J Shanghai Jiaotong Univ Sci

Journal of Shanghai Jiaotong University(Science) >

2026 , Vol. 31 >Issue 3: 800 - 810

DOI: https://doi.org/10.1007/s12204-026-2942-9

Celebrating 30 Years

Global Trends in Early-Onset Ischemic Heart Disease Linked to Obesity, 1990–2021: Insights from the Global Burden of Disease Study

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  • 1. State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Division of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 3. Tsinghua Medicine, Tsinghua University, Beijing 100084, China; 4. Aging Biomarker Consortium, Beijing 100000, China

Received date: 2025-12-11

  Revised date: 2026-05-21

  Accepted date: 2026-05-28

  Online published: 2026-06-20

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Abstract

Obesity is a major modifiable risk factor for early-onset ischemic heart disease (IHD), yet its contribution to the global burden across regions and demographics is not fully quantified. This study assesses global trends in obesity-related early-onset IHD, focusing on young adults (aged 25–39 years). We utilized Global Burden of Disease Study 2021 data to track 30-year trends in obesity and early-onset IHD via average annual percentage changes (AAPCs) and socio-demographic index (SDI)-stratified disability-adjusted life year (DALY) counts. Pearson correlation was then applied to evaluate the associations between these variables. Further multi-factor adjustment analysis was conducted using a multivariable linear regression model on 5-year age-stratified data. A significant positive correlation was found between the AAPC in obesity age-standardized prevalence rate (ASPR) and the AAPC in early-onset IHD age-standardized mortality rate (ASMR) (ρ=0.36, P<0.001) and ASPR (ρ=0.29, P<0.001) among young males, with stronger associations than in females. The impact of obesity on early-onset IHD prevalence and mortality strengthened with age, peaking at 35–39 years old for both male and female. Even after having adjusted for dietary, environmental, and metabolic risk factors, obesity remains the top IHD risk factor in almost all subgroups. Clearly, obesity is strongly linked to higher morbidity and mortality in early-onset IHD.

Cite this article

Yang Liujia, Ji Hongwei, Zhang Jiawen, Huang Honghao, Xu Wei, Wang Donghao, Zhang Zheng, Huang Xinyue, Liu Qi, Zhong Yiming, Chen Yifan, Pu Jun . Global Trends in Early-Onset Ischemic Heart Disease Linked to Obesity, 1990–2021: Insights from the Global Burden of Disease Study[J]. Journal of Shanghai Jiaotong University(Science), 2026 , 31(3) : 800 -810 . DOI: 10.1007/s12204-026-2942-9

References

[1] Vos T, Lim S S, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019 [J]. The Lancet, 2020, 396(10258): 1204-1222.
[2] Gulati R, Behfar A, Narula J, et al. Acute myocardial infarction in young individuals [J]. Mayo Clinic Proceedings, 2020, 95(1): 136-156.
[3] Sun J H, Qiao Y N, Zhao M, et al. Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2019: A systematic analysis of Global Burden of Disease Study 2019 [J]. BMC Medicine, 2023, 21(1): 222.
[4] Wu Z G, Liu L, Wang W W, et al. Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients with premature coronary artery disease: A retrospective cohort study [J]. Cardiovascular Diabetology, 2022, 21(1): 142.
[5] Zeitouni M, Clare R M, Chiswell K, et al. Risk factor burden and long-term prognosis of patients with premature coronary artery disease [J]. Journal of the American Heart Association, 2020, 9(24): e017712.
[6] Wienbergen H, Boakye D, Günther K, et al. Lifestyle and metabolic risk factors in patients with early-onset myocardial infarction: A case-control study [J]. European Journal of Preventive Cardiology, 2022, 29(16): 2076-2087.
[7] Zhan H Q, Han G L, Wei C A, et al. Applications of artificial intelligence in cardiac electrophysiology and clinical diagnosis with magnetic resonance imaging and computational modeling techniques [J]. Journal of Shanghai Jiao Tong University (Science), 2025, 30(1): 53-65.
[8] Welsh A, Hammad M, Piña I L, et al. Obesity and cardiovascular health [J]. European Journal of Preventive Cardiology, 2024, 31(8): 1026-1035.
[9] Gao M, Lv J, Yu C Q, et al. Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study [J]. PLoS Medicine, 2020, 17(10): e1003351.
[10] Iacobellis G. Epicardial fat links obesity to cardiovascular diseases [J]. Progress in Cardiovascular Diseases, 2023, 78: 27-33.
[11] WHO. Obesity and overweight [EB/OL]. (2025-12-08) [2025-12-10]. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
[12] Lee K X, Quek K F, Ramadas A. Dietary and lifestyle risk factors of obesity among young adults: A scoping review of observational studies [J]. Current Nutrition Reports, 2023, 12(4): 733-743.
[13] Aggarwal R, Yeh R W, Joynt Maddox K E, et al. Cardiovascular risk factor prevalence, treatment, and control in US adults aged 20 to 44 years, 2009 to March 2020 [J]. JAMA, 2023, 329(11): 899.
[14] GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021 [J]. The Lancet, 2024, 403(10440): 2133-2161.
[15] Safiri S, Karamzad N, Singh K, et al. Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990–2019 [J]. European Journal of Preventive Cardiology, 2022, 29(2): 420-431.
[16] An X Q, Liu Z Y, Zhang L W, et al. Co-occurrence patterns and related risk factors of ischaemic heart disease and ischaemic stroke across 203 countries and territories: A spatial correspondence and systematic analysis [J]. The Lancet Global Health, 2025, 13(5): e808-e819.
[17] GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021 [J]. The Lancet, 2025, 405(10481): 813-838.
[18] Liu X, Wu Y T, Li F, et al. Global burden of early-onset ischemic heart disease, 1990 to 2019 [J]. JACC Advances, 2025, 4(1): 101466.
[19] GBD 2021 Demographics Collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: A comprehensive demographic analysis for the Global Burden of Disease Study 2021 [J]. The Lancet, 2024, 403(10440): 1989-2056.
[20] Xie J C, Wang M Q, Long Z P, et al. Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: Systematic analysis of the Global Burden of Disease Study 2019 [J]. BMJ, 2022, 379: e072385.
[21] Ran J, Zhou P, Wang J X, et al. Global, regional, and national burden of heart failure and its underlying causes, 1990–2021: Results from the global burden of disease study 2021 [J]. Biomarker Research, 2025, 13(1): 16.
[22] Stone N J, Smith S C, Orringer C E, et al. Managing atherosclerotic cardiovascular risk in young adults JACC state-of-the-art review [J]. Journal of the American College of Cardiology, 2022, 79(8): 819-836.
[23] Sun D, Ding Y Q, Yu C Q, et al. Joint impact of polygenic risk score and lifestyles on early- and late-onset cardiovascular diseases [J]. Nature Human Behaviour, 2024, 8(9): 1810-1818.
[24] Balasubramanian S, Naruka M S, Tewari G. Electrocardiogram signal denoising using optimized adaptive hybrid filter with empirical wavelet transform [J]. Journal of Shanghai Jiao Tong University (Science), 2025, 30(1): 66-80.
[25] Rajendran A, Minhas A S, Kazzi B, et al. Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women [J]. Atherosclerosis, 2023, 384: 117269.
[26] Regitz-Zagrosek V, Gebhard C. Gender medicine: Effects of sex and gender on cardiovascular disease manifestation and outcomes [J]. Nature Reviews Cardiology, 2023, 20(4): 236-247.
[27] Haider A, Bengs S, Luu J, et al. Sex and gender in cardiovascular medicine: Presentation and outcomes of acute coronary syndrome [J]. European Heart Journal, 2020, 41(13): 1328-1336.
[28] Kivimäki M, Strandberg T, Pentti J, et al. Body-mass index and risk of obesity-related complex multimorbidity: An observational multicohort study [J]. The Lancet Diabetes & Endocrinology, 2022, 10(4): 253-263.
[29] Mohammadian Khonsari N, Khashayar P, Shahrestanaki E, et al. Normal weight obesity and cardiometabolic risk factors: A systematic review and meta-analysis [J]. Frontiers in Endocrinology, 2022, 13: 857930.
[30] Jayedi A, Soltani S, Zargar M S, et al. Central fatness and risk of all cause mortality: Systematic review and dose-response meta-analysis of 72 prospective cohort studies [J]. BMJ, 2020, 370: m3324.
[31] Powell-Wiley T M, Poirier P, Burke L E, et al. Obesity and cardiovascular disease: A scientific statement from the American heart association [J]. Circulation, 2021, 143(21): e984-e1010.
[32] Xiao X Z, Miao Y B. Heart rate sensing method based on short millimeter wave radar sequence [J]. Journal of Shanghai Jiao Tong University (Science), 2025, 30(4): 683-692.

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