To analyze the burden of atherosclerotic cardiovascular disease (ASCVD) attributable to lifestyle and metabolic factors in China from 1990 to 2021 and predict its future trends, providing evidence for public health prevention and control.

Based on the Global Burden of Disease (GBD) 2021 database, we extracted disability-adjusted life years (DALYs) of ASCVD attributable to 7 key risk factors: dietary, low physical activity, smoking, high body mass index (BMI), high fasting blood glucose, high low-density lipid cholesterol (LDL-C), and hypertension. Age-standardized DALY rates (ASDR) were also calculated to account for variations in age structure, and an ARIMA model was applied to predict future trends.

① Overall trend analysis showed the leading risk factor for ischemic heart disease (IHD) shifted from dietary risks in 1990 to hypertension in 2021, while hypertension and smoking remained the primary risk factors for ischemic stroke (IS) and peripheral artery disease (PAD), respectively. ② In BRICS nations, hypertension was the dominant risk factor for both IHD and IS, whereas in China, smoking and high fasting blood glucose continued to be the major drivers of PAD burden. ③ Sex-specific analysis revealed that hypertension was the leading risk factor for IHD and IS in both males and females. For PAD, smoking was the main risk factor in males, while high fasting blood glucose was for females. Age-stratified analysis revealed that in the 15-49 age group, dietary, high LDL-C and smoking were the primary factor for IHD, IS and PAD, respectively; in the 50-69 group, dietary predominated IHD risk, hypertension IS, and smoking PAD; and among those aged ≥70 years, hypertension was the leading risk factor for both IHD and IS, and high fasting blood glucose was for PAD. ④ ARIMA model forecasted that by 2035, DALYs for IHD, IS, and PAD will increase to 82.816 million, 46.808 million, and 0.192 million person-years, respectively.

The ASCVD burden attributable to lifestyle and metabolic factors continues to rise in China from 1990 to 2021, and is projected to further increase by 2035.

We suggest that current prevention and control priorities are enhanced management of metabolic factors, tailored interventions by sex and age, promotion of healthy lifestyles and tobacco control, and establishment of an integrated system of prevention-treatment-rehabilitation-research.