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. 2025 Jul 22;86(3):165-177.
doi: 10.1016/j.jacc.2025.04.061.

The Global Syndemic of Modifiable Cardiovascular Risk Factors Projected From 2025 to 2050

Bryan Chong  1 , Jayanth Jayabaskaran  1 , Silingga Metta Jauhari  2 , Jobelle Chia  3 , Carel W le Roux  4 , Anurag Mehta  5 , Georgios K Dimitriadis  6 , Yiming Chen  1 , Sue Anne Toh  7 , Yosef Manla  8 , Wael Al Mahmeed  8 , Siew Pang Chan  2 , Rachel Goh  1 , Srinithy Nagarajan  1 , Henry Li  9 , Gwyneth Kong  10 , Yip Han Chin  10 , Jiong-Wei Wang  11 , Han Shi Jocelyn Chew  12 , Evangelos Kontopantelis  13 , Mark Muthiah  14 , Jack Wei Chieh Tan  15 , Derek Hausenloy  16 , Gemma A Figtree  17 , Mamas A Mamas  18 , A Mark Richards  19 , Stephen J Nicholls  20 , Mark Y Chan  21 , Gregory Y H Lip  22 , Gregory Roth  23 , George A Mensah  24 , Laurence S Sperling  25 , Nicholas W S Chew  26
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Free article

The Global Syndemic of Modifiable Cardiovascular Risk Factors Projected From 2025 to 2050

Bryan Chong et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Cardiovascular diseases (CVDs) are the leading cause of global mortality. Understanding epidemiologic trends in the modifiable risk factors driving CVDs is essential in designing effective countermeasures.

Objectives: The aim of this study was to forecast geospatial trends of modifiable cardiovascular risk factors, namely high systolic blood pressure (SBP), high fasting plasma glucose, high body mass index (BMI), high low-density lipoprotein cholesterol, and tobacco use from 2025 to 2050.

Methods: Historical data on disability-adjusted life years (DALYs) and mortality from the GBD (Global Burden of Disease) 2021 study were used to forecast the burden associated with modifiable cardiovascular risk factors from 2025 to 2050. Trends across GBD super-regions, sex, sociodemographic index, and age groups were examined.

Results: In 2050, high SBP (1,694.2 [95% uncertainty interval [UI]: 1,454.6-1,933.9] per 100,000 population) will contribute to the highest age-standardized DALYs, followed by high low-density lipoprotein cholesterol (657.6 [95% UI: 511.9-803.3] per 100,000 population), high BMI (495.2 [95% UI: 330.8-659.6] per 100,000 population), tobacco use (493.7 [95% UI: 378.2-609.1] per 100,000 population), and high fasting plasma glucose (466.7 [95% UI: 311.9-621.5] per 100,000 population). Although age-standardized DALY rates will fall across all cardiovascular risk factors from 2025 to 2050, overall crude DALYs associated with cardiovascular risk factors are projected to rise within the same period. High SBP (rising by 99 million DALYs; 44.1% increase), and high BMI (increasing by 44 million DALYs; 88.0% increase) will have the greatest rise in crude DALYs from 2025 to 2050.

Conclusions: Although the projected decline in age-standardized DALYs of modifiable cardiovascular risk factors suggest improved management of CVDs, crude DALYs will continue to rise due to population growth and aging.

Keywords: cardiovascular disease; disability-adjusted life years; global burden; standard modifiable risk factors.

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the NUHS Clinician Scientist Program (NCSP2.0/2024/NUHS/NCWS), National Medical Research Council Transition Award (TA24jul-0008), centre grant (CG21APR1008), and the CArdiovascular DiseasE National Collaborative Enterprise (CADENCE) Singapore National Clinical Translational Program. The funders had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, or approval of the manuscript. Dr Mehta has received institutional research grants from Novartis and Amgen. Dr Toh has received grants from the American Heart Association, Institute of Translational Medicine and Therapeutics, University of Pennsylvania, USA, National Medical Research Council (Singapore), Merck, and Johnson & Johnson; has served on advisory boards and/or speakers bureau (no fees were received personally) for Eli Lilly, Novo Nordisk, Eli Lilly Johnson & Johnson, Boehringer Ingelheim, AstraZeneca, Sanofi, Novartis, Abbott Nutrition, Abbott Diabetes Care, and Dexcom; and is a shareholder, CEO, and Medical Director of NOVI Health. Dr Chan receives speaker fees and research grants from AstraZeneca, Abbott Technologies, and Boston Scientific; and receives salary support from a National Medical Research Council Clinician Scientist Award-Senior Category (MOH-000280-00). Dr Chew has received research grant support from NUHS Seed Fund (NUHSRO/2022/RO5+6/Seed-Mar/03), National Medical Research Council Research Training Fellowship (MH 095:003/008-303), National University of Singapore Yong Loo Lin School of Medicine’s Academic Fellowship Scheme, the NUHS Clinician Scientist Program (NCSP2.0/2024/NUHS/NCWS), and the National Medical Research Council Transition Award (TA24jul-0008). Dr Richards holds the New Zealand Heart Foundation Chair of Cardiovascular Studies; and has received advisory board fees and/or grant support from Roche Diagnostics, Novo Nordisk, Abbott Laboratories, Thermo Fisher, Medtronic, SphingoTec, Novartis, and AstraZeneca. Dr le Roux receives grants from the Irish Research Council, Science Foundation Ireland, AnaBio, and the Health Research Board; serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, and Boehringer Ingelheim; is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here; andwas the chief medical officer and director of the Medical Device Division of Keyron in 2011; both of these are unremunerated positions. Dr le Roux was a previous investor in Keyron, which develops endoscopically implantable medical devices intended to mimic the surgical procedures of sleeve gastrectomy and gastric bypass. The product has only been tested in rodents, and none of Keyron’s products are currently licensed. They do not have any contracts with other companies to put their products into clinical practice. No patients have been included in any of Keyron’s studies, and they are not listed on the stock market. Dr le Roux was gifted stock holdings in September 2021 and divested all stock holdings in Keyron in September, 2021. He continues to provide scientific advice to Keyron for no remuneration. Dr Dimitriadis has received research grants from Novo Nordisk and DDM; has received payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from Novo Nordisk, Rhythm Pharmaceuticals, Johnson & Johnson/Ethicon, and Medtronic. Dr Lip has served as a consultant and speaker for Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos (no fees were received personally) outside the submitted work. Dr Chong receives research support from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, National University of Singapore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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