Global, regional, and national cardiovascular disease burden attributable to smoking from 1990 to 2021: Findings from the GBD 2021 Study

INTRODUCTION: Smoking poses a serious threat to cardiovascular health. The aim of the study is to evaluate the global, regional, and national burden of smoking-attributable cardiovascular disease (CVD) and set priorities for future tobacco control. METHODS: Data on deaths and years lived with disability (YLDs) for smoking-related CVD from 1990 to 2021, including age-standardized rates (ASRs), were sourced from the Global Burden of Disease (GBD) 2021. This study is a secondary descriptive analysis of the GBD 2021 data. We used the estimated annual percentage change (EAPC) to reflect temporal trends in disease burden and conducted a sensitivity analysis using the average annual percentage change (AAPC) to corroborate the findings. We also analyzed the relationship between disease burden and the Sociodemographic Index (SDI). RESULTS: In 2021, smoking-related CVD caused 2.25 million deaths and 3.09 million YLDs globally, marking increases of 26.16% and 59.73% from 1990, respectively. However, from 1990 to 2021, the global age-standardized mortality rate (ASMR) and age-standardized years lived with disability rate (ASYR) for smoking-related CVDs decreased, with EAPCs of -1.94 and -0.92, respectively. Between 1990 and 2021, Australasia and Tropical Latin America experienced the largest declines in ASMR and ASYR, with EAPCs of -5.54 and -2.63, respectively, while Lesotho and Mali had the largest increases, with EAPCs of 2.68 and 1.67, respectively. Throughout the period, the burden of smoking-related CVD was consistently higher in men. Moreover, the trend of decline in disease burden was slower in men compared to women (EAPC for ASMR: -1.78 for men vs -3.25 for women). In 2021, countries with higher SDI also had higher ASYR. CONCLUSIONS: Although the global burden of smoking-related CVD has declined over the past three decades, the challenge remains severe, particularly in less developed countries and regions. More proactive and effective tobacco control measures should be urgently implemented in countries where the burden of smoking-related CVD is severe.