The Weight of Cardiovascular Diseases: Addressing the Global Cardiovascular Crisis Associated with Obesity

Abstract

Obesity is a growing global epidemic with significant implications for cardiovascular diseases (CVD). It couples as an independent risk factor and driver for multiple pathways leading to CVDs. Here we examine obesity's impact on CVD and propose actionable strategies. Data from the NCD Risk Factor Collaboration (NCD-RisC), Global Burden of Disease (GBD) survey, and regional health surveys databases were used. We examined trends in obesity prevalence and CVD mortality attributable to high body mass index (BMI), disaggregated by sex, geography, socioeconomic status, and urban-rural residence. Evidence from national policy initiatives and clinical management guidelines was also reviewed. As of 2022, over 1 billion people globally were living with obesity. Since 1990 the age-standardised obesity prevalence has doubled among women (from 8.8% to 18.5%) and tripled among men (from 4.8% to 14%). Globally, the number of annual CVD deaths attributable to high BMI (25 kg/m² or over) more than doubled between 1990 and 2021, reaching 1.9 million in 2021. Reducing global obesity to 2019 levels could save an estimated US$2.2 trillion annually by 2060. Positive steps have been made in recent years, with the implementation of several global, national and local initiatives that show promise in tackling obesity and CVDs, in addition to the emergence of potentially game-changing medical interventions, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs). Yet, to tackle obesity and associated CVD, there is a need for a holistic approach across clinical and public health interventions that accounts for the multiple determinants of obesity. We recommend the implementation of evidence-based, cost-effective public health measures, and the incorporation of obesity-specific recommendations into cardiovascular guidelines. Addressing the global cardiovascular crisis linked to obesity will require coordinated efforts from policymakers, healthcare systems, and global health organisations.

Keywords: CVD global data; Obesity; body mass index; cardiovascular diseases.

Figure 1

The association between obesity and CVDs.

Figure 2

Age-standardised prevalence of obesity in 2022. Source: NCD Risk Factor Collaboration.

Figure 3

Absolute difference in the age-standardised prevalence of obesity between women and men in 1990 and 2022. Note: A positive difference indicates the prevalence is higher among women; a negative difference indicates the prevalence is higher among men. Source: NCD Risk Factor Collaboration.

Figure 4

Age-standardised prevalence of obesity by education level in adults aged over 25 years in select countries. Note: Country income groupings for this figure are as follows – Low-income: Sierra Leone; Lower-middle-income: Bangladesh and Ghana; Upper-middle-income: Albania; High-income: USA and the United Kingdom. Data sources: All data are based on publicly available nationally representative health examination surveys, including – Sierra Leone, DHS 2019; Bangladesh, DHS 2022; Ghana, DHS 2022; Albania, DHS 2017–2018; United Kingdom, Health Survey for England 2017–2019, USA NHANES, 2021–2023.