Global and Indian cardiovascular disease mortality dynamics across multiregional epidemiological transitions differential risk factor burdens and integrated policy frameworks for advancing sustainable development goal 3.4

Abstract Background Cardiovascular diseases (CVDs) continue to be the leading cause of mortality worldwide, accounting for approximately 19.8 million deaths in 2022, with ischemic heart disease and stroke responsible for the majority of this burden. Despite improvements in health systems, CVD mortality has increased across all World Health Organization (WHO) regions, reflecting population ageing, persistent exposure to behavioural and metabolic risk factors, and marked regional inequities. India, within the WHO South-East Asia Region, contributes substantially to global CVD mortality and exhibits pronounced inter-state variation. A comprehensive synthesis of global and national CVD mortality patterns, subtype distribution, risk-factor profiles, and policy responses is essential for guiding prevention strategies and advancing progress toward Sustainable Development Goal (SDG) 3.4. Methods This study employed a descriptive epidemiological review design using publicly available secondary data from authoritative sources, including WHO Global Health Estimates (2000–2020), WHO Global Summary Estimates, Global Burden of Disease (GBD) 2020, the India State-Level Disease Burden Initiative (ISLDBI), and reports from the Institute for Health Metrics and Evaluation. The review followed a structured framework encompassing (i) global and Indian CVD mortality burden and temporal trends, (ii) distribution of major behavioural and metabolic CVD risk factors, and (iii) synthesis of global and Indian policy initiatives for CVD prevention and control. Results Globally, the number of deaths attributable to CVDs increased steadily from 14.3 million in 2000 to 17.8 million in 2020, with ischemic heart disease accounting for the largest share, followed by stroke. Substantial variation was observed in the proportion of deaths due to CVDs across WHO regions. In India, CVD deaths rose from 1.69 million in 2000 to 2.56 million in 2020, with the proportion of total deaths attributable to CVDs increasing from 24.3% to 35.3%. Marked disparities were evident across state groups. High systolic blood pressure emerged as the leading risk factor for CVD mortality globally and in India, followed by elevated LDL cholesterol and fasting plasma glucose. Conclusion The findings highlight a sustained rise in CVD mortality globally and in India, driven primarily by ischemic heart disease and stroke, with pronounced regional and subnational disparities. Strengthening population-level prevention, risk-factor control, and equitable implementation of existing cardiovascular health programmes is critical for reducing the growing CVD burden and achieving SDG 3.4.