Cardiovascular Disease in the Middle East and North Africa, 1990-2021: Burden, Trends, and Risk Factors.

Purpose of review: Cardiovascular disease (CVD) continues to exact a heavy toll across the Middle East and North Africa. We analyzed Global Burden of Disease 2021 data to characterize trends in CVD mortality, disability‑adjusted life‑years (DALYs), and incidence from 1990 to 2021, identify leading risk factors, and highlight country‑level disparities that inform policy action.

Recent findings: Age‑standardized CVD death rates declined by 31% and DALY rates by 36% over three decades, while incidence fell only 8%. Progress was highly uneven: Lebanon and Qatar cut DALYs by > 60%, whereas Libya's burden rose and Egypt still records > 12 000 DALYs per 100,000. Metabolic risks including obesity, hypertension, dyslipidemia, and hyperglycemia accounted for nearly half of 2021 DALYs. This contribution outweighed that of behavioral and environmental risks, despite sizeable declines in tobacco use and air-pollution exposure. Countries with robust data systems and universal coverage achieved the fastest gains; conflict‑affected or lower‑income states lagged markedly. Although regional CVD burden is trending downward, persistent heterogeneity and the rising dominance of metabolic risk highlight an urgent need for prevention‑centered, context‑specific strategies. Strengthening primary care, expanding registries, integrating digital health and environmental surveillance, and fostering cross‑country collaboration will be critical to sustain and equalize cardiovascular progress across the Middle East and North Africa.