Over the past three decades, CVD among WCBA globally has exhibited adverse temporal trends. Significant heterogeneity exists in the risk across age, period, and birth cohorts across different countries. Regions with a high SDI consistently demonstrated heightened period risk throughout the study. Conversely, the prevalence in low-middle and low SDI regions showed progressive deterioration across successive birth cohorts. Within the WCBA, the substantial population growth in low SDI regions and the burden in older women (ages 40–49) from high SDI regions have together accentuated the detrimental burden of CVD. The persisting health disparities across various regions are concerning.
Globally, the incidence of CVD in WCBA is rising, with an increasing emphasis from adolescence to adulthood. This trend poses novel challenges for healthcare system infrastructures and policy-making. Key risk factors, such as hypertension, dyslipidemia, diabetes, obesity, unhealthy diets, sedentary lifestyles, and smoking, lead to CVD development 21. Women appear to have an elevated risk for hypertension-related acute myocardial infarction 22. In addition, this phenomenon is also related to the pervasive increase in body mass index (BMI) driven in part by expanding urbanization. Women tend to have higher BMIs than men, particularly in developed nations 23. Obesity is also implicated in adverse pregnancy outcomes, such as hypertensive disorders of pregnancy and gestational diabetes. Central obesity, a primary characteristic of the metabolic syndrome, is more prevalent in women than men 24. Another study indicated that women with diabetes have a 44% higher risk of developing coronary heart disease than men with the same condition 25. Hence, early diabetes management is vital to prevent disease progression and reduce cardiovascular risk. Women exposed to these risk factors, given their heightened risk of type 2 diabetes and cardiovascular disease later in life, necessitate particular attention and follow-up, especially those with elevated fasting blood glucose levels during pregnancy 26. Together, obesity and diabetes significantly contribute to the prevalence and mortality rates of cardiovascular diseases in women and should be primary targets for health interventions.
Regarding smoking among women in Western and Central Europe, the prevalence among women in certain developed countries considerably surpasses the global average. Notably, the prevalence is especially high among women aged 15 to 19 27. Despite extensive tobacco control efforts, the prevalence of smoking among women has largely remained unchanged and has even increased in many countries 28. There is a pressing need for innovative solutions for targeted management, and there's a demand for evidence to support gender-specific treatment and interventions.
Pregnancy is an inevitable concern during the adult life of WCBA. Compared to the general population, pregnant female with CVD face higher risks of adverse maternal and fetal outcomes, including hypertensive disorders of pregnancy, pre-eclampsia, cesarean delivery, preterm birth, low birth weight, and stillbirth 29. These risks might be associated with medication use. Furthermore, compared to men, women have reported increased gender-specific adverse effects related to antihypertensive medications 30. Hence, understanding the CVD burden in WCBA is paramount for providing cardiovascular care to women with CVD both before and during pregnancy.
Among WCBA, the age effect on cardiovascular diseases presents a similar risk across different SDI regions with increasing age, consistent with the overall trend of CVD prevalence. Regarding the cohort effect, later-born individuals demonstrate higher overall risk than those born earlier, except in high SDI regions. On the one hand, countries in high SDI regions, relying on robust and accessible healthcare systems, are better equipped to address and manage cardiovascular diseases, significantly contributing to improved diagnosis and cure rates. On the contrary, in many nations with lower socioeconomic development, the expanding population has limited access to primary healthcare and lacks expert guidelines, medications, and healthcare personnel, potentially resulting in graver outcomes 31. On the other hand, over the past 30 years, most countries have witnessed increasing urbanization and modernization, leading to heightened exposures to harmful substances such as light and chemical pollutants, escalating urban carbon emissions, and deteriorating air quality, thereby fueling the prevalence of CVD 32. It's noteworthy that, excluding high SDI regions, period and cohort effects synergistically contribute to rising prevalence. Moreover, among 204 countries and territories, the effects of age, period, and birth cohort on the prevalence of CVD in women are highly heterogeneous, underscoring diverse disease patterns worldwide and the necessity for each country to formulate health policy solutions for early detection and targeted management.
To the best of our knowledge, this is the first study targeting the WCBA, utilizing the APC model to comprehensively analyze the temporal trends of CVD at global, regional, and national levels. We provide a deeper understanding of the temporal trends of CVD in the WCBA, offering valuable insights for epidemiology and health policy formulation.
Several limitations should be noted. Firstly, due to the imperfections in the healthcare systems of underdeveloped countries, misdiagnosis and missed diagnoses could occur in GBD studies. These could pose challenges to the accurate assessment of CVD. Secondly, to overcome the unbalanced quality caused by massive original data from different countries, the GBD collaborators adopted efficient data cleaning methods and advanced statistical modeling. However, this could lead to an over-reliance on modeled data in GBD studies and a failure to consider sociocultural and ethnic differences. Additionally, it is important to recognize the latency inherent in GBD data and the study's inability to explore prevalence trends within different regions of individual countries.