New research is shedding light on the significant and growing global public health burden posed by
Despite global declines in age-standardized ASCVD incidence and mortality rates, the absolute number of cases and deaths among the working-age population continues to increase. Findings suggest the need for region-specific and precision-based interventions according to SDI level, with emphasis on health education, risk factor management, and early screening.1
ASCVD involves plaque buildup in artery walls, which includes conditions such as acute coronary syndrome and peripheral artery disease, and can cause a heart attack, stable or unstable angina, stroke, transient ischemic attack, or aortic aneurysm. According to the American Heart Association, ASCVD- related conditions remain the leading cause of morbidity and mortality globally.2,3
“To date, most estimates of the CVD burden have focused on the total population at the global, regional, and national levels, with limited attention paid to the burden of ASCVD among working-age populations—who are key contributors to both households and society at large,” Yang-Guang Yin, of Nanjing Medical University in China, and colleagues wrote.1
To address gaps in research related to the burden of ASCVD among this population, investigators derived health burden estimates from the Global Burden of Disease 2021 dataset for annual data on ischemic heart disease (IHD), ischemic stroke (IS), and peripheral artery disease (PAD).1
In the present analysis, investigators defined the working-age population as individuals aged 15–64 years according to standard demographic classifications. Of note, PAD data provided by the GBD 2021 database are only available for individuals ≥ 40 years of age. For analytical consistency, investigators assumed PAD incidence and burden in the 15–39-year age group to be 0, as no data were available.1
Based on SDI values in GBD 2021, countries were grouped into 5 development levels: low (<0.47), low-middle (0.47–0.62), middle (0.62–0.71), high-middle (0.71–0.81), and high (>0.81).1
Study results showed that while age-standardized incidence and mortality rates of IHD, IS, and PAD have declined in many parts of the world, particularly in high-SDI regions, the absolute number of new cases and deaths continues to rise globally, with the greatest increases seen in low- and middle-SDI regions. Age effects showed that risk of both incidence and mortality climbed steeply with advancing age across all ASCVD subtypes, with a sharper increase in lower-SDI settings.1
Period effects revealed improvements in IHD and IS outcomes in high- and high-middle-SDI regions, likely reflecting advances in prevention and treatment, while less favorable or worsening trends were observed in low- and low-middle-SDI regions, particularly for PAD, where incidence and mortality have been increasing.1
Cohort analysis suggests more recent generations in high- and high-middle-SDI regions have experienced lower risks of ASCVD, especially for IHD and IS, indicating generational improvements in risk factor control. However, in lower-SDI regions, investigators noted cohort effects were weaker, stagnant, or in some cases worsening, suggesting younger populations in these settings are not benefiting equally from global progress.1
“This study underscores that although significant progress has been made in reducing the incidence and mortality of ASCVD among the working-age population at both global and SDI-region levels, the disease remains a critical public health threat,” investigators concluded.1 “The findings suggest that context-specific, accessible healthcare strategies should be formulated based on the socio-economic and healthcare resource profiles of different SDI regions. Furthermore, to curb the ongoing epidemic of ASCVD, multisectoral collaboration is urgently needed to promote cross-sector public health interventions and coordinated resource integration, ultimately improving cardiovascular health among the global working-age population.”
References
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Yan Y, Xie J, Wu H, Tang Y-G, Yin Y-G. The burden of atherosclerotic cardiovascular disease among working-age people across SDI regions: an age–period–cohort study based on the GBD 2021. Front. Cardiovasc. Med. 12:1609672.
doi:10.3389/fcvm.2025.1609672 -
American Heart Association. Atherosclerotic Cardiovascular Disease (ASCVD). Accessed September 23, 2025.
https://www.heart.org/en/professional/quality-improvement/ascvd -
American Heart Association. What is Atherosclerosis? Accessed September 23, 2025.
https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis