## CHAPTER SUMMARY AND CENTRAL ILLUSTRATION

Chapter Summary

This chapter highlights the global burden of cardiovascular disease (CVD) using comparable health metrics from the Global Burden of Disease (GBD) 2019 study. It discusses cause- and region-specific trends, from 1990 through 2019, in the major CVDs, including ischemic heart disease, stroke, abdominal aortic aneurysm, atrial fibrillation, congenital heart disease, infective endocarditis, and valvular heart disease (see Fuster and Hurst’s Central Illustration). Despite a decline in age-specific death rates, CVD prevalence and mortality have increased since 1990, to more than 18.6 million deaths in 2019, largely the result of population growth and aging. About 60% of these deaths occur in low, low-middle, and middle sociodemographic index (SDI) countries, and nearly half of the deaths are in women. Age-standardized mortality from CVD declined significantly (52.8%) in high-SDI countries; however, global CVD deaths did not change. The chapter explores modifiable and nonmodifiable risk factor trends, COVID-19, pregnancy-related cardiovascular risk factors, air pollution, mental illness, human immunodeficiency virus (HIV) infection, and social determinants of health. Modeling studies suggest that significant reductions in premature CVD are possible by 2025 if multiple risk factor targets are achieved; however, given current trends, the probability of dying prematurely from CVD is projected to remain unchanged in many of the world’s most populous regions.

## INTRODUCTION: WHAT’S NEW IN THE GLOBAL BURDEN OF CARDIOVASCULAR DISEASES?

The rich history of cardiac diseases and the development of cardiovascular medicine as a specialty highlight many of the remarkable advances made in the prevention, detection, treatment, and control of cardiovascular disease (CVD) worldwide. Despite these advances, the global burden of CVDs remains large and is increasing. For example, CVDs continue to be the leading cause of mortality and accounted for 18.6 million deaths worldwide in 2019 alone.1 They are also a major contributor to premature death, disability, health care expenditures, and lost productivity globally. CVDs contribute nearly half of the estimated $47 trillion in economic output that would be lost due to noncommunicable diseases by 2030.2 Projections for the United States alone suggest that the costs of CVD will skyrocket from$555 billion in 2016 to \$1.1 trillion by 2035.3

This chapter is aimed at health-care providers and students, public health researchers, epidemiologists, and policymakers seeking a better understanding of the field. This overview emphasizes cause-specific and region-specific trends of CVDs and related risk factors as estimated for the Global Burden of Disease 2019 (GBD 2019) study.1,4,5 The chapter begins with an overview of CVD in the context of global health and then addresses important global and regional patterns of cardiovascular mortality as well as the implications of population growth and aging. It then provides updated estimates of summary measures of health for ischemic heart disease ...

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