Changes in global cardiovascular disease burden following the COVID-19 pandemic: An interrupted time-series analysis

Objectives To quantify whether global and country-level trajectories of age-standardized cardiovascular disease (CVD) mortality, incidence, and disability-adjusted life-years (DALYs) changed after the COVID-19 pandemic relative to historical trends. Design Interrupted time-series analysis using Bayesian structural time-series models and piecewise log-linear regression. Setting Global, encompassing 204 countries and territories. Participants Population-level aggregated data from the Global Burden of Disease 2023 study (1990–2023), stratified by sex. Main outcome measures Age-standardized CVD mortality rate (ASMR-CVD), incidence rate (ASIR-CVD), and DALY rate (DALY-CVD). Results Globally, observed ASMR-CVD and DALY-CVD consistently exceeded counterfactual expectations after 2019, with excess estimates of 6.2%–8.4% and 6.0%–6.9%, respectively (posterior probabilities >95%). ASIR-CVD showed no meaningful global excess (0.24%–0.43%, probabilities 60%–71%). Piecewise regression confirmed significant post-2019 slope increases for ASMR-CVD (annual +0.97%, p = .044) and DALY-CVD (+1.13%, p = .012), but not for ASIR-CVD. Country-level analyses revealed substantial heterogeneity: significant upward slope changes were seen in 69 countries for ASIR-CVD, and in 54 countries each for ASMR-CVD and DALY-CVD; the largest increases occurred in Mauritius for mortality and DALYs and in Argentina for incidence. Conclusions The postpandemic period was marked by a robust global deceleration of prior declining trends in CVD mortality and disability, with no comparable shift in incidence at the global level, though many countries experienced significant incidence increases. These persistent and geographically uneven changes underscore the need for strengthened cardiovascular prevention, healthcare delivery, and surveillance, especially in settings with sustained unfavorable trends.