Diabetol Metab Syndr. 2026 Sep 12;18(1):204. doi: 10.1186/s13098-026-02236-7.
ABSTRACT
AIMS: This study aims to analyze the global burden of atherosclerotic cardiovascular disease (ASCVD) attributable to high low-density lipoprotein cholesterol (LDL-c), high body mass index (BMI), or high fasting plasma glucose (FPG) in young and middle-aged adults (15-49 years) from 1990 to 2021, with projections extending to 2050.
METHODS: Leveraging data from the Global Burden of Disease (GBD) 2021 study, we concentrated on ASCVD burden attributable to three risk factors in young and middle-aged adults. We scrutinized crude death rates, number of deaths, and estimated annual percentage changes (EAPCs) across sexes, countries, regions, and socio-demographic index (SDI) categories. To forecast future trends, we employed the Bayesian age-period-cohort (BAPC) model. Locally weighted scatterplot smoothing (LOESS) regression (span = 0.5) was used to visualize associations between crude death rates and SDI levels across 21 GBD regions and 204 countries.
RESULTS: The ASCVD burden attributable to three risk factors in young and middle-aged adults followed broadly similar epidemiological patterns. In 2021, ischemic heart disease (IHD) burden attributable to three risk factors substantially exceeded ischemic stroke (IS) and lower extremity peripheral artery disease (LEPAD), and men exhibited consistently a higher burden than women. From 1990 to 2021, global trends in crude death rates for ASCVD attributable to three risk factors in young and middle-aged adults remained relatively stable. Significant regional and national variation was observed. At regional SDI levels, crude death rates for IHD showed an inverted M-shaped pattern (peaks at SDI 0.45 and 0.70), while IS and LEPAD demonstrated inverted L-shaped patterns (plateauing at SDI 0.70-0.76). Across 204 countries in 2021, crude death rates from ASCVD attributable to three risk factors increased gradually below SDI 0.60, showed a slight U-shape between 0.60-0.75, and declined sharply above 0.75. Projections indicate that ASCVD attributable to three risk factors will increase to varying degrees in young and middle-aged adults by 2050.
CONCLUSION: The burden of ASCVD attributable to three risk factors in young and middle-aged adults calls for concerted and integrated management strategies. Urgent public health measures targeting these risk factors are needed to mitigate the projected rise in ASCVD burden.
PMID:42745273 | DOI:10.1186/s13098-026-02236-7