Global burden and trends of cardiovascular disease attributable to low vegetable intake: a global burden of disease 1990–2021 analysis and projection to 2035

Abstract Cardiovascular disease (CVD) remains among the leading causes of death and disability worldwide. Although diet is a modifiable risk factor, the specific contribution of low vegetable intake to CVD burden has not been fully quantified. We assessed the burden of CVD attributable to a diet low in vegetables from 1990 to 2021 and projected trends up to 2035 using data from the Global Burden of Disease (GBD) 2021 study. Age-standardized mortality rates (ASMRs) and estimated annual percentage changes were calculated to describe temporal trends. Bayesian age–period–cohort models were used to predict future trajectories up to 2035. Analyses were stratified by sex, age group, CVD subtype, and sociodemographic index (SDI) quintile. Globally, ASMR declined, but absolute deaths increased. The burden was highest in low- to moderate-SDI regions, particularly in South Asia. Men aged ≥55 years were most affected, and hypertensive heart disease was the leading subtype. Projections indicate that global ASMR will continue to decline gradually through 2035. Age-standardized mortality has declined globally over the past three decades; however, the absolute burden continues to rise. These findings highlight the importance of targeted dietary interventions and public health policies.