Thirty-three-year trends in ischemic heart and cerebrovascular mortality among brazilian women: age-specific patterns and regional inequalities

Background Cardiovascular disease (CVD) remains the leading cause of death among women in Brazil. Although age-standardized mortality has declined over recent decades, concerns persist regarding premature mortality and regional disparities, particularly for ischemic heart disease (IHD). Purpose Evaluate long-term trends in mortality from IHD and cerebrovascular diseases (CBVDs) among Brazilian women from 1990 to 2023, with emphasis on premature mortality in reproductive age (10–49 years) and geographic heterogeneity. Methods Nationwide ecological time-series study using data from the Brazilian Mortality Information System from 1990 to 2023. Deaths were classified according to ICD-9/10 codes. Age-standardized mortality rates (per 100,000 women) were calculated using the direct method, adopting the 2022 Brazilian population as standard. Trends were estimated using log-linear regression and expressed as annual percent change (APC) with 95% confidence intervals (CI). Analyses included proportional mortality, rate ratios (≥50/<50 years), and absolute deaths. Data from Brazilian Federative Units (FUs) were used to calculate region-standardized mortality rates by geographic region. Results From 1990 to 2023, age-standardized mortality declined among women for both IHD (−46%; 81.9 to 44.3 per 100,000) and CBVDs (−56%; 106.9 to 47.3 per 100,000). Among women < 50 years, the reduction was markedly greater for CBVDs than for IHD. CBVDs mortality declined by 65% (12.6 to 4.4 per 100,000; APC −3.58%, 95%CI −3.76 to −3.41), whereas IHD decreased by 38% (5.9 to 3.7 per 100,000; APC −1.53%, 95%CI −1.71 to −1.35; p<0.001 for both). The annual rate of decline for CBVDs was more than twice that observed for IHD in this age group. Despite declining rates, absolute IHD deaths increased by 33% among women <50, whereas CBVDs deaths decreased by 31%. Nearly half of premature cardiovascular deaths occurred in women aged 40–49 years. In women ≥50, both causes showed substantial reductions, with CBVDs decreasing by 58% and IHD by 49%, converging to approximately 150 per 100,000 in 2023. Regional disparities were pronounced for IHD in younger women: Southern and Southeastern regions experienced substantial reductions, whereas several Northern and Northeastern regions showed stable or increasing mortality. In contrast, CBVDs declined consistently across all regions. Conclusion Although cardiovascular mortality declined substantially among Brazilian women over three decades, reductions differed markedly by cause and age. Among women <50 years, CBVDs declined more than twice as fast as IHD, reflecting substantial gains in premature stroke prevention. In contrast, premature IHD showed a slower decline and rising absolute burden, particularly concentrated in women aged 40–49 years, with persistent regional inequalities. These findings underscore the need for targeted, sex-specific strategies to address the emerging burden of premature IHD in women.