Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100053, China.
Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian 364000, China.
Chin Med J (Engl). 2023 Oct 20;136(20):2442-2450. doi: 10.1097/CM9.0000000000002839. Epub 2023 Sep 5.
Atherosclerosis-related diseases represent significant health issues among adults globally. Despite their widespread impact, comprehensive data concerning the global and national burden and trends of these diseases remain sparse. Our objective is to examine the trends in the burden of atherosclerosis among adults from 1990 to 2019 at both global and national levels.
We reported the average annual percentage changes (AAPCs) in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of atherosclerosis-related diseases (ischemic heart disease [IHD], ischemic stroke, and peripheral arterial disease [PAD]) at the global and national levels among individuals based on a trend analysis of the Global Burden of Diseases Study (GBD) 2019. We further analyzed these global trends as a function of age, gender, and the social development index. We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends.
Globally, the AAPC of IHD incidence rose from 1990 to 2019 (0.20; 95% confidence interval [CI], 0.12-0.28), with substantial surges in 1995, 2001, 2005, 2010, and 2017. Conversely, AAPC of IHD mortality rates exhibited a different trend until a rise in 2014. The AAPC of incidence rates of ischemic stroke and PAD also escalated during the same period, with respective 0.43 (95% CI, 0.39-0.48) and 0.13 (95% CI, 0.06-0.21). For ischemic stroke, both incidence and mortality soared in 2014, while PAD incidence declined in 1994 and 1998, then sharply climbed in 2016. Nationally, the Northern Mariana Islands experienced the steepest increase in IHD and PAD incidence and mortality between 1990 and 2019. China saw a significant rise in ischemic stroke incidence, whereas the highest mortality rate increase occurred in Timor-Leste. By sociodemographic index (SDI) quintile, low-middle-, middle-, and high-middle-SDI countries all showed upward trends in IHD, ischemic stroke, and PAD incidence. Simultaneously, IHD and ischemic stroke mortality rates, as well as DALYs, dropped in the low-, high-middle-, and high-SDI nations. However, PAD mortality rates and DALYs saw an uptick across all SDI quintiles. Regarding age demographics, a global decrease in the AAPC IHD incidence as noted in individuals above 55 years old, in contrast to an increase in the 20-55 age group during this period. AAPC of mortality rates for IHD, ischemic stroke, and PAD decreased across all ages. The AAPC showed an increase in IHD incidence in both genders. Conversely, IHD's DALYs saw a reduction in both males and females. Ischemic stroke patterns mirrored these trends, whereas all measures for PAD exhibited growth for both sexes.
From 1990 to 2019, there was an overall increasing trend in the global incidence of all three clinical manifestations of atherosclerosis. Between 1990 and 2019, both the mortality rate and DALYs for IHD and ischemic stroke declined across all age groups. Overall, the burden of atherosclerosis-related diseases has not significantly decreased and even shows signs of trending upward. These findings strongly suggest that despite some progress made, efforts to control atherosclerosis diseases globally need to be intensified.
动脉粥样硬化相关疾病是全球成年人面临的重大健康问题。尽管这些疾病的影响广泛，但关于它们在全球和国家层面的负担和趋势的全面数据仍然很少。我们的目的是研究 1990 年至 2019 年期间全球和国家层面成年人动脉粥样硬化负担的趋势。
我们根据 2019 年全球疾病负担研究（GBD）的趋势分析，报告了基于个体的动脉粥样硬化相关疾病（缺血性心脏病[IHD]、缺血性卒中和外周动脉疾病[PAD]）的患病率、发病率、死亡率和残疾调整生命年（DALYs）的全球和国家层面的平均年百分比变化（AAPC）。我们进一步分析了这些全球趋势，包括年龄、性别和社会发展指数。我们还使用联合点回归分析确定了全球趋势变化最大的年份。
全球范围内，IHD 发病率的 AAPC 从 1990 年上升至 2019 年（0.20；95%置信区间[CI]，0.12-0.28），1995 年、2001 年、2005 年、2010 年和 2017 年有明显上升。相反，IHD 死亡率的 AAPC 趋势在 2014 年之前有所下降。同期，缺血性卒中和 PAD 的发病率也呈上升趋势，分别为 0.43（95%CI，0.39-0.48）和 0.13（95%CI，0.06-0.21）。对于缺血性卒，发病率和死亡率在 2014 年都飙升，而 PAD 的发病率在 1994 年和 1998 年下降，然后在 2016 年急剧上升。在国家层面，北马里亚纳群岛在 1990 年至 2019 年期间经历了 IHD 和 PAD 发病率和死亡率的最大增长。中国缺血性卒的发病率显著上升，而东帝汶的死亡率上升幅度最大。按社会发展指数（SDI）五分位数，中低、中、高-中 SDI 国家的 IHD、缺血性卒和 PAD 的发病率都呈上升趋势。同时，IHD 和缺血性卒的死亡率以及 DALYs 在低、高-中、高 SDI 国家下降。然而，所有 SDI 五分位数的 PAD 死亡率和 DALYs 都有所上升。在年龄方面，55 岁以上人群的 IHD 发病率 AAPC 呈全球下降趋势，而在此期间 20-55 岁年龄组的发病率则呈上升趋势。IHD、缺血性卒和 PAD 的死亡率的 AAPC 呈全球下降趋势。IHD 的发病率在所有性别中都呈上升趋势。相反，IHD 的 DALYs 在男性和女性中都有所减少。缺血性卒的模式与之相似，而 PAD 的所有措施在男女中均呈现增长。
从 1990 年到 2019 年，全球所有三种动脉粥样硬化临床表现的发病率呈总体上升趋势。1990 年至 2019 年期间，所有年龄组的 IHD 和缺血性卒的死亡率和 DALYs 均有所下降。总的来说，动脉粥样硬化相关疾病的负担并没有显著减少，甚至有上升的趋势。这些发现强烈表明，尽管取得了一些进展，但仍需要加强全球控制动脉粥样硬化疾病的努力。
