Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019
Gregory A. Roth(University of Washington), George A. Mensah(National Heart Lung and Blood Institute), Catherine O. Johnson(University of Washington), Giovanni Addolorato(Università Cattolica del Sacro Cuore), Enrico Ammirati(Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda), Larry M. Baddour(Mayo Clinic), Noël C. Barengo(Florida International University), Andrea Beaton(Cincinnati Children's Hospital Medical Center), Emelia J. Benjamin(Boston University), Catherine P. Benziger(Essentia Health), Aimé Bonny(University of Douala), Michael Bräuer(University of British Columbia), Marianne Brodmann(Medical University of Graz), Thomas J. Cahill, Jonathan R. Carapetis(The Kids Research Institute Australia), Alberico L. Catapano(University of Milan), Sumeet S. Chugh(Cedars-Sinai Smidt Heart Institute), Leslie T. Cooper(Jacksonville College), Josef Coresh(Johns Hopkins University), Michael H Criqui(University of California San Diego), Nicole DeCleene(Ochsner Health System), Kim A. Eagle(University of Michigan), Sophia Emmons‐Bell(University of Washington), Valery L. Feigin(University of Washington), Joaquim Fernández‐Solà(Hospital Clínic de Barcelona), Gerry Fowkes(Massachusetts General Hospital), Emmanuela Gakidou(University of Washington), Scott M. Grundy(The University of Texas Southwestern Medical Center), Feng J. He(Essentia Health), George Howard(University of Alabama at Birmingham), Frank B. Hu(Harvard University), Lesley A. Inker(Tufts Medical Center), Ganesan Karthikeyan(All India Institute of Medical Sciences), Nicholas J Kassebaum(University of Washington), Walter J. Koroshetz(National Institute of Neurological Disorders and Stroke), Carl J. Lavie(Ochsner Health System), Donald M. Lloyd‐Jones(Northwestern University), Hong Lü(University of Kentucky), Antonio Mirijello(Casa Sollievo della Sofferenza), Awoke Misganaw Temesgen(University of Washington), Ali H. Mokdad(University of Washington), Andrew Moran(Columbia University Irving Medical Center), Paul Muntner(University of Alabama at Birmingham), Jagat Narula(Icahn School of Medicine at Mount Sinai), Bruce Neal(Universidade Federal do Rio de Janeiro), Mpiko Ntsekhe(University of Cape Town), Glaucia Moraes de Oliveira(Universidade Federal do Rio de Janeiro), Catherine M Otto(Essentia Health), Mayowa Owolabi(University of Ibadan), Michael Pratt(University of California San Diego), Sanjay Rajagopalan(University School), Marissa B Reitsma(Universidade Federal de Minas Gerais), Antônio Luiz Pinho Ribeiro(Universidade Federal de Minas Gerais), Nancy A. Rigotti(Massachusetts General Hospital), Anthony Rodgers(The George Institute for Global Health), Craig Sable(Children's National), Saate Shakil(University of Washington), Karen Sliwa‐Hahnle(University of Cape Town), Benjamin Stark(Boston University), Johan Sundström(Uppsala University), Patrick Timpel(Technische Universität Dresden), Imad M. Tleyjeh(King Fahd Medical City), Marco Valgimigli(University Hospital of Bern), Theo Vos(University of Washington), Paul K. Whelton(Tulane University), Magdi Yacoub(Imperial College London), Liesl Zühlke(University of Cape Town), Chris Murray(University of Washington), Valentı́n Fuster(Harvard University), Gregory A. Roth(University of Washington), George A. Mensah(National Heart Lung and Blood Institute), Catherine O. Johnson(University of Washington), Giovanni Addolorato(Università Cattolica del Sacro Cuore), Enrico Ammirati(Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda), Larry M. Baddour(Mayo Clinic), Noël C. Barengo(Florida International University), Andrea Beaton(Cincinnati Children's Hospital Medical Center), Emelia J. Benjamin(Boston University), Catherine P. Benziger(Essentia Health), Aimé Bonny(University of Douala), Michael Bräuer(University of British Columbia), Marianne Brodmann(Medical University of Graz), Thomas J. Cahill, Jonathan R. Carapetis(The Kids Research Institute Australia), Alberico L. Catapano(University of Milan), Sumeet S. Chugh(Cedars-Sinai Smidt Heart Institute), Leslie T. Cooper(Jacksonville College), Josef Coresh(Johns Hopkins University), Michael H Criqui(University of California San Diego), Nicole DeCleene(Ochsner Health System), Kim A. Eagle(University of Michigan), Sophia Emmons‐Bell(University of Washington), Valery L. Feigin(University of Washington), Joaquim Fernández‐Solà(Hospital Clínic de Barcelona), F. Gerry R. Fowkes(Massachusetts General Hospital), Emmanuela Gakidou(University of Washington), Scott M. Grundy(The University of Texas Southwestern Medical Center), Feng J. He(Essentia Health), George Howard(University of Alabama at Birmingham), Frank B. Hu(Harvard University), Lesley A. Inker(Tufts Medical Center), Ganesan Karthikeyan(All India Institute of Medical Sciences), Nicholas J Kassebaum(University of Washington), Walter J. Koroshetz(National Institute of Neurological Disorders and Stroke), Carl J. Lavie(Ochsner Health System), Donald M. Lloyd‐Jones(Northwestern University), Hong Lü(University of Kentucky), Antonio Mirijello(Casa Sollievo della Sofferenza), Awoke Temesgen Misganaw(University of Washington), Ali H. Mokdad(University of Washington), Andrew Moran(Columbia University Irving Medical Center), Paul Muntner(University of Alabama at Birmingham), Jagat Narula(Icahn School of Medicine at Mount Sinai), Bruce Neal(Universidade Federal do Rio de Janeiro), Mpiko Ntsekhe(University of Cape Town), Gláucia Maria Moraes de Oliveira, Catherine M Otto(University of Washington), Mayowa Owolabi(University of Ibadan), Michael Pratt(University of California San Diego), Sanjay Rajagopalan(University School), Marissa B Reitsma(Universidade Federal de Minas Gerais), Antônio Luiz Pinho Ribeiro(Universidade Federal de Minas Gerais), Nancy A. Rigotti(Massachusetts General Hospital), Anthony Rodgers(The George Institute for Global Health), Craig Sable(Children's National), Saate Shakil(University of Washington), Karen Sliwa, Benjamin Stark(Boston University), Johan Sundström(Uppsala University), Patrick Timpel(Technische Universität Dresden), Imad M. Tleyjeh(King Fahd Medical City), Marco Valgimigli(University Hospital of Bern), Theo Vos(University of Washington), Paul K. Whelton(Tulane University), Magdi Yacoub(Imperial College London), Liesl Zühlke(University of Cape Town), Mohsen Abbasi‐Kangevari, Alireza Abdi, Aidin Abedi, Victor Aboyans, Woldu A. Abrha, Eman Abu‐Gharbieh, Abdelrahman Ibrahim Abushouk, Dilaram Acharya, Tim Adair, Oladimeji Adebayo, Zanfina Ademi, Shailesh M Advani, Khashayar Afshari, Ashkan Afshin, Gina Agarwal, Pradyumna Agasthi, Sohail Ahmad, Sepideh Ahmadi, Muktar Beshir Ahmed, Budi Aji, Yonas Akalu, Wuraola Akande‐Sholabi, Addis Aklilu, Chisom Joyqueenet Akunna, Fares Alahdab, Ayman Al‐Eyadhy, Khalid F. AlHabib, Sheikh Mohammad Alif, Vahid Alipour, Syed Mohamed Aljunid, François Alla, Amir Almasi‐Hashiani, Sami Almustanyir, Rajaa Al‐Raddadi, A. Kofi Amegah, Saeed Amini, Arya Aminorroaya, Hubert Amu, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, Tudorel Andrei, Cătălina Liliana Andrei, Alireza Ansari‐Moghaddam, Zelalem Alamrew Anteneh, Ippazio Cosimo Antonazzo, Benny Antony, Razique Anwer, Lambert Appiah, Jalal Arabloo, Johan Ärnlöv, Kurnia Dwi Artanti, Zerihun Ataro, Marcel Ausloos, Leticia Ávila‐Burgos, Asma Awan, Mamaru Ayenew Awoke, Henok Tadesse Ayele, Muluken Altaye Ayza, Samad Azari, D. BETTEGA P. CALZOLARI S. M. DOGLIA B(University of Milan), Nafiseh Baheiraei, Atif Amin Baig, Ahad Bakhtiari, Maciej Banach, Palash Chandra Banik, Emerson Augusto Baptista, Miguel A. Barboza, Lingkan Barua, Sanjay Basu(University School), Neeraj Bedi, Yannick Béjot, Derrick Bennett, Isabela M. Benseñor, Adam E. Berman, Yihienew Mequanint Bezabih, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Ali Bijani(University of Washington), Boris Bikbov, Mulugeta Molla Birhanu, Archith Boloor, Luísa Campos Caldeira Brant, Hermann Brenner, Н. И. Брико, Zahid A Butt, Florentino Luciano Caetano dos Santos, Leah E. Cahill, Lucero Cahuana-Hurtado, Luis Alberto Cámera, Ismael Campos‐Nonato, Carlos Cantú‐Brito, Josip Car(The Kids Research Institute Australia), Juan Jesús Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Ester Cerin, Jaykaran Charan, Vijay Kumar Chattu, Simiao Chen, Ken Lee Chin, Jee-Young Jasmine Choi, Dinh‐Toi Chu(Cedars-Sinai Smidt Heart Institute), Sheng‐Chia Chung, Massimo Círillo, Sean Coffey, Sara Conti, Vera Marisa Costa, David K Cundiff, Omid Dadras, Baye Dagnew, Xiaochen Dai, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Vanessa De la Cruz‐Góngora, Fernando de la Hoz, Jan‐Walter De Neve, Edgar Denova‐Gutiérrez, Meseret Derbew Molla, Behailu Tariku Derseh, Rupak Desai, Günther Deuschl, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Raja Ram Dhungana, Mostafa Dianatinasab, Daniel Díaz, Shirin Djalalinia, Клара Докова, Abdel Douiri, Bruce Bartholow Duncan, André Rodrigues Durães, Arielle Wilder Eagan, Sanam Ebtehaj, Aziz Eftekhari, Sahar Eftekharzadeh, Michael Ekholuenetale(University of California San Diego), Nevine El Nahas, Islam Y. Elgendy, Muhammed Elhadi, Shaimaa I El-Jaafary, Sadaf Esteghamati, Atkilt Esaiyas Etisso, Oghenowede Eyawo, Ibtihal Fadhil, Emerito Jose A Faraon, Pawan Faris, Medhat Farwati, Farshad Farzadfar, Eduarda Fernandes, Carlota Fernández Prendes, Pietro Ferrara, Irina Filip, Florian Fischer, David Flood, Takeshi Fukumoto, Mohamed M. Gad, Shilpa Gaidhane, Morsaleh Ganji, Jalaj Garg, Abadi Kahsu Gebre, Birhan Gebresillassie Gebregiorgis, Kidane Z. Gebregzabiher, Gebreamlak Gebremedhn Gebremeskel, Lemma Getacher, Abera Getachew Obsa, Alireza Ghajar, Ahmad Ghashghaee, Nermin Ghith, Simona Giampaoli, Syed Amir Gilani, Paramjit Gill, Richard F Gillum, Е. В. Глушкова, E. V. Gnedovskaya, Mahaveer Golechha, Kebebe Bekele Gonfa, Amir Hossein Goudarzian, Alessandra C. Goulart, Jenny S. Guadamuz, Avirup Guha, Yuming Guo, Rajeev Gupta, Vladimir Hachinski, Nima Hafezi‐Nejad, Teklehaimanot Gereziher Haile, Randah R Hamadeh, Samer Hamidi, Graeme J. Hankey, Arief Hargono, Risky Kusuma Hartono, Maryam Hashemian, Abdiwahab Hashi, Shoaib Hassan, Hamid Yimam Hassen, Rasmus Havmoeller, Simon I Hay, Khezar Hayat, Golnaz Heidari, Claudiu Herţeliu, Ramesh Holla, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Ayesha Humayun, Ivo Iavicoli, Charles Ibeneme, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena Ilić, Milena Ilić, Usman Iqbal, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Rakibul M. Islam, Hiroyasu Iso, Masao Iwagami, Vardhmaan Jain, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Ranil Jayawardena, Panniyammakal Jeemon, Ravi Prakash Jha, Jost B. Jonas, Jitendra Jonnagaddala, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir(University of Washington), Tanvir Kahlon, Rizwan Kalani, Rohollah Kalhor, Ashwin Kamath, Ibrahim Kamel, Himal Kandel, Amit Kandel, André Karch(Cincinnati Children's Hospital Medical Center), Ayele Semachew Kasa, Patrick DMC Katoto, Gbenga A Kayode, Yousef Khader, Mohammad Khammarnia, Muhammad Khan, Md Nuruzzaman Khan, Maseer Khan, Ejaz Ahmad Khan, Khaled Khatab, Gulam Muhammed Al Kibria, Yun Jin Kim(University of Michigan), Gyu Ri Kim(University of Michigan), Ruth W Kimokoti, Sezer Kısa, Adnan Kısa, Mika Kivimäki, Dhaval Kolte, Ali Koolivand(University of Washington), Vladimir Andreevich Korshunov, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi(University of Douala), Kewal Krishan, Vijay Krishnamoorthy, Barthélémy Kuate Defo, Burcu Küçük Biçer, Vaman Kulkarni, G Anil Kumar, Nithin Kumar, Om Kurmi, Dian Kusuma, Gene F. Kwan, Carlo La Vecchia, Ben Lacey(Essentia Health), Tea Lallukka, Qing Lan(University School), Savita Lasrado, Zohra S Lassi, Paolo Lauriola, Wayne R. Lawrence, Avula Laxmaiah, Kate E LeGrand, Ming‐Chieh Li(Jacksonville College), Bingyu Li(Jacksonville College), Shanshan Li(Jacksonville College), Stephen S Lim(University of Washington), Lee‐Ling Lim(University of Washington), Hualiang Lin, Ziqiang Lin, Ro‐Ting Lin, Xuefeng Liu, Alan D Lopez, Stefan Lorkowski, Paulo A. Lotufo, Alessandra Lugo, Nirmal K. M(University of California San Diego), Fabiana Madotto, Morteza Mahmoudi, Azeem Majeed, Reza Malekzadeh, Ahmad Azam Malik, Abdullah Al Mamun, Navid Manafi, Mohammad Alì Mansournia, LG Mantovani, Santi Martini, Manu Raj Mathur, Giampiero Mazzaglia, Suresh Mehata, Man Mohan Mehndiratta, Toni Meier, Ritesh G. Menezes, Atte Meretoja, Tomislav Meštrović, Bartosz Miazgowski, Tomasz Miazgowski, Irmina Maria Michałek, Ted R. Miller, Erkin М Мirrakhimov, Hamed Mirzaei, Babak Moazen, Masoud Moghadaszadeh, Yousef Mohammad, Dara K. Mohammad, Shafiu Mohammed, Mohammed A. Mohammed, Yaser Mokhayeri, Mariam Molokhia, Ahmed Al Montasir, Ghobad Moradi, Rahmatollah Moradzadeh, Paula Moraga, Lídia Morawska, Ilais Moreno Velásquez, Jakub Morze, Sumaira Mubarik, Walter Muruet-Gutierrez(National Institute of Neurological Disorders and Stroke), Kamarul Imran Musa, Ahamarshan Jayaraman Nagarajan, Mahdi Nalini, Vinay Nangia, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Bruno Ramos Nascimento, Vinod C Nayak, Javad Nazari, Milad Nazarzadeh, Ruxandra Irina Negoi, Sandhya Neupane Kandel, Huong Lan Thi Nguyen, Molly R Nixon, Bo Norrving(University of Douala), Jean Jacques Noubiap, Brice Nouthé, Christoph Nowak(University of Washington), Oluwakemi Ololade Odukoya, Felix Akpojene Ogbo, Andrew T Olagunju, Hans Orru, Alberto Ortíz, Samuel M Ostroff, Jagadish Rao Padubidri, Raffaele Palladino, Adrian Pană, Songhomitra Panda‐Jonas, Utsav Parekh, Eun‐Cheol Park, Mojtaba Parvizi, Fatemeh Pashazadeh Kan, Urvish Patel, Mona Pathak, Rajan Paudel, Veincent Christian Filipino Pepito, Arokiasamy Perianayagam, Norberto Perico, Hai Quang Pham, Thomas Pilgrim, М. А. Пирадов(University of California San Diego), Farhad Pishgar, Vivek Podder, Р. В. Полибин, Akram Pourshams, Dimas Ria Angga Pribadi, Navid Rabiee, Mohammad Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Vafa Rahimi‐Movaghar, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Ivo Rakovac, Pradhum Ram, Sudha Ramalingam, Juwel Rana, Priyanga Ranasinghe, Sowmya J Rao, Priya Rathi, Lal Rawal, Wasiq Faraz Rawasia, Reza Rawassizadeh, Giuseppe Remuzzi, André M. N. Renzaho, Aziz Rezapour, Seyed Mohammad Riahi, Ross Roberts-Thomson, Leonardo Roever, Peter Rohloff, Michele Romoli, Gholamreza Roshandel, Godfrey Mutashambara Rwegerera, Seyedmohammad Saadatagah, Maha Saber-Ayad, Siamak Sabour, Simona Sacco, Masoumeh Sadeghi, Sahar Saeedi Moghaddam, Saeed Safari, Amirhossein Sahebkar, Sana Salehi, Hamideh Salimzadeh, Mehrnoosh Samaei, Abdallah M Samy, Itamar S Santos, Milena M Santric-Milicevic, Nizal Sarrafzadegan, Arash Sarveazad, Thirunavukkarasu Sathish, Monika Sawhney, Mete Şaylan, María Inês Schmidt, Aletta E. Schutte, Subramanian Senthilkumaran, Sadaf G Sepanlou, Feng Sha(University of Washington), Saeed Shahabi, Izza Shahid, Masood Ali Shaikh, Mahdi Shamali, Morteza Shamsizadeh, Md Shajedur Rahman Shawon, Aziz Sheikh, Mika Shigematsu, Min‐Jeong Shin, Jae Il Shin, Rahman Shiri, Ivy Shiue, Kerem Shuval, Soraya Siabani, Tariq Jamal Siddiqi, Diego Augusto Santos Silva, Jasvinder A. Singh, Ambrish Singh Mtech, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Amin Soheili(Boston University), Emma Elizabeth Spurlock, Leo Stockfelt, Stefan Stortecky, Saverio Stranges, Rizwan Suliankatchi Abdulkader, Hooman Tadbiri, Eyayou Girma Tadesse, Degena Bahrey Tadesse, Masih Tajdini, Md. Tariqujjaman, Berhane Fseha Teklehaimanot, Mohamad‐Hani Temsah, Ayenew Kassie, Bhaskar Thakur, Kavumpurathu R. Thankappan, Rekha Thapar, Amanda G. Thrift, Binod Timalsina, Marcello Tonelli, Mathilde Touvier, Marcos Roberto Tovani‐Palone, Avnish Tripathi, Jaya Prasad Tripathy, Thomas Clement Truelsen, Guesh M. Tsegay, Gebiyaw Wudie Tsegaye, Nikolaos Tsilimparis, Biruk Shalmeno Tusa, Stefanos Tyrovolas, Krishna Kishore Umapathi, Brigid Unim, Bhaskaran Unnikrishnan, Muhammad Usman, Muthiah Vaduganathan, Pascual Valdéz, Tommi Vasankari, Diana Zuleika Velazquez, Narayanaswamy Venketasubramanian, Giang Thu Vu, Isidora S Vujcic, Yasir Waheed, Yanzhong Wang, Fang Wang, Jingkai Wei, Robert G Weintraub, Abrha H. Weldemariam, Ronny Westerman, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles Wolfe, Befikadu Legesse Wubishet, Gelin Xu, Ali Yadollahpour(University of Washington), Kazumasa Yamagishi, Lijing L. Yan(All India Institute of Medical Sciences), Srikanth Yandrapalli, Yuichiro Yano, Hiroshi Yatsuya, Tomas Yeheyis, Yigizie Yeshaw, Christopher Sabo Yilgwan, Naohiro Yonemoto, Chuanhua Yu, Hasan Yusefzadeh, Geevar Zachariah, Sojib Bin Zaman, Muhammed Shahriar Zaman, Maryam Zamanian, Ramin Zand, Alireza Zandifar, Afshin Zarghi, Михаил Сергеевич Застрожин, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Yunquan Zhang, Wangjian Zhang, Chenwen Zhong, Zhiyong Zou, Yves Miel H Zuñiga, Christopher J L Murray(University of Washington), Valentı́n Fuster(Harvard University)
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Abstract
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.
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