Divergent Trends in Stroke and Ischemic Heart Disease Mortality and Disability in Western Sub-Saharan Africa Compared with Global Progress, 1990-2023

Background Cardiovascular disease remains the leading cause of death worldwide, yet progress in reducing its burden has not been shared equally across regions. Sub-Saharan Africa has previously been identified as the only world region where age-standardized cardiovascular mortality failed to decline, but long-term, disease-specific trends in Western Sub-Saharan Africa (WSSA) remain poorly characterized. Methods We conducted an ecological trend analysis using Global Burden of Disease (GBD) 2023 data to evaluate age-standardized mortality and disability-adjusted life years (DALYs) for stroke and ischemic heart disease (IHD) in WSSA and globally from 1990 to 2023. Linear and segmented regression assessed long-term trends and breakpoints, risk factor attribution examined six major cardiovascular risk factors, and Pearson correlation evaluated associations between the Socio-demographic Index (SDI) and mortality. Results Global stroke and IHD mortality declined by 51.7% and 38.2%, respectively, between 1990 and 2023. In WSSA, stroke mortality declined by only 21.8%, while IHD mortality increased by 3.3%. Segmented regression identified a breakpoint in IHD mortality around 2007, after which the trend reversed from declining to increasing. High systolic blood pressure was the leading attributable risk factor for both diseases, while obesity, ambient air pollution, and elevated fasting glucose showed the largest relative increases. SDI rose 69.5% in WSSA but correlated strongly only with stroke mortality (r = 0.87), not IHD (r = 0.21). Conclusions WSSA is falling behind global cardiovascular progress, with IHD mortality reversing course despite substantial socioeconomic development. Targeted investment in hypertension control, cardiometabolic risk reduction, and cardiovascular care capacity is urgently needed to prevent this divergence from deepening.