Global trends in cardiovascular mortality attributable to high body mass index: 1990–2021 analysis with future projections

Objective: Cardiovascular disease (CVD) remains a major global cause of death, with high body mass index (BMI) as a key modifiable risk factor. This study examines global and regional patterns of CVD mortality attributable to high BMI from 1990 to 2021, with projections to 2032. Methods: Using Global Burden of Disease 2021 data from 204 countries, we analyzed age-standardized mortality rates (ASMRs) and population-attributable fractions by sex, age, socio-demographic index (SDI), and region. Future trends were estimated using a Bayesian age-period-cohort model, with uncertainity intervals from 1000 posterior simulations. Results: High BMI-related deaths due to CVD rose from 0.9 million in 1990 to 1.9 million in 2021, with ASMR declining from 24.43 to 22.77 per 100,000 (-6.83 %). High-middle SDI regions had the highest ASMR, while low-middle SDI regions saw the largest increase. Mortality rose for hypertensive heart disease and atrial fibrillation and flutter, but declined for ischemic heart disease and stroke. Older adults accounted for most deaths, though ASMR increased among those aged 15–49. By 2032, deaths are projected to reach 2.5 million (+33 %), with ASMR dropping to 22.06. Conclusion: Despite modest ASMR declines, high-BMI-related CVD deaths are rising, especially in low-SDI regions, underscoring the need for targeted prevention.