Global burden of cardiovascular disease in young adults aged 20–24: trends by sociodemographic index, 1990–2021

Background Cardiovascular disease is the leading cause of death and disability worldwide, yet its burden in early adulthood remains poorly characterised. Although recent global analyses report declining mortality alongside rising prevalence among individuals aged 15-39 years, aggregating this broad age range may obscure important life-stage differences. Young adulthood (ages 20-24 years) represents a critical transitional period marked by changes in lifestyle and metabolic risk factors that shape long-term cardiovascular risk trajectories, with potentially greater impact in low- and middle-income countries. Methods We analyzed Global Burden of Disease 2021 estimates for 204 countries, stratified by Sociodemographic Index quintiles. Outcomes included age-standardized prevalence, death, and disability-adjusted life year rates, as well as disability-adjusted life years attributable to behavioral, metabolic, and environmental or occupational risks. Age-standardized rates were calculated using the Global Burden of Disease 2021 standard population. Results The number of individuals aged 20-24 years living with cardiovascular disease increased from 7.0 to 9.6 million (+37%), with prevalence rising by approximately 13% (95% uncertainty interval=9.7-15.5%). The proportion of cases occurring in low- and low-middle-Sociodemographic Index regions increased from 38% to 60%. Globally, disability-adjusted life year and death rates declined by 21% and 25%, respectively, driven primarily by reductions in high-Sociodemographic Index countries. Metabolic risks accounted for the largest share of burden, with disability-adjusted life years attributable to high body-mass index increasing by approximately 90%. Conclusions Despite declines in mortality, the global burden of cardiovascular disease among young adults aged 20-24 years is increasing, particularly in low-Sociodemographic Index regions, underscoring the need for early and targeted prevention strategies.