Global Health Metrics Cardiovascular diseases—Level 2 cause Summary Cardiovascular diseases were responsible for 393 million (95% UI 368^-17) DALYs in 2019, and were the leading Level 2 cause of disease burden. Overall, there were 18 ■ 6 million (17 ■ 1-19 ■ 7) deaths due to cardiovascular diseases in both sexes combined in 2019. Definition This aggregate cause incorporates death and disability resulting from 11 cardiovascular causes, led by ischaemic heart disease, stroke, and hypertensive heart disease, as well as disability due to heart failure. Both atherosclerotic and non-atherosclerotic cardiovascular diseases are included. What is new in GBD 2019? • Non-fatal data have been updated for a subset of causes including ischaemic heart disease and heart failure. • In order to better represent population-level disease prevalence, new adjustments were developed and applied to administrative health facility data for causes that are subcategories of cardiovascular disease. • Adjustment for alternative study methods and case definitions were applied to data before analysis in DisMod-MR. These adjustments varied by cause and case definition and were implemented using our MR-BRT modelling tool. Prevalence Incidence Deaths YLLs YLDs DALYs Cases Rate (per Cases Rate (per Deaths Rate(per Counts Rate(per Counts Rate (per Counts Rate (per (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) (millions) 100000) 2019 Both sexes 523 6431-6 55-5 684-3 18-6 239-8 359 4438-7 34-4 424-9 393 4863-6 (497 to (6110-0 to (52-3 to (646-4 to (17-1 to (219-4 to (335 to (4139-9 to (24-9 to (308-3 to (368 to (4548-7to 550) 6759-8) 58-9) 725-6) 19-7) 254-9) 380) 4704-7) 43-6) 538-9) 417) 5164-2) Females 275 6402-6 27-6 642-7 8-94 204-0 152 3508-3 18-9 440-2 171 3948-5 (261 to (6078-9 to (26-1 to (607-2 to (7-92 to (180-9 to (13 8 to (3l83-7to (13-8 to (320-3 to (156 to (3616-6 to 290) 6740-0) 29-3) 680-1) 9-71) 221-5) 165) 3796-5) 23-8) 555-2) 184) 4248-6) Males 248 6471-7 27-8 729-8 9-63 280-8 207 5443-9 15-5 407-4 222 5851-3 (235 to (6l36-7to (26-2 to (687-7 to (8-90 to (259-2 to (191 to (5042-5 to (11-2 to (296-2 to (206 to (5448-2 to 261) 6814-4) 29-6) 774-5) 10-3) 299-8) 222) 5831-0) 19-8) 521-3) 237) 6247-7) Percentage change 2010- 19 Both sexes 26-6% 0-6% 24-6% -1-6% 17-1% -11-1% 11-2% -12-2% 27-6% 1-6% 12-5% -11-2% (26-0 to (0-3 to (23-7 to (-2-1 to (11-4 to (-15-3 to (5-1 to (-16-8 to (26-3 to (0-8 to (6-8 to (-15-6 to 27-1) 1-0) 25-5) -1-0) 22-9) -7-0) 17-3) -7-5) 29-0) 2-5) 18-1) -6-8) Females 26-4% 1-0% 25-0% -1-1% 17-6% -11-2% 12-1% -12-1% 27-9% 2-3% 13-6% -10-7% (25-9 to (0-5 to (24-0 to (-1-7 to (9-9 to (-16-8 to (4-0 to (-18-3 to (26-5 to (1-3 to (6-1 to (-16-4 to 27-0) 1-4) 26-0) -0-5) 25-5) -5-4) 20-4) -5-7) 29-4) 3-3) 21-0) -4-9) Males 26-7% 0-2% 24-2% -2-0% 16-7% -11-1% 10-6% -12-3% 27-2% 0-9% 11-6% -11-5% (26-1 to (-0-1 to (23-3 to (-2-6 to (9-0 to (-16-5 to (2-8 to (-18-4 to (25-8 to (0-0 to (4-2 to (-17-2 to 27-4) 0-6) 25-2) -1-3) 24-1) -5-8) 18-1) -6-5) 28-7) 1-9) 18-7) -6-0) Total sources Incidence 599 Prevalence 646 Remission 0 Causes of death 3901 Other 361 Table 1:Total sources used in GBD 2019 estimation Numbers in parentheses are 95% uncertainty intervals. Table 2: Global prevalence, incidence, deaths, YLLs, YLDs, and DALYs in counts and age-standardised rates for both sexes combined, females, and males, 2019, with percentage change between 2010 and 2019 Deaths YLLs YLDs DALYs 1990 1st 3rd 11th 3rd 2010 1st 1st 11th 1st 2019 1st 1st 10th 1st Table3'- Rank among Level 2 causes for global deaths, YLLs, YLDs, and DALYs in 1990,2010, and 2019, for both sexes combined □ Rheumatic heart disease □ Ischaemic heart disease ■ Stroke □ Hypertensive heart disease □ Cardiomyopathy and myocarditis □ Atrial fibrillation and flutter CH Other cardiovascular and ci rculatory diseases I I Other causes Figure 1: Composition of DALYs by constituent Level 3 causes for both sexes combined, 2019 S86 www.thelancet.com Vol 396 October 17,2020 Global Health Metrics High systolic blood pressure High LDL cholesterol High body-mass index High fasting plasma glucose Smoking Ambient particulate matter pollution Diet high in sodium Diet low in whole grains Kidney dysfunction Household air pollution from solid fuels 20 30 40 Percentage 50 60 Figure 2: Percentage of DALYs attributable to top risk factors for both sexes combined, 2019 GBD super-region ■ High income # Central Europe, eastern Europe, and central Asia ♦ South Asia • Southeast Asia, east Asia, and Oceania • Sub-Saharan Africa A Latin America and Caribbean T North Africa and Middle East 25 000 -20 000 -15 000 -10 000 -5000 - Females Males □ YLDs HYLDs ■ YLLs CHylls 50 000 -i 40 000 -\ 30 000 S 20 000 A „tC- c> c> & c> c> c> c> & c> c> c> c> c> & c> c> c> c> & c> Age group Figure 3: Age-standardised DALY rates for each location by SDI, both sexes combined, 2019 Figure 4- Composition of DALYs by YLLs and YLDs, age group, and sex, 2019 Figure 5'- Age-standardised DALY rates (per 100 000) by location, both sexes combined, 2019 www.thelancet.com Vol 396 October 17,2020 S87