Cardiovascular mortality attributable to dietary risk factors in 54 countries in the WHO European Region from 1990 to 2019: an updated systematic analysis of the Global Burden of Disease Study

Abstract Aims This study aimed to estimate the association between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region (WHO ER) by age and sex using the data of the Global Burden of Diseases Study (GBD) from 1990 to 2019. Methods and results For this purpose, 13 dietary risks and 13 forms of CVDs were included in the study, and the comparative risk assessment framework of the GBD was used to estimate the deaths attributable to them. The study included four regions, with a total of 54 countries. In 2019, 1.55 million (95 % UI, 1.2-1.9 million) people in the WHO ER died from CVDs attributable to suboptimal diet. Diet-related CVD deaths (DRCDs) accounted for 16.4 % of total deaths and 36.7 % of CVD deaths in 2019. Between 1990 and 2019, there was a DRCDs reduction of 8.1 % and the age-standardized death rate decreased. The deaths were almost equally distributed between women (777 714 deaths) and men (772 519 deaths). The distribution of death numbers between the sexes has changed only slightly over the study period. The largest percentage across the age groups was found in the group 85+ years (32.1 %). Most DRCDs in the WHO ER were caused by a diet low in whole grains (326 755 deaths), followed by a diet low in legumes (232 918 deaths) and a diet high in sodium (193 713 deaths). Overall, 80.3% of deaths were due to ischaemic heart disease, which was the most common cause of death in all countries. Conclusion In terms of CVD deaths in the WHO ER, more than every third death is attributable to an unbalanced diet, making the diet one of the most important factors in preventing premature CVD death in the WHO ER.