Global Burden and Trends of Cardiovascular Disease Attributable to Low Vegetable Intake: A GBD 1990–2021 Analysis and Projection to 2035

​​ Background : Cardiovascular disease (CVD) remains among the leading causes of death and disability worldwide. Dietary patterns are modifiable determinants of CVD, and a diet low in vegetables is a pervasive nutritional risk factor whose independent contribution to the global CVD burden has not been fully quantified. Objective: This study aimed to systematically assess the global, regional, and national burden of CVD attributable to a diet low in vegetables from 1990 to 2021 and to forecast future trends up to 2035 using comprehensive data from the Global Burden of Disease (GBD) 2021 study. ​​ Methods : We extracted data on CVD attributable to low vegetable intake from the GBD 2021 database. Age-standardized mortality rates (ASMR) and estimated annual percentage changes were calculated to describe temporal trends. Bayesian age–period–cohort models were applied to predict future trajectories through 2035. Analyses were stratified by sex, age group, CVD subtype, and sociodemographic index (SDI) quintile. ​​ Results : From 1990 to 2021, the global ASMR for CVD attributable to insufficient vegetable intake continued to decline. However, the absolute number of deaths increased. The burden was highest in regions with low to moderate SDI, particularly in South Asia. Men and adults aged ≥ 55 years accounted for the greatest number of deaths. Notably, hypertensive heart disease has surpassed stroke and ischemic heart disease as the leading cause of CVD mortality linked to low vegetable intake. Projections indicate that the global ASMR will continue to decline slowly until 2035. ​​ Conclusions : Although age-standardized CVD mortality attributable to low vegetable intake has declined globally over the past three decades, the absolute burden continues to rise due to demographic shifts. This underscores the urgent need for targeted dietary interventions and public health policies that promote vegetable consumption, particularly among older adults, men, and populations in low- and middle-SDI regions.