Global, regional, and national burden of cardiovascular diseases among postmenopausal women, 1990–2040: a systematic analysis for the global burden of disease study 2021
Shuangfei Xu, Jia Shang, Shaoqiang Yang, Delong Li, Ejuan Zhang, Fang Lei, Mengliu Zeng, Lijin Lin
Abstract
BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. In postmenopausal women, physiological changes and hormonal transitions accelerate cardiovascular risk, yet global, sex-specific evidence for this group remains limited. Understanding their burden is essential to address biological vulnerabilities and structural inequities. AIM OF REVIEW: This review provides the first comprehensive global, regional, and national assessment of CVD burden among women aged ≥ 55 years from 1990 to 2021 and projects trends to 2040. It synthesizes epidemiological patterns, socio-demographic disparities, and major modifiable risk factors, with the goal of informing gender-sensitive and equity-oriented cardiovascular prevention and policy strategies. KEY SCIENTIFIC CONCEPTS OF REVIEW: Data were obtained from the Global Burden of Disease (GBD) Study 2021, encompassing 204 countries and territories. Incidence, prevalence, mortality, and disability-adjusted life years were analyzed using age-standardized rates. Temporal trends were quantified with estimated annual percentage changes , and decomposition analysis identified demographic (population growth, aging) and epidemiological contributions. Inequalities were evaluated using slope and concentration indices across socio-demographic index (SDI) levels. Bayesian age-period-cohort models were applied to forecast CVD burden through 2040. Key findings indicate that although age-standardized incidence and mortality rates declined globally, absolute CVD cases and deaths nearly doubled due to demographic expansion. Disparities widened: high-SDI regions achieved the steepest reductions, while low-SDI regions showed slower progress or worsening trends. Ischemic heart disease and stroke remained the dominant contributors, endocarditis was the fastest-rising subtype, and high systolic blood pressure consistently emerged as the leading modifiable risk factor. Collectively, these findings highlight a growing and uneven burden of CVD in postmenopausal women. Strengthened hypertension control, integrated prevention strategies, and investment in primary healthcare-particularly in low-SDI settings-are urgently needed. This review provides a woman-centered evidence base to support equitable cardiovascular health policy and resource allocation.