The global cardiovascular-kidney-liver-metabolic burden from 1990 to 2023.
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- Record sourced from PubMed, PMID 42668515.
- Also identified by DOI 10.1016/j.eclinm.2026.104155 and PMC identifier 13524663.
- Licence recorded as CC BY-NC-ND.
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Abstract
The cardiovascular-kidney-liver-metabolic (CKLM) framework represents the multi-organ interplay of systemic metabolic disorders that drive the global burden of cardiovascular diseases (CVD). This study is a descriptive epidemiological analysis of the Global Burden of Disease Study 2023 that examines the trends in mortality and disability-adjusted life years (DALYs) associated with atherosclerotic CVD, chronic kidney disease (CKD), type 2 diabetes (T2D), obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), from 1990 to 2023, across 204 countries and territories. Epidemiological trends were stratified by age, sex, region, and sociodemographic index (SDI). In 2023, the global CKLM burden contributed to 626.7 million DALYs, with an age-standardized DALY rate of 6944.3 per 100,000 population. Atherosclerotic CVD was the largest contributor to the CKLM burden (3924.2 [95% Uncertainty Interval {UI}: 3666.9-4181.4]), followed by obesity (1500.0 [95% UI: 730.4-2206.5]), T2D (956.7 [95% UI: 794.4-1142.4]), CKD (523.8 [95% UI: 468.0-590.1]), and MASLD (39.6 [95% UI: 31.2-49.9]). From 1990 to 2023, CKLM-related age-standardized DALYs fell 24.4%, primarily driven by improvements in atherosclerotic CVD (41.5% decrease), while rapid increases were seen in T2D (37.5% increase) and obesity (23.3% increase). Disparities in CKLM burden exist across SDI, geography, and age-sex categories. Improvements in the global CKLM burden, driven by gains in CVD prevention, are offset by the rising burden of upstream CKLM drivers including obesity, T2D, CKD and MASLD. Population-focused strategies for prevention need to target shared risk factors driving the CKLM syndemic to achieve the greatest reduction in overall morbidity and mortality. This research was supported by the NMRC Research Transition Award and the CSDU Clinician-Scientist Grant.