Metabolism: clinical and experimental · 2026
Global and regional projections of atherosclerotic cardiovascular-kidney-liver-metabolic disease burden to 2050: a forecasting analysis for the global burden of disease study 2023.
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Jayabaskaran Jayanth, Nagarajan Srinithy, Himan Haryo Raden, Kok Jordan, Tan Ernest En-Rae, Chong Bryan, Kong Gwyneth, Chen Yiming, Chew H S Jocelyn, Khan Muhammad Shahzeb, Wang Jiong-Wei, Mamas Mamas A, Zhou Xiao-Dong, Zheng Ming-Hua, Byrne Christopher D, Targher Giovanni, Hausenloy Derek, Lip Gregory, Chan Mark Y, Nicholls Stephen J, Chew Nicholas W S
Аннотация
BACKGROUND: Cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), metabolic dysfunction-associated steatotic liver disease (MASLD), and obesity coexist under the cardiovascular-kidney-liver-metabolic (CKLM) framework and account for nearly one third of global deaths, yet long-term projections of their combined burden are lacking.
METHODS: Using the Global Burden of Disease 2023 study, we projected incidence, prevalence, mortality, and disability-adjusted life years (DALYs) across 204 countries from 2026 to 2050, stratified by age, sex, geography, and sociodemographic index (SDI). The CKLM burden was organised into metabolic antecedents, comprising T2DM, CKD, MASLD and obesity; and downstream atherosclerotic CVD, comprising ischaemic heart disease, stroke, aortic aneurysm, and peripheral artery disease. ARIMA was selected as the primary forecasting model following out-of-sample validation of five candidate time-series models. Risk-deleted analyses estimated burden reduction achievable through elimination of modifiable risk factors.
RESULTS: By 2050, the global CKLM burden is projected to affect 4.7 billion (95%UI: 4.4 to 5.0 billion) aggregate prevalent condition counts, with 220.6 million incident cases (95%UI: 208.9 to 232.3 million), contributing 860.1 million DALYs and 32.4 million deaths. Crude DALYs are projected to rise 52.1% (95%UI: 23.6 to 80.7) from 2026 to 2050, driven by a 25.8% (95%UI: 10.7 to 40.8) rise in atherosclerotic CVD and a doubling of metabolic antecedents (100.0%; 95%UI: 14.9 to 185.0). Age-standardised DALY rates are anticipated to fall 14.9% (95%UI: -37.4 to 7.5), with a 31.4% (95%UI: -45.8 to -16.9) reduction in atherosclerotic CVD offset by a 14.6% (95%UI: -47.4 to 76.6) rise in metabolic antecedents. Metabolic antecedents are projected to expand from 35.7% to 48.1% of total CKLM burden between 2026 and 2050. CKLM burden is highest and fastest-growing in low-middle SDI regions and South Asia. Risk-deleted analyses identify high fasting plasma glucose (39.4% reduction), high systolic blood pressure (34.4% reduction), and dietary risks (28.1% reduction) as the highest-yield modifiable targets.
INTERPRETATION: By 2050, modest improvements in age-standardised cardiovascular-kidney-liver-metabolic morbidity will be overwhelmed by a substantial rise in absolute burden driven by population ageing and growth, as upstream metabolic antecedents expand from one-third to nearly half of the total CKLM composition.
METHODS: Using the Global Burden of Disease 2023 study, we projected incidence, prevalence, mortality, and disability-adjusted life years (DALYs) across 204 countries from 2026 to 2050, stratified by age, sex, geography, and sociodemographic index (SDI). The CKLM burden was organised into metabolic antecedents, comprising T2DM, CKD, MASLD and obesity; and downstream atherosclerotic CVD, comprising ischaemic heart disease, stroke, aortic aneurysm, and peripheral artery disease. ARIMA was selected as the primary forecasting model following out-of-sample validation of five candidate time-series models. Risk-deleted analyses estimated burden reduction achievable through elimination of modifiable risk factors.
RESULTS: By 2050, the global CKLM burden is projected to affect 4.7 billion (95%UI: 4.4 to 5.0 billion) aggregate prevalent condition counts, with 220.6 million incident cases (95%UI: 208.9 to 232.3 million), contributing 860.1 million DALYs and 32.4 million deaths. Crude DALYs are projected to rise 52.1% (95%UI: 23.6 to 80.7) from 2026 to 2050, driven by a 25.8% (95%UI: 10.7 to 40.8) rise in atherosclerotic CVD and a doubling of metabolic antecedents (100.0%; 95%UI: 14.9 to 185.0). Age-standardised DALY rates are anticipated to fall 14.9% (95%UI: -37.4 to 7.5), with a 31.4% (95%UI: -45.8 to -16.9) reduction in atherosclerotic CVD offset by a 14.6% (95%UI: -47.4 to 76.6) rise in metabolic antecedents. Metabolic antecedents are projected to expand from 35.7% to 48.1% of total CKLM burden between 2026 and 2050. CKLM burden is highest and fastest-growing in low-middle SDI regions and South Asia. Risk-deleted analyses identify high fasting plasma glucose (39.4% reduction), high systolic blood pressure (34.4% reduction), and dietary risks (28.1% reduction) as the highest-yield modifiable targets.
INTERPRETATION: By 2050, modest improvements in age-standardised cardiovascular-kidney-liver-metabolic morbidity will be overwhelmed by a substantial rise in absolute burden driven by population ageing and growth, as upstream metabolic antecedents expand from one-third to nearly half of the total CKLM composition.