World Heart Day: Global burden of CVD highlights regional gaps and new preventive strategies

CVD remains the leading cause of disease burden worldwide, responsible for one in three deaths, according to the latest Global Burden of Disease (GBD) Study special report published in JACC, the flagship journal of the American College of Cardiology. 

The special report assessed 376 diseases in 204 countries between 1990 and 2023. CVD remains the leading cause of disability-adjusted life years (DALYs) and deaths globally. 

In 2023, CVDs caused 437 million DALYs, a 1.4-fold increase from 320 million in 1990, with a 16-fold difference between countries with the lowest and highest DALY rates. Deaths from CVDs rose from 13.1 million in 1990 to 19.2 million in 2023.

“This research provides countries with a clear view of where progress is being made and where urgent action is needed,” says Gregory Roth, MD, senior author of the paper and professor in the Division of Cardiology at the University of Washington.

“By targeting the most important and preventable risks, with effective policies and proven, cost-effective treatments, we can work to reduce premature mortality from non-communicable diseases. Each country can find reliable evidence and a kind of policy prescription for better cardiovascular health in our results.”

Leading causes

Leading causes of CVD-related deaths in the study included ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease. Notably, 79.6% of all CVD DALYs in 2023 were attributable to modifiable risk factors — up by 97.4 million since 1990. 

Metabolic risks such as high body mass index (BMI) and high fasting plasma glucose accounted for 67.3% of CVD DALYs, followed by behavioral (44.9%) and environmental/occupational factors (35.8%), including air pollution, lead exposure, and rising temperatures.

Role of sleep in women’s health

Alongside updated global statistical findings, new research is shedding light on emerging risk factors. 

Poor sleep during menopause significantly raises long-term heart risks, highlighting the need to treat sleep as a core factor in prevention.A new review published in Menopause tracked nearly 3,000 women over two decades, finding poor sleep during menopause significantly increased long-term heart health risks, especially when combined with hypertension and nicotine use.

Notably, only 21% of midlife women in the study achieved optimal cardiovascular health scores under the American Heart Association’s Life’s Essential 8 tool. The researchers pinpointed sleep quality as a significant predictor of heart health.

“We have long focused on diet and exercise in cardiovascular prevention, but this study shows sleep is just as critical, especially during the menopause transition,” comments Australia’s leading integrative cardiologist, Dr. Ross Walker.

The review also highlights that hormonal shifts during menopause affect fat distribution, lipid metabolism, and mitochondrial health. 

Mitochondria depend on ubiquinol for energy production and oxidative balance. Natural ubiquinol levels decline from age 20, accelerating during menopause and potentially undermining cardiovascular resilience.

“Without healthy mitochondria, our hearts simply can’t function at their optimum,” Walker explains.

“This makes supporting our mitochondrial function not just an add-on — but a vital component of preventative cardiovascular care, particularly for women in the menopause stage.”

Underfunded women’s health research

The findings of the women’s health study align with calls from the World Economic Forum to address underfunding in women’s health research. Menopause-related conditions received less than 1% of research funding between 2019 and 2023. 

Greater focus, experts argue, could deliver up to US$1 trillion in annual global GDP by 2040 while improving women’s quality of life.

National frameworks such as Australia’s National Women’s Health Strategy 2020–2030 and the UN’s Decade of Healthy Ageing (2021–2030) highlight the importance of preventive measures, including lifestyle interventions and nutritional support, to improve cardiovascular outcomes.

“We now have compelling evidence that sleep belongs at the top of the checklist for long-term heart health. Recognizing and addressing the gender gap in cardiovascular care will help ensure women enter later life with well-supported healthier hearts,” Walker underscores.