Global, Regional, and National Burden of Atherosclerotic Cardiovascular Disease in Pre- and Post-Menopausal Women: 1990-2021 Trends and 2041 Projections from the Global Burden of Disease Study

BackgroundThe global burden and temporal trends of atherosclerotic cardiovascular disease (ASCVD) stratified by menopausal status have not been comprehensively described.MethodsAge-standardized incidence rates (ASIR), prevalence rates (ASPR), disability-adjusted life year rates (ASDALYR), and death rates (ASDR) for ASCVD, including ischemic heart disease (IHD), ischemic stroke (IS), and lower extremity peripheral artery disease (LEPAD), were estimated among pre- and post-menopausal women from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Temporal trends were quantified using average annual percent change, and the population attribution fractions were calculated for established ASCVD risk factors. Projections to 2041 were generated using the Nordpred model.ResultsIn 2021, the highest IHD burden was observed in low-middle socio-demographic index (SDI) regions, whereas the highest LEPAD burden occurred in high SDI regions among both pre- and post-menopausal women. Among premenopausal women, ASIR and ASPR for IS demonstrated a negative correlation with SDI level. Between 1990 and 2021, premenopausal women exhibited increases in IHD ASIR (12.86%) and ASPR (11.43%), accompanied by reductions in ASDALYR (23.97%) and ASDR (24.35%). In contrast, postmenopausal women experienced a modest increase in ASPR (4.14%) along with declines in ASIR (10.61%), ASDALYR (34.99%), and ASDR (37.09%). The contribution of specific risk factors varied by menopausal status: elevated low-density lipoprotein cholesterol, systolic blood pressure, and body mass index were predominant among premenopausal women, whereas elevated fasting glucose and kidney dysfunction contributed more substantially among postmenopausal women. Projections to 2041 indicate continued increases in ASCVD incidence and prevalence numbers, particularly among postmenopausal women.ConclusionsThe burden of ASCVD varies significantly by menopausal status and across socio-demographic regions. Age-specific and regionally targeted screening, prevention, and resource allocation strategies are warranted to address the projected rise in ASCVD among women.