Global Burden of Ischemic Cardio-Cerebrovascular Disease among Women from 1990 to 2021, with Projections to 2050

Objective: The global burden, secular trends, and future projections of ischemic cardio-cerebrovascular disease (ICCVD), a composite indicator of ischemic heart disease (IHD) and ischemic stroke (IS), have not been specifically described in women. This study was aimed at estimating the global ICCVD burden from 1990 to 2021, and the projected burden from 2022 to 2050, in women. Methods: Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) with 95% uncertainty intervals (UI), and corresponding average annual percentage change (AAPC) with 95% confidence intervals (CI) and associated P-values, were calculated for women at global, regional, and national levels according to data from Global Burden of Disease 2021. Age-specific patterns, DALYs attributable to risk factors, and DALY projections to 2050 were also examined. Results: In women, the global age-standardized prevalence of ICCVD increased from 3063 (95% UI: 2786 to 3339) per 100,000 population in 1990 to 3127 (2778 to 3476) per 100,000 population in 2021, and the AAPC was 0.03% (95% CI: 0.02% to 0.05%), whereas the incidence, mortality, and DALYs decreased (all P < 0.001). Notably, the age-standardized ICCVD incidence among women resurged in the past decade (0.29%), following a decline from 1990 to 2011 (−0.66%), whereas men experienced a consistent decline between 1990 and 2021. Low-middle Sociodemographic Index (SDI) countries consistently exhibited the highest age-standardized ICCVD incidence among women from 1990 to 2021, whereas only middle SDI countries demonstrated an increasing trend in age-standardized incidence over this period. Age-specific incidence rates increased among people younger than 60 years (0.14%) but decreased among people older than 60 years (−0.55%). High systolic blood pressure remained the leading risk factor for ICCVD in women, whereas high temperatures exhibited the most rapid relative increase in associated DALYs. DALYs for ICCVD in women are projected to continue declining through 2050, but the fatal burden will remain substantial, accounting for 87.4% of the total burden in 2050. Conclusions: ICCVD has posed a severe burden on women, largely driven by a notable resurgence in its incidence and prevalence over the past decade, alongside a pronounced increase in early-onset cases. Despite the projected decreasing trend in DALYs by 2050, the fatal burden is expected to remain the leading health threat. Our findings highlight the urgent need for public health strategies focusing on risk factor management and effective treatment to mitigate the ICCVD burden among women.