Background and Objectives: To our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. To examine ischemic stroke burdens at global, regional and national levels in terms of sex, age and social development index (SDI). Methods: Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and disability-adjusted life-years (DALY) trends of ischemic stroke. Measures were stratified by sex, region, country, age and SDI. Results: The global age-standardized incidence rate (ASIR) of ischemic stroke decreased from 1990 to 2019, with an EAPC of -0.43 [95% confidence interval (CI), -0.54 to -0.32]. High-middle and middle SDI regions had much higher ASIR, ASDR and age-standardized DALY rates due to ischemic stroke than other SDI regions. Regionally, East Asia had the highest ASIR of ischemic stroke in 2019 and the largest increase in the ASIR from 1990 to 2019. Nationally, Egypt (EAPC, 1.40; 95% CI, 1.27 to 1.52) and China (EAPC, 1.10; 95% CI, 1.00 to 1.20) had the most pronounced increases in the ASIR of ischemic stroke. Globally, there was an increase in ischemic stroke incidence with increasing age, especially in females aged 50–69 years or older. The global age-standardized death rate (ASDR) decreased from 1990 to 2019, with an EAPC of -1.63 (95% CI, -1.72 to -1.53). The ASDR and age-standardized DALY rates increased most in Southern sub-Saharan Africa, Eastern sub-Saharan Africa and Southeast Asia. Conclusions: The ASIR, ASDR and the age-standardized DALY rates remained high in high-middle and middle SDI regions. East Asia, Southern sub-Saharan Africa, Eastern sub-Saharan Africa, and Southeast Asia had the greatest burden of ischemic stroke. Globally, females had a greater burden of ischemic stroke than males, especially those aged 50–69 years or older.

The United Nation’s Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios. We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Deaths between 1990 and 2013 for cardiovascular disease (CVD), diabetes, chronic respiratory disease, cancer, and other NCDs were extracted, along with population numbers. We disaggregated deaths into parts attributable and unattributable to high systolic blood pressure (SBP), smoking, high body mass index (BMI), high total cholesterol, physical inactivity, and high fasting glucose. Risk factor exposure and deaths by NCD category were projected to 2030. Eight simulated scenarios were also constructed to explore how premature mortality will be affected if the World Health Organization’s targets for risk factors reduction are achieved by 2030. If current trends for each risk factor continued to 2030, the total premature deaths from NCDs would increase from 3.11 million to 3.52 million, but the premature mortality rate would decrease by 13.1%. In the combined scenario in which all risk factor reduction targets are achieved, nearly one million deaths among persons 30 to 70 years old due to NCDs would be avoided, and the one-third reduction goal would be achieved for all NCDs combined. More specifically, the goal would be achieved for CVD and chronic respiratory diseases, but not for cancer and diabetes. Reduction in the prevalence of high SBP, smoking, and high BMI played an important role in achieving the goals. Reaching the goal of a one-third reduction in premature mortality from NCDs is possible by 2030 if certain targets for risk factor intervention are reached, but more efforts are required to achieve risk factor reduction.

Background: Ischemic heart disease (IHD) imposes the greatest disease burden globally, especially in low‐ and middle‐income countries (LMICs). We aim to examine the population‐attributable fraction and risk‐attributable death and disability‐adjusted life years (DALYs) for IHD in 137 low‐ and middle‐income countries. Methods and Results: Using comparative risk assessment framework from the 2019 Global Burden of Disease study, the population‐attributable fraction and IHD burden (death and DALYs) attributable to risk factors in low‐income countries, lower‐middle‐income countries (LMCs), and upper‐middle‐income countries were assessed from 2000 to 2019. In 2019, the population‐attributable fraction (%) of IHD deaths in relation to all modifiable risk factors combined was highest in lower‐middle‐income countries (94.2; 95% uncertainty interval, 91.9–96.2), followed by upper‐middle‐income countries (93.5; 90.4–95.8) and low‐income countries (92.5; 90.0–94.7). There was a >13‐fold difference between Peru and Uzbekistan in age‐standardized rates (per 100 000) of attributable death (44.3 versus 660.4) and DALYs (786.7 versus 10506.1). Dietary risks accounted for the largest proportion of IHD’s behavioral burden in low‐ and middle‐income countries, primarily attributable to diets low in whole grains. High systolic blood pressure and high low‐density lipoprotein cholesterol remained the 2 leading causes of DALYs, with the former topping the list in 116 countries, while the latter led in 21 of the 137 countries. Compared with 2000 to 2010, the increases in risk‐attributable deaths and DALYs among upper‐middle income countries were slower from 2010 to 2019, while the trends in low‐income countries and lower‐middle income countries were opposite. Conclusions: IHD’s attributable burden remains high in low‐ and middle‐income countries. Considerable heterogeneity was observed among different income‐classified regions and countries.

Background: Ischemic heart disease (IHD) is the leading cause of premature death which poses public health challenges worldwide. Previous studies focused on the overall population in China. However, variations in temporal and spatial patterns across subgroups remain unknown. This study was to analyze how the IHD burden among Chinese and subgroup populations changes in response to temporal and spatial trends from 1990 to 2016. Methods: Based on data from the updated estimate in the 2016 Global Burden of Disease (GBD) study, we used years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) to describe the IHD burden. The percentage and annual average percentage changes were applied to illustrate temporal and spatial variations of the IHD burden stratified by age, sex, and province, over the periods 1990–2016, 1990–2005, and 2005–2016. We estimate population-attributable fraction (PAF) for 24 modifiable risk factors at the provincial level in 2016. Results: YLD rates, YLL rates, and DALY rates for IHD underwent a notable increase among all age groups and increased by 119.4, 83.3, and 84.5% nationally from 1990 to 2016. In YLD rates, a greater increase was seen in females (124.4%) compared to males (114.0%), while males experienced a more substantial increase than that in females in YLL rates (99.3% vs. 60.5%) and DALY rates (99.7% vs. 63.2%) from 1990 to 2016. Compared with 1990–2005, annual average changes in the overall population in YLL rates (3.5% vs. 1.8%) and DALY rates (3.5% vs. 1.9%) showed a tardier increase whereas an opposite increasing trend of YLD rates (3.5% vs. 4.0%) was observed between 2005 and 2016. Geographically, all provinces saw declines in the YLLs/YLDs ratio from 2005 to 2016, with seventeen of thirty-three provinces showing an upward trend between 1990 and 2005. Most provinces witnessed a remarkable upsurge in the age-standardised DALY rate from 1990 to 2016 whereas the economically advantaged region Macao (52.2%) saw the most marked reduction. High systolic blood pressure and high LDL cholesterol remained the two leading risk factors of IHD in all provinces in 2016. Diet high in sodium was the leading behavioral risks in twenty-eight provinces with smoking heading the list in five provinces. Conclusions: China has made significant achievements in preventing premature death from IHD along with the increased risk of disability. Substantial disparities in temporal and spatial trends of the IHD burden emphasize concerns for elderly men and those in economically disadvantaged regions with resource constraints. Regional differences in the IHD burden can be partly explained by modifiable risk factors. By having identified these disparities, targeted IHD prevention and control strategies will help to bridge these gaps.

Background: High sodium intake elevates blood pressure and thereby raises cardiovascular diseases ( CVD s). Sodium intake is high in northern China, including Shandong province where the SMASH (Shandong‐Ministry of Health Action on Sodium and Hypertension) is currently underway. Methods and Results: Blood pressure values and sodium intake measurements using 24‐hour urinary excretion were collected from the 2011 SMASH baseline survey, which was conducted in 20 counties/districts using a multistage stratified cluster random sampling method. We derived cause‐specific mortality from the Shandong Death Registration System ( SDRS ) during the same year and used population‐attributable fraction to estimate annual CVD s deaths attributable to high sodium intake (mediated through elevated systolic blood pressure) and CVD deaths averted by achieving different sodium‐reduction targets. Overall, 16 100 (95% uncertainty intervals, 11 000–22 600) CVD deaths among adults aged 25 to 69 years, including 5600 (4000–6500) for ischemic heart disease and 9000 (6700–11 600) for stroke, were attributable to higher sodium intake (2000 mg/day or 5.0 g/day of salt as a reference) in Shandong in 2011, accounting for 19.9% (13.7–25.0%) of total CVD deaths. The benefit of CVD deaths from sodium reduction is considerable with 8800 (6400–13 600), 6700 (4900–11 600), and 8500 (6000–10 800) averted, respectively, if sodium intake was reduced from the 2011 baseline to 3500 mg/day, 4000 mg/day, or reduced by 30%. Conclusions: Nearly 20% of CVD deaths among adults aged 25 to 69 years could be attributable to the systolic blood pressure–raising effect of high sodium intake in Shandong in 2011. Potential benefits from population reduction of sodium intake are considerable.