Between 1990 and 2013, cardiovascular death rates increased by 40.8 percent despite a 39.3 percent decrease in age-specific death rates, according to an analysis of the Global Burden of Disease study.

Lead researcher Gregory A. Roth, MD, MPH, of the University of Washington in Seattle, and colleagues noted that the increase was mostly due to an aging population and population growth.

Results were published online April 2 in the New England Journal of Medicine.

The Global Burden of Disease study included data from 188 countries, and the researchers identified 10 cardiovascular causes of death: ischemic heart disease, ischemic stroke, hemorrhagic stroke, hypertensive heart disease, cardiomyopathy and myocarditis, rheumatic heart disease, aortic aneurysm, atrial fibrillation and flutter, endocarditis and peripheral vascular disease.

In 2013, 17.3 million people died from cardiovascular disease. After determining the number of deaths, researchers put the causes of deaths into three explanatory categories: growth in the total population, change in the population structure with regard to age and sex and change in the age-, sex- and cause-specific rates of death.

They found the number of cardiovascular deaths attributed to population aging increased 55 percent and the number of cardiovascular deaths attributed to population growth increased 25.1 percent between 1990 and 2013. During that time period, the number of deaths due to ischemic heart disease increased by 2.4 million, representing the largest number of cardiovascular-related deaths.

In terms of regions, South Asia (97.4 percent increase) and East Asia (47.2 percent increase) had the largest increases in cardiovascular deaths during the period studied. Central Europe and Western Europe were the only regions to have decreases in cardiovascular deaths. They experienced declines of 5.2 percent and 12.8 percent, respectively.

In high-income North America, there was no detectable change in the number of cardiovascular deaths, according to the researchers. They said some high-income regions had large decreases in cardiovascular deaths due to epidemiologic change. Possible reasons include a decrease in exposure to tobacco smoking, improvements in diet and improvements in treating and preventing cardiovascular disease.

The researchers said cause-specific mortality data were limited in some countries, so the estimates of cardiovascular mortality may not be totally accurate. However, they said the Global Burden of Disease study used rigorous out-of-sample predictive validity testing, which increased their confidence in the accuracy of the data.