Global, regional, and national trends in tobacco-induced cardiovascular disease burden for 1990–2021 with projections to 2045: A comprehensive analysis based on the Global Burden of Disease Study 2021

Tobacco use is a major risk factor for cardiovascular disease (CVD), and its global disease burden trends require further clarification. This study aims to analyze trends in global CVD burden attributable to tobacco in 1990-2021 and project mortality rates and disease burden through 2045. Using Global Burden of Disease Study (GBD) 2021 data, we analyzed temporal trends using age-period-cohort models, evaluated change points with Joinpoint regression, and conducted forecasting using Bayesian age-period-cohort (BAPC) models. In 2021, tobacco-attributable CVD deaths reached 2.147 million globally (71.3% increase from 1990), although age-standardized mortality rates decreased to 25.36 per 100000 (83.3% reduction). Mortality rates were lowest in high SDI regions (326.71 per 100000) and highest in low-middle sociodemographic index (SDI) regions (788.05 per 100000). The proportion of deaths among those aged ≥80 years increased from 19.2% to 26.2%. Global mortality rates decreased by 1.8% annually, with a greater decline in females (-2.6%) than males (-1.6%). Projections suggest that by 2045, global CVD deaths may reach approximately 3.267 million (52.1% potential increase), although age-standardized mortality rates are expected to decrease to around 38.6 per 100000 (15.9% estimated reduction). Disability-adjusted life years (DALYs) are projected to potentially increase to 75.755 million (39.9% estimated increase), while age-standardized DALY rates could decline to approximately 1008.02 per 100000. Between 1990 and 2021, global tobacco-attributable CVD mortality rates showed a declining trend, with notable regional, sex, and age disparities. Projections indicate that while age-standardized rates will continue to decrease, absolute numbers of deaths and disease burden will increase. The findings emphasize the need to strengthen tobacco control and CVD prevention in low-middle SDI regions.