Major arterial cardiovascular diseases impose distinct burden profiles in the United States: IHD dominates death and health loss, stroke contributes combined fatal and disabling burden, and PAD exhibits high incidence but lower direct-attributable death within GBD cause-specific estimates.
In 2021, IHD had the greatest mortality burden among the three major arterial cardiovascular diseases examined.
PAD exhibited the highest incidence among the three diseases but the lowest direct-attributable mortality.
Stroke had the greatest nonfatal burden as measured by years lived with disability among the three diseases.
Age-standardized death rates declined for all three diseases from 1990 to 2021, with IHD showing the most rapid decline.
Age-standardized death rates for all three diseases correlated inversely with the Sociodemographic Index (SDI) across US states.
The three major arterial cardiovascular diseases show divergent burden profiles that prior analyses examining them in isolation have not fully captured.
This research analyzed data from the 2021 Global Burden of Disease study to compare how three major artery-related heart and vascular conditions — ischemic heart disease (IHD, caused by blocked coronary arteries), stroke, and peripheral artery disease (PAD, blockages in limb arteries) — affect people across all US states from 1990 to 2021. Rather than looking at each disease separately as most prior studies have done, this study compared them side by side using multiple measures of disease burden including deaths, disability, and new cases. The findings show that these three diseases have very different patterns: IHD causes the most deaths, stroke causes the most long-term disability, and PAD is diagnosed most frequently but causes relatively few direct deaths. The study also found that death rates fell for all three diseases between 1990 and 2021, with IHD showing the steepest decline (about 3% per year). However, burden was not evenly distributed: states with lower socioeconomic development consistently had higher death rates from all three conditions, with this gap being most pronounced for stroke and IHD and somewhat smaller for PAD. This suggests that social and economic factors play an important role in who is most affected by these diseases. This research suggests that because these three arterial diseases affect people in meaningfully different ways — one killing more, one disabling more, one occurring more frequently — public health efforts and medical surveillance systems should be tailored to the specific profile of each disease rather than treating them as interchangeable. The geographic variation across states also points to opportunities for targeted prevention efforts in higher-burden regions.
Jin Z. (2026). Divergent Burden Patterns of Major Arterial Cardiovascular Diseases Across US States.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048952