Background:
Cardiovascular diseases (CVD) remain the leading cause of death in Germany. Quantifying their burden and temporal trends is essential to guide prevention and health policy. Using data from the Global Burden of Disease (GBD) 2023 Study, we examined the magnitude, composition, and temporal development of cardiovascular mortality in Germany from 1990 to 2023.
Methods:
GBD 2023 estimates for Germany were analyzed for major cardiovascular conditions, including ischemic heart disease, stroke, hypertensive heart disease, rheumatic heart disease, and cardiomyopathy. Outcomes comprised absolute deaths and age-standardized mortality rates per 100 000 population. Trends between 1990 and 2023 were assessed, stratified by sex and age where available. The relative contribution of metabolic, behavioral, and environmental risk factors was described using the GBD comparative risk assessment framework.
Results:
In 2023, cardiovascular diseases accounted for approximately one third of all deaths in Germany, corresponding to several hundred thousand deaths nationally. Among specific causes, ischemic heart disease remained the predominant contributor, with an age-standardized mortality rate of 198.7 deaths per 100 000 (95 % CI 167.9–215.6) in 2023, compared with 312.2 per 100 000 (288.4–326.0) in 1990 — representing a decline of about 36 % over three decades. Mortality from ischemic stroke fell from 115.9 to 56.8 per 100 000 (–51 %), while hemorrhagic stroke declined from 25.4 to 19.1 per 100 000 (–25 %). In contrast, rheumatic heart disease increased from 5.5 to 8.5 per 100 000 (+53 %), and hypertensive heart disease rose from 27.8 to 33.5 per 100 000 (+20 %). According to the GBD risk framework, high systolic blood pressure, elevated body mass index, dyslipidemia, and smoking remained the principal modifiable contributors to cardiovascular mortality, while air pollution also accounted for a measurable fraction of deaths.
Conclusions:
Despite a marked decline in age-standardized cardiovascular mortality since 1990, CVD continue to represent Germany’s foremost cause of death. Persistent exposure to metabolic and behavioral risk factors—particularly hypertension, obesity, and smoking—continues to sustain a substantial preventable burden. Strengthening population-wide prevention, promoting healthy lifestyles, and addressing regional disparities remain key priorities to reduce the cardiovascular disease burden in an aging population.
