CVD Still the Leading Cause of Death and Disease Globally

Cardiovascular disease remains the top cause of death and disease around the globe, but the risks are not shared equally, according to the latest assessment from the Global Burden of Disease (GBD) collaborators.

Published today in JACC to coincide with presentations at the United Nations General Assembly 2025, the analysis showed that nearly 20 million people around the world died and 437 million disability-adjusted life-years (DALYs) were lost from cardiovascular disease in 2023. There were 8.91 million deaths from ischemic heart disease and 6.79 million deaths from stroke, the two leading causes of cardiovascular DALYs (193 and 157 million, respectively).

“We want to be very clear that cardiovascular disease continues to increase for almost all of the world and that risk factor [control] has not improved enough to reduce this growing burden,” senior researcher Gregory Roth, MD (Institute for Health Metrics and Evaluation/University of Washington, Seattle), told TCTMD. “In particular, we see high blood pressure as the leading risk factor, accounting for a huge amount of cardiovascular disease globally.”

Between 1990 and 2023, there was a 1.4-fold increase in the number of DALYs lost to cardiovascular disease, with an approximate 16-fold difference between countries with the lowest and highest cardiovascular disease DALY rates. The largest burden of cardiovascular disease was seen in countries rated in the low-to-middle sociodemographic index (SDI), a marker of social and economic conditions that influence health outcomes. By region, Oceania had the highest rate of DALYs, while high-income countries from the Asia Pacific region had the lowest (10,344 versus 1,693 per 100,000 people, respectively).

Among men and women, there were 42.9% and 28.6% increases, respectively, in DALYs lost due to cardiovascular disease between 1990 and 2023.

Big Differences by Region

Nearly 80% of the DALYs lost to cardiovascular disease globally were attributable to modifiable risk factors. The biggest risk factors driving death and disability are high systolic blood pressure, poor diet, high LDL cholesterol levels, and air pollution. The number of DALYs attributable to metabolic, behavioral, and environmental/occupational factors increased by 39.0% from 1990 to 2023. Overall, the cardiovascular disease DALYs attributable to metabolic risks climbed by 45.4%.

“There is a distinction I want to make between risk factors that are not declining fast enough, or have remained static, versus risk factors that are actually expanding,” said Roth. “Obesity and diabetes are the two risks that are actually driving cardiovascular disease up at this point and that’s going on for most of the world, including much of the developing world, or those in the lower-middle sociodemographic index, which is the way we classify it.”

Between 1990 and 2023, cardiovascular disease DALYs attributable to high body mass index increased by 114% and those attributable to high fasting plasma glucose levels climbed by 76%. 

Cardiovascular risk factors varied by region, with hypertension being the predominant risk factor in sub-Saharan Africa. In Eastern and Central Europe, on the other hand, the largest contributors to cardiovascular disease are tobacco and alcohol use. Identifying the risk factors driving morbidity and mortality would allow policymakers to focus on more targeted interventions, such as national taxation strategies on tobacco or alcohol, to improve cardiovascular health in a given country, said Roth.

Ambient and household air pollution, said Roth, is an “underappreciated risk factor,” but it is evident that it is an important contributor to atherosclerotic cardiovascular disease. One of the biggest risks is lead, a heavy metal that increases blood pressure as well as heart disease overall. While exposure to unleaded gasoline in the past contributed to the problem, there are significant risks associated with lead from industrial and nonindustrial sources, such as ceramics, electronics, paint, and even food sources, said Roth.

“If we can identify and remediate those sources, we can lower the risk of cardiovascular disease for whole populations for many decades to come,” he said.

Health Contexts

In general, Roth said that one of the major drivers of health is the “context” in which people live. Poverty, access to healthcare, and environmental risks are all contributors to a person’s health.

“The thing about cardiovascular disease is that it’s so treatable, but you have to be in the right setting,” he said. “You have to have access to healthcare, you have to be able to pay out-of-pocket expenses, if needed. There has to be access to prehospital care. If you have chest pain, there needs to be an ambulance that can actually come get you and take you to the hospital.”

Although the purpose of the GBD collaboration is to focus on the burden of cardiovascular disease and to support evidence-based health policy, Roth highlighted the polypill, particularly a fixed-dose combination with multiple antihypertensive medications, as a potential tool to address the burden of systolic hypertension.

“We have to start chipping away all of these barriers to individuals using medications and the therapies, taking better advantage of community health workers and telehealth to try and make sure that these interventions that we have that are effective are actually getting used,” he said.

In 2023, the World Health Organization added three polypills to its list of essential medications, meaning that these combination therapies should be “available in functioning health systems at all times, in appropriate dosage forms, of assured quality, and at prices individuals and health systems can afford.”