Global, regional and national burden of cardiovascular disease in perimenopausal women: a systematic analysis of global burden of disease data and time trends

Background Perimenopause represents a pivotal transitional phase in female reproductive ageing, characterized by a marked decline in estrogen levels and a concomitant surge in cardiovascular disease (CVD) risk. With the global perimenopausal female population exceeding 850 million and continuing to expand due to demographic ageing, understanding the long-term trends and regional disparities in CVD burden among this group is critical. However, a comprehensive analysis of these patterns remains lacking. Methods Utilizing data from the Global Burden of Disease (GBD) 2021 study, we examined CVD-related deaths and disability-adjusted life-years (DALYs) among perimenopausal women across 204 countries and territories from 1990 to 2021. Joinpoint regression models were employed to assess temporal trends via average annual percentage change (AAPC), while regional variations were evaluated based on socio-demographic index (SDI) and geographic location. Results Global Trends : Between 1990 and 2021, CVD-related deaths among perimenopausal women rose from 334,000 to 414,000 (AAPC = 0.71%), while DALYs increased from 14.23 million to 18.39 million (AAPC = 0.84%), with notable fluctuations in 1998 and 2003. SDI Stratification : Medium-SDI regions bore the highest burden (145,000 deaths, 6.46 million DALYs in 2021), whereas high-SDI areas exhibited a declining trend (26,000 deaths, 1.29 million DALYs in 2021). Age and Regional Differences : The 50–54-year age group experienced the steepest rise in CVD burden. Oceania recorded the highest mortality increase (AAPC = 2.46%), while South Asia had the highest absolute death toll (249,000). Disease Spectrum : Ischemic heart disease (IHD) and stroke dominated, accounting for 82.7% of deaths and 81.6% of DALYs. Atrial fibrillation showed the fastest mortality growth (AAPC = 2.11%), while Rheumatic heart disease (RHD) DALYs declined significantly (AAPC = -0.63%). Conclusions The global CVD burden among perimenopausal women continues to escalate, disproportionately affecting low-to-middle SDI regions and women aged 50–54. Targeted, gender-sensitive prevention strategies—particularly for Ischemic heart disease (IHD) and stroke—are urgently needed to mitigate disease burden in high-risk populations.