Cardiovascular burden fell for 20 years. US maternal mortality stayed an outlier.

Cardiovascular disease is the leading cause of death in women worldwide and a primary contributor to maternal mortality in the United States [s1]. Those two facts are usually discussed in separate literatures — cardiology in one, obstetrics in the other. An analysis published in JACC: Advances in June puts them in the same frame, using Global Burden of Disease 2023 data to compare US women of reproductive age with their counterparts in other high-income countries [s1].

What was compared

The analysis covered women aged 15 to 49 and ran from 2003 to 2023 [s1]. It evaluated cardiovascular disease prevalence and disability-adjusted life years, cardio-kidney-metabolic risk factors, maternal mortality rates, and mortality attributed to hypertensive disorders of pregnancy [s1].

"Cardio-kidney-metabolic" is a framing the cardiology field has adopted in recent years to describe the interlocking cluster of adiposity, dysglycaemia, blood pressure and kidney function, rather than treating each as a separate risk factor.

The direction of travel was good

Over the 20 years, US cardiovascular disease prevalence among women of reproductive age declined from 3.7% to 3.1%, and disability-adjusted life year rates fell by 20% [s1].

That is genuine improvement over two decades. It is also the whole of the good news in this paper. Despite the decline, US cardiovascular burden in this group remained higher than in other high-income countries [s1].

The risk factor gaps

Where the comparison widens is in the risk factors. Disability-adjusted life year rates attributable to cardio-kidney-metabolic factors in the United States, relative to other high-income countries, were [s1]:

• 4-fold higher for body mass index above 21 kg/m²
• 3-fold higher for fasting plasma glucose above 95 mg/dL
• 2-fold higher for systolic blood pressure above 115 mm Hg

Note the thresholds. These are not clinical diagnostic cut-offs — a BMI of 21 is squarely within the normal range, and a systolic pressure of 115 mm Hg is not hypertension. They are the theoretical minimum-risk exposure levels the Global Burden of Disease study uses to attribute burden, which means these figures describe the whole population distribution shifting, not just the tail.

Maternal mortality

In 2023, the United States and Southern Latin America had the highest maternal mortality rates among the regions compared, at 33.8 and 65.2 per 100,000 live births respectively [s1]. Mortality attributed to hypertensive disorders of pregnancy was 2.8 and 8.9 per 100,000 live births for the same two [s1].

The United States being grouped with the highest-mortality regions in a comparison of high-income countries is the finding, and it sits awkwardly beside the 20-year decline in cardiovascular disability in the same population [s1].

What the design can and cannot support

This is an analysis of modelled burden estimates, not of individual patient records. Global Burden of Disease figures are constructed from vital registration, survey and administrative data with substantial statistical modelling in between, and the uncertainty around any single national estimate is wider than a point figure suggests.

It is also ecological. Showing that a country has both high cardio-kidney-metabolic burden and high maternal mortality does not establish that the first causes the second in individual pregnancies, even where the mechanism is plausible and hypertensive disorders of pregnancy are reported separately [s1].

Nor does the analysis address the distributional question that dominates US maternal mortality discussion. A national rate averages across groups whose rates differ substantially, and this comparison is between countries rather than within them.

What the authors conclude

That US women of reproductive age face a disproportionate burden of cardiovascular disease, cardio-kidney-metabolic risk factors and maternal mortality relative to other high-income countries, and that integrating early cardiovascular and cardio-kidney-metabolic screening and management into US health care should be an urgent national priority [s1].

That is a recommendation about health system design, and this paper is evidence of a gap rather than evidence that the proposed remedy closes it. What the analysis does establish is that the two problems — chronic cardiometabolic risk in young women, and deaths around pregnancy — are the same problem measured at two points in time.

This article is informational and is not medical advice.

Sources

• Maternal Mortality and Cardio-Kidney-Metabolic Risk Factors Across High-Income Countries — JACC: Advances, 2026-06-17