Global, regional, and national burden of cardiovascular diseases among postmenopausal women, 1990–2040: a systematic analysis for the global burden of disease study 2021

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 (DALYs) were analyzed using age-standardized rates (ASRs). Temporal trends were quantified with estimated annual percentage changes (EAPCs), 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 ASIR and ASMR 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.