Frontiers in Cardiovascular Medicine · Nov 10, 2026
Global, regional, and national burden and trends of cardiovascular diseases attributable to high alcohol use: analysis of the Global Burden of Disease Study 1990-2021 with projections to 2050
By Yinxiu Guo, Zhaochen Sun, Linfeng Fang et al.
Background Cardiovascular disease (CVD) is a leading global cause of death, yet the disease burden attributable to high alcohol use—a key independent risk factor—remains inadequately assessed across time and regions. We aimed to assess the global burden of CVD—including five major subtypes—attributable to high alcohol use from 1990 to 2021, and projected trends through 2050. Methods We obtained data on deaths and disability-adjusted life years (DALYs) for CVD and its five subtypes from 1990 to 2021 from the Global Burden of Disease (GBD) 2021. Total percentage changes in age-standardized death and DALY rates from 1990 to 2021 were calculated. We also examined ecological associations with the Socio-demographic Index (SDI) and used a Bayesian age-period-cohort (BAPC) model to project disease burden from 2022 to 2050. Results In 2021, an estimated 385.8 thousand global CVD deaths were attributable to high alcohol use (age-standardized mortality rate [ASMR] 4.6 per 100,000; total percentage change -36.3% from 1990 to 2021), and an estimated 9.3 million DALYs were attributable to high alcohol use (age-standardized DALY rate [ASDR] 107.6 per 100,000; total percentage change -31.2%). Geographic disparities were marked: Eastern Europe (ASMR 17.2), Central Europe (9.8), and Southern sub-Saharan Africa (7.5) had the highest burdens, versus the lowest in North Africa/Middle East (0.5). Stroke, hypertensive heart disease, and cardiomyopathy dominated, with stroke particularly high in East Asia. Mortality increased with age and was higher in males, and burden showed a non-linear ecological association with SDI. Projections suggest that by 2050, the age-standardized rates of alcohol-attributable CVD for most subtypes may rise, with persistent male predominance. Conclusion Despite a decline in CVD mortality attributable to high alcohol use over the past 30 years, the absolute burden remains substantial—especially in Eastern Europe, Central Europe, and Southern Sub-Saharan Africa—highlighting the urgent need for effective alcohol control interventions.