Burden, Trends, Risk Factors, and Forecast of Ischemic Heart Disease, Rheumatic Heart Disease, and Atrial Fibrillation and Flutter From 1990 to 2040: A Comparative Analysis of China, the United States, and Europe Based on the Global Burden of Disease Study and the Potential Impact of the COVID-19 Pandemic.

Background: Understanding the global burden of cardiovascular diseases is essential for developing effective preventive strategies and guiding policy measures worldwide. Despite significant advances in diagnosis and treatment, cardiovascular diseases remain the leading cause of morbidity and mortality across all regions. Assessing their temporal trends and regional disparities can provide valuable insights for optimizing resource allocation and improving global health outcomes. Methods: We used data from the Global Burden of Disease 2021 (GBD 2021) to analyze the incidence, prevalence, deaths, Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability-Adjusted Life Years (DALYs) of three major cardiovascular diseases-Atrial Fibrillation and Flutter (AFF), Ischemic Heart Disease (IHD), and Rheumatic Heart Disease (RHD)-globally and in the People's Republic of China, Europe, and the United States of America (USA). Comparative analyses and projections were performed through 2040. Results: Globally, age-standardized incidence rates (ASIRs, per 100,000 population) from 1990 to 2021 slightly declined for AFF (52.51 to 52.12) and IHD (419.54 to 372.9) but increased for RHD (44.87 to 50.74). In China and the USA, AFF incidence rose (42.63 to 44.92 and 75.22 to 89.18, respectively), and IHD incidence in China increased (315.31 to 365.67). RHD incidence declined across all three regions. Notably, AFF and IHD trends increased after 2019, potentially related to COVID-19. Conclusion: This study reveals distinct global and regional trends in the burden of AFF, IHD, and RHD from 1990 to 2021. The burden of AFF and IHD declined in most regions but showed a potential increase during the COVID-19 pandemic, while RHD continued to rise, particularly in low-SDI (Sociodemographic Index) countries. These findings provide valuable evidence to guide targeted prevention strategies and optimize resource allocation in global cardiovascular health policy.