Burden of cardiovascular disease in Brazil, 1996–2023: a retrospective descriptive study of the epidemiology and impact on public healthcare

Background Cardiovascular diseases (CVD) are the leading cause of death worldwide, and their epidemiology is correlated with genetic predisposition and exposure to risk. Brazil is a developing country with a vast territory, which leads to structural inequalities. We aimed to comprehensively characterise the epidemiology and burden of CVD in Brazil between 1996 and 2023, examining temporal trends, regional disparities, demographic patterns, healthcare costs, and heart transplantation. Methods We conducted a nationwide retrospective descriptive ecological study using aggregated administrative data from the Brazilian Unified Health System (SUS), Brazil's publicly funded national health system. Mortality, hospitalization, and heart transplantation data from 1996 to 2023 were analysed according to sex, race/ethnicity, age, and geographic region. We estimated mortality rates for the major CVD, hospital length of stay, healthcare expenditures, and heart transplantation activity. Findings Acute myocardial infarction remained the leading cause of cardiovascular mortality throughout the study period, while hypertensive diseases overtook heart failure after 2016 as the second leading cause of death. The overall CVD mortality rate—calculated as the number of CVD-related deaths divided by the total population and expressed as a percentage—increased from 7.3% in 1998 to 8.3% in 2023, peaking at 10.1% in 2021. Marked regional, age-, sex-, and race/ethnicity-related disparities were observed, including the complete absence of heart transplantation in the North region throughout the study period. Although hospitalization rates remained relatively stable, CVD-related healthcare expenditures and heart transplantation activity increased over time. Interpretation CVD remains a major and growing public health challenge in Brazil, with substantial regional and demographic inequalities in disease burden and access to specialised care. These findings highlight the need for targeted public health strategies and more equitable allocation of healthcare resources to reduce cardiovascular morbidity and mortality. Funding This study was funded by CNPq, CAPES, FAPEMIG, INCT.