The global cardiovascular-kidney-liver-metabolic burden from 1990 to 2023
Abstract
Background The cardiovascular-kidney-liver-metabolic (CKLM) framework represents the multi-organ interplay of systemic metabolic disorders that drive the global burden of cardiovascular diseases (CVD). Methods This study is a descriptive epidemiological analysis of the Global Burden of Disease Study 2023 that examines the trends in mortality and disability-adjusted life years (DALYs) associated with atherosclerotic CVD, chronic kidney disease (CKD), type 2 diabetes (T2D), obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), from 1990 to 2023, across 204 countries and territories. Epidemiological trends were stratified by age, sex, region, and sociodemographic index (SDI). Findings In 2023, the global CKLM burden contributed to 626.7 million DALYs, with an age-standardized DALY rate of 6944.3 per 100,000 population. Atherosclerotic CVD was the largest contributor to the CKLM burden (3924.2 [95% Uncertainty Interval {UI}: 3666.9–4181.4]), followed by obesity (1500.0 [95% UI: 730.4–2206.5]), T2D (956.7 [95% UI: 794.4–1142.4]), CKD (523.8 [95% UI: 468.0–590.1]), and MASLD (39.6 [95% UI: 31.2–49.9]). From 1990 to 2023, CKLM-related age-standardized DALYs fell 24.4%, primarily driven by improvements in atherosclerotic CVD (41.5% decrease), while rapid increases were seen in T2D (37.5% increase) and obesity (23.3% increase). Disparities in CKLM burden exist across SDI, geography, and age-sex categories. Interpretation Improvements in the global CKLM burden, driven by gains in CVD prevention, are offset by the rising burden of upstream CKLM drivers including obesity, T2D, CKD and MASLD. Population-focused strategies for prevention need to target shared risk factors driving the CKLM syndemic to achieve the greatest reduction in overall morbidity and mortality. Funding This research was supported by the NMRC Research Transition Award and the CSDU Clinician-Scientist Grant.
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Authors: Jayanth Jayabaskaran, Haryo Raden Himan, Srinithy Nagarajan, Bryan Chong, Yiming Chen, Ernest En-Rae Tan, Carel W. le Roux, Muhammad Shahzeb Khan, Anurag Mehta, Mark D. Muthiah, Jiong‐Wei Wang, Xiaodong Zhou, Ming‐Hua Zheng, Lijing L. Yan, A Mark Richards, Mamas A. Mamas, D. Hausenloy, Gregory Lip, Mark Y. Chan, Arun J. Sanyal, George A. Mensah, Laurence S. Sperling, Nicholas Chew
Institutions: Peking University, University of Liverpool, Emory University, Baylor Medical Center at Garland, Duke University, University College London, University of Otago, National University of Singapore, National University Health System, Virginia Commonwealth University, Wuhan University, Wenzhou Medical University, Liverpool John Moores University, University College Dublin, Baylor College of Medicine, National Institutes of Health, Duke-NUS Medical School, First Affiliated Hospital of Wenzhou Medical University, Duke Institute for Health Innovation, Aalborg University, Keele University, National University Hospital, National Heart Centre Singapore, Heart Hospital Baylor Plano, Liverpool Heart and Chest Hospital, National Heart Lung and Blood Institute, Duke Kunshan University, Emory Clinic, National University Heart Centre Singapore, George Institute for Global Health