Divergent Burden Patterns of Major Arterial Cardiovascular Diseases Across US States

Background Stroke, ischemic heart disease (IHD), and peripheral artery disease (PAD) are major manifestations of systemic arterial pathology, yet prior analyses have largely examined them in isolation, limiting comparative burden assessment across US states. Methods Using GBD (Global Burden of Disease) 2021 estimates, prevalence, incidence, deaths, disability‐adjusted life years, years of life lost, and years lived with disability for stroke, IHD, and PAD were quantified across US states from 1990 to 2021. National trends, age‐specific patterns, and state‐level variation were characterized using age‐standardized rates, spatial mapping, estimated annual percentage changes, and correlations with the Sociodemographic Index. Results In 2021, IHD had the greatest mortality burden (age‐standardized death rate, 78.9 per 100 000 [95% UI, 69.9–83.9] versus 30.3 per 100 000 [95% UI, 26.0–32.5] for stroke). PAD exhibited the highest incidence (211.8 per 100 000 [95% UI, 189.7–235.8]) but lower direct‐attributable death (1.7 per 100 000 [95% UI, 1.5–1.9]). Stroke had the greatest nonfatal burden (years lived with disability rate, 166.9 per 100 000 [95% UI, 121.0–211.9]). Age‐standardized death rates declined for all 3 diseases from 1990 to 2021, most rapidly for IHD (estimated annual percentage change, −3.01% [95% CI, −3.15% to −2.86%]), and correlated inversely with the Sociodemographic Index (stroke, ρ=−0.692; IHD, ρ=−0.661; PAD, ρ=−0.419; all P ≤0.002). Conclusions Major arterial cardiovascular diseases impose distinct burden profiles in the United States: IHD dominates death and health loss, stroke contributes combined fatal and disabling burden, and PAD exhibits high incidence but lower direct‐attributable death within GBD cause‐specific estimates. Disease‐specific surveillance and prevention are warranted.