Cardiovascular diseases burden attributable to dietary risk factors in 204 countries and territories

Cardiovascular diseases (CVDs) are the world’s leading public health concern, and suboptimal diet is a major modifiable determinant of cardiovascular health. This study quantified global, regional, and national CVDs deaths and disability-adjusted life years (DALYs) attributable to 13 dietary risk factors between 1990 and 2023, using 2023 Global Burden of Disease data covering 204 countries and territories. Diet-attributable outcomes were estimated as absolute numbers and age-standardized rates (ASRs), stratified by age, sex, socio-demographic index (SDI), and CVD subtypes, with temporal changes assessed. In 2023, dietary risks globally caused 5.91 million (95% uncertainty interval [UI]: 2.37–8.63 million) CVD deaths and 141.12 million (95% UI: 56.03–198.28 million) DALYs, corresponding to ASRs of 65.78 deaths and 1557.26 DALYs per 100,000 population. Considerable geographic heterogeneity was observed. China had the largest CVD deaths (1.36 million) but a moderate ASR (62.05 per 100,000). Globally, high sodium intake was the leading risk for CVD mortality and DALYs, followed by diet low in fruits and whole grains, particularly for ischemic heart disease and stroke. High-middle and high SDI regions experienced the greatest burden from high sodium intake, whereas low-middle and low SDI regions were more affected by low fruits intake. Males consistently experienced higher diet-attributable CVD burden than females. Although absolute numbers increased over time, ASRs for all dietary risks declined from 1990 to 2023. Despite declining ASRs, the global burden of diet-related CVDs remains substantial and unevenly distributed, requiring targeted, context-specific dietary interventions, particularly sodium reduction and increased fruits and whole grain intake.