attributable to HBMI across various regions and populations, offering valuable insights for guiding policy and research efforts.

Keywords: cardiovascular disease; epidemiology; global burden of disease; high body mass index; public health.

Figure 1

Contribution of the HBMI-attributable CVD burden in different locations. Contribution of the HBMI-attributable CVD deaths (A) and DALYs (B) for both genders, globally and by region, in 1990 and 2021. HBMI, high body mass index; CVD, cardiovascular disease; DALYs, disability-adjusted life years.

Figure 2

The global distribution of ASDR of CVD attributable to HBMI for both genders in 2021. ASDR of CVD (A), aortic aneurysm (B), atrial fibrillation and flutter (C), hypertensive heart disease (D), ischemic heart disease (E), lower extremity peripheral arterial disease (F), and stroke (G) attributable to HBMI for both genders in 204 countries and territories in 2021. ASDR, age-standardized DALYs (disability-adjusted life years) rate; CVD, cardiovascular disease; HBMI, high body mass index.

Figure 3

Age-specific rates of global DALYs of CVD attributable to HBMI, by gender, in 2021 and the corresponding EAPC from 1990 to 2021. Global DALY rates of CVD (A), aortic aneurysm (B), atrial fibrillation and flutter (C), hypertensive heart disease (D), ischemic heart disease (E), lower extremity peripheral arterial disease (F), and stroke (G) attributable to HBMI in different age groups, by gender, in 2021. EAPC of global DALY rates of CVD (H), aortic aneurysm (I), atrial fibrillation and flutter (J), hypertensive heart disease (K), ischemic heart disease (L), lower extremity peripheral arterial disease (M), and stroke (N) attributable to HBMI in different age groups, by gender, from 1990 to 2021. DALYs, disability-adjusted life years; CVD, cardiovascular disease; HBMI, high body mass index; EAPC, estimated annual percentage change.

Figure 4

Correlations between ASDR of CVD attributable to HBMI and SDI at the regional level. ASDR of CVD (A), aortic aneurysm (B), atrial fibrillation and flutter (C), hypertensive heart disease (D), ischemic heart disease (E), lower extremity peripheral arterial disease (F), and stroke (G) attributable to HBMI at the global level and 21 regions, by SDI, 1990–2021. Black line represents the expected ASDR based on SDIs in all locations. ASDR, age standardized DALYs (disability-adjusted life years) rate; CVD, cardiovascular disease; HBMI, high body mass index; SDI, socio-demographic index.

Figure 5

Projections of CVD DALYs by 2045 based on the BAPC model. The DALYs of CVD (A), aortic aneurysm (B), atrial fibrillation and flutter (C), hypertensive heart disease (D), ischemic heart disease (E), lower extremity peripheral arterial disease (F), and stroke (G) attributable to HBMI. BAPC, Bayesian age-period-cohort; DALYs, disability-adjusted life years; CVD, cardiovascular disease; HBMI, high body mass index.