Epidemiology of cardiovascular disease

The burden of atrial fibrillation (AF) is increasing worldwide; however, most existing data on AF epidemiology are from Western regions. According to our analyses, the estimated absolute prevalence of AF in the Asia–Pacific region in 2023 was approximately 80 million, which is much higher than has been calculated for other global regions.

In this Review, Khan and colleagues explore the evolving global epidemiology of heart failure (HF), focusing on changes in incidence and prevalence across the spectrum of left ventricular ejection fraction. The authors highlight the disparities in our understanding of HF epidemiology in low-income and middle-income countries, affirming the need for improved surveillance and resource allocation in vulnerable areas and populations.

Acute coronary syndromes (ACS) are a major contributor to death from cardiovascular disease. In this Review, Timmis and colleagues present data on mortality from ACS for 122 countries and examine the regional and temporal changes in the epidemiology of ACS over the past 20 years.

Individuals with type 2 diabetes mellitus are at high risk of developing cardiovascular disease (CVD). In the context of type 2 diabetes mellitus, Wong and Sattar discuss established and novel mechanisms of CVD, risk assessment and patient stratification, and strategies to reduce multiple risk factors to prevent CVD.

The global prevalence of atrial fibrillation (AF) is increasing, largely as a result of a rise in modifiable risk factors. In this Review, Sanders and colleagues summarize the epidemiology of AF and discuss lifestyle changes and risk factor interventions for the primary and secondary prevention of AF.

In this Review, Lutsey and Zakai describe the epidemiology of venous thromboembolism, including incidence, risk factors and outcomes; summarize opportunities for primordial, primary and secondary prevention; and highlight the importance of reducing disparities in venous thromboembolism incidence and management, and opportunities to reduce them.

The mortality and birth prevalence of congenital heart disease (CHD) have shifted in the past 50 years owing to advances in diagnosis and treatment. In this Review, Marelli and colleagues discuss the effect of this shift in CHD epidemiology on outcomes and disease burden in adult patients and describe new initiatives and technology that can improve the delivery of health care.

Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. In this Review, Prendergast and colleagues discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

In this Review, Zhou and colleagues summarize the current data on the global epidemiology of blood pressure and hypertension and evaluate changes over time. They also present estimates of the mortality effects of elevated blood pressure and discuss interventions that can reduce the burden of high blood pressure.

Dyslipidaemias, particularly hypercholesterolaemia, are major risk factors for cardiovascular disease. In this Review, Catapano and colleagues summarize the latest data on plasma lipid levels and associated deaths and trends in these parameters over the past four decades in different regions of the world.

In this Review, Bossone and Eagle discuss the epidemiology, management and outcomes of the most common aortic diseases: aortic aneurysms and acute aortic syndromes, including aortic dissection.

Current estimates of the prevalence of hypertrophic, dilated and arrhythmogenic cardiomyopathies are probably conservative because of the overlapping phenotypes, incomplete and age-related expression, and variable penetrance of these conditions. In this Review, McKenna and Judge discuss the clinical and genetic diagnosis of the inherited cardiomyopathies, with the aim of better defining the epidemiology of these diseases.

Inherited arrhythmias are a major cause of sudden cardiac death, particularly among young individuals. In this Review, Offerhaus and colleagues provide an overview of the epidemiology of inherited ventricular arrhythmias, focusing on natural history, prevalence and patient demographics.

The prevalence of obesity has increased worldwide in the past ~50 years, reaching pandemic levels. Remarkable regional differences exist in obesity prevalence and trends, which might help to identify societal causes of obesity and provide guidance for the most promising intervention strategies.

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. Dunlay and colleagues summarize the epidemiological data on HFpEF, with a focus on the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, morbidity and mortality after diagnosis, and quality of life.

The epidemiology of pulmonary arterial hypertension (PAH) has evolved considerably in the past 2 decades. In this Review, Lau and colleagues describe how this evolving epidemiology has influenced the treatment and management of PAH.

The global epidemic of type 2 diabetes mellitus (T2DM) and its complications is a major threat to public health. This Review provides an updated view of the global epidemiology of T2DM and the dietary, lifestyle and other risk factors for T2DM and its complications.

Peripheral artery disease (PAD) is undergoing a major epidemiological transition, with a rapid shift from high-income to low-income and middle-income countries. In this Review, Fowkes et al. describe the measurement of PAD in populations, as well as the worldwide prevalence, risk factors, and burden of the disease.

Heart failure (HF) is a global epidemic affecting >37.7 million individuals globally. HF is associated with increased morbidity and mortality, and confers a substantial burden on the health-care system. In this Review, Ziaeian and Fonarow summarize the latest epidemiological data on HF in both developed and developing countries, and provide an overview of associated risk factors and aetiologies contributing to the disease burden.

Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.

Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a common, often-recurring condition that is occurring with increasing frequency, despite the availability of prophylactic treatments. The epidemiology of VTE involves interactions between predispositions to thrombosis and a range of risk factors, including hospitalization, cancer, and pregnancy.

Takotsubo syndrome is an acute cardiac disorder first identified in Japan in 1990. The pathophysiology of Takotsubo syndrome is complex and involves the neuroendocrine system. Cardiovascular responses are often induced by a sudden surge in sympathetic activation and subsequent catecholamine concentration. In this Review, Akashi et al. discuss the epidemiology, diagnosis, and prognosis of the syndrome, as well as some of the proposed pathophysiological mechanisms underlying its development.

The prevalence of atrial fibrillation (AF) is estimated to increase worldwide, mainly as a consequence of generalized population ageing. Even though the rise in AF prevalence is a global trend, data from Africa, Asia, and South America are limited and might underestimate the true frequency of AF. In this Review, the authors discuss the available epidemiological data on AF and highlight the widespread inadequacy of its treatment.

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that affects women in the final stages of pregnancy or shortly after birth. The underlying pathophysiology of PPCM is incompletely understood. In this Review, Hilfiker-Kleiner and Sliwa summarize the epidemiology of this condition, the current understanding of its aetiology and risk factors, and propose novel biomarkers and treatment strategies for women with PPCM.

Epidemiological studies of cardiovascular disease generally, and coronary heart disease specifically, have provided the basis for clinical trials that document the efficacy of risk-factor interventions, and are the basis of preventive cardiology. In this Review, Nathan Wong discusses the evolution of CHD epidemiology from the 1940s to the present, and examines the contributions of large population studies to the field.

The epidemiology of valvular heart disease in the industrialized world has evolved since the 1950s, with a rising prevalence of degenerative etiologies and a reduction in rheumatic heart disease (RHD). In developing countries, however, RHD remains the primary cause of valve dysfunction. Professors Iung and Vahanian discuss the epidemiology of the various manifestations of valvular heart disease in adults, together with insights from studies that reflect developments in valvular intervention.

The prevalence of coronary artery disease, and its manifestation as acute coronary syndromes (ACS), has reached a pandemic level as a consequence of modernization of the developing world. Drs. Ruff and Braunwald discuss the evolving demographics of ACS, including the impact of the introduction of troponin testing and the change in the definition of myocardial infarction. They also highlight the importance of modifiable risk factors and adherence to guideline-recommended therapy.

Abdominal aortic aneurysms (AAAs) are a localized dilatation of the aorta that represents a systemic disease process. Mortality associated with a ruptured AAA is high, but no tests to predict the risk of rupture currently exist. In this Review, Nordon and colleagues outline the pathophysiology and epidemiology of AAA and the risk factors for this condition. They also discuss factors that influence the outcome of patients with AAA after surgical management.

Thoracic aortic dissection (TAD) is the progressive separation of the layers of the thoracic aortic wall; this condition is strongly related to excessive dilatation of the aorta and is associated with very high mortality. The authors of this article present an in-depth review of the incidence, demographic distribution, and factors associated with TAD and related thoracic aortic syndromes, as well as a discussion of the challenges involved in assessing the epidemiology of these conditions.

Congenital heart disease is the most frequent of congenital disorders in newborns. Reliable epidemiological data for congenital heart disease, however, have been difficult to obtain owing to divergences in definitions, classifications, and methodologies of different studies. The authors of this Review discuss the latest changes in the epidemiology of congenital heart disease and its complications.

Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE have been identified. The diagnostic work-up for PE should comprise safe, efficient and noninvasive methods. In this Review, Renée Douma and colleagues discuss the epidemiology of PE, its risk factors and clinical presentation, together with the latest advances in the diagnostic approach to this condition.

Sudden cardiac arrest causes more than 60% of all deaths from cardiovascular disease. In this Review, Adabag and colleagues discuss trends in the incidence of sudden cardiac death (SCD), and the risk factors and triggers of this devastating event. The authors also highlight the lack of a concise definition for SCD and suggest that prospective community surveillance programs, using multiple sources to identify cases, would enable more accurate determination of SCD burden. They also review the growing evidence for the role of public-access defibrillators in improving survival after sudden cardiac arrest.

Cardiovascular diseases are the leading cause of death in Latin America and the Caribbean (LAC), precipitated by the unique milieu of population growth, rapid urbanization, socioeconomic disparities and prevalent cardiometabolic risk factors. Brant and colleagues summarize trends in cardiometabolic health in LAC and discuss tailored, innovative solutions to address the growing burden of disease in the region.

The prevalence of hypertension in China has risen steadily in the past two to three decades. In this Review, Wang and colleagues summarize the latest epidemiological data on hypertension in China, describe the risk factors for hypertension that are relevant to this population, and provide an overview of initiatives aimed at improving awareness, treatment and control of hypertension, especially in the low-resource rural setting.

In this Review, Townsend et al. describe the epidemiology of cardiovascular disease across the WHO European Region and call for improved surveillance and monitoring to inform the development and implementation of evidence-based preventive and treatment approaches.

The Framingham Heart Study (FHS) has been collecting epidemiological data on cardiovascular risk factors and disease for >70 years. In this Timeline Perspectives article, the authors summarize the major achievements of the FHS, highlight some of the seminal publications and discuss how epidemiological research has changed and continues to evolve.

Cardiovascular disease (CVD) is the leading cause of death in China. In this Review, Zhao and colleagues summarize eight important features of the evolving epidemiology of CVD in China and discuss how this information can help to develop effective and timely strategies to prevent and treat CVD.

In the past 2 decades, an increasing prevalence of risk factors for cardiovascular disease, such as obesity, physical inactivity, and diabetes mellitus, has been observed among young adults (aged 18–45 years) living in developed countries. In their Review, Andersson and Vasan discuss the evolving risk factor burden and available epidemiological data on cardiovascular disease in young adults.

Cardiovascular mortality among the almost 600 million people living in the Eastern Mediterranean region (EMR) has been proposed to increase more dramatically in the next decade than in any other region except Africa. Turk-Adawi and colleagues summarize the available data on cardiovascular disease burden, risk factors, and treatment modalities for the EMR population.

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease. In their Review, Keates et al. provide a contemporary overview of the cardiovascular risk profile of the African population by summarizing the historical pattern of cardiovascular disease in Africa.