BACKGROUND: The association between nonoptimal temperatures and cardiovascular mortality risk is recognized. However, a comprehensive global assessment of this burden is lacking. OBJECTIVES: The goal of this study was to assess global cardiovascular mortality burden attributable to nonoptimal temperatures and investigate spatiotemporal trends. METHODS: Using daily cardiovascular deaths and temperature data from 32 countries, a 3-stage analytical approach was applied. First, location-specific temperature-mortality associations were estimated, considering nonlinearity and delayed effects. Second, a multivariate meta-regression model was developed between location-specific effect estimates and 5 meta-predictors. Third, cardiovascular deaths associated with nonoptimal, cold, and hot temperatures for each global grid (55 km × 55 km resolution) were estimated, and temporal trends from 2000 to 2019 were explored. RESULTS: Globally, 1,801,513 (95% empirical CI: 1,526,632-2,202,831) annual cardiovascular deaths were associated with nonoptimal temperatures, constituting 8.86% (95% empirical CI: 7.51%-12.32%) of total cardiovascular mortality corresponding to 26 deaths per 100,000 population. Cold-related deaths accounted for 8.20% (95% empirical CI: 6.74%-11.57%), whereas heat-related deaths accounted for 0.66% (95% empirical CI: 0.49%-0.98%). The mortality burden varied significantly across regions, with the highest excess mortality rates observed in Central Asia and Eastern Europe. From 2000 to 2019, cold-related excess death ratios decreased, while heat-related ratios increased, resulting in an overall decline in temperature-related deaths. Southeastern Asia, Sub-Saharan Africa, and Oceania observed the greatest reduction, while Southern Asia experienced an increase. The Americas and several regions in Asia and Europe displayed fluctuating temporal patterns. CONCLUSIONS: Nonoptimal temperatures substantially contribute to cardiovascular mortality, with heterogeneous spatiotemporal patterns. Effective mitigation and adaptation strategies are crucial, especially given the increasing heat-related cardiovascular deaths amid climate change.

Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia

Department of Environmental Health Harvard T H Chan School of Public Health Harvard University Boston Massachusetts USA

Department of Epidemiology School of Public Health Cheeloo College of Medicine Shandong University Jinan China

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London United Kingdom

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London United Kingdom; Institute of Social and Preventive Medicine University of Bern Bern Switzerland; Oeschger Center for Climate Change Research University of Bern Bern Switzerland

Department of Public Health University of Otago Wellington New Zealand

Department of Statistics Computer Science and Applications G Parenti University of Florence Florence Italy

Environment and Health Modelling Lab Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London United Kingdom

Environmental Health Department Instituto Nacional de Saúde Dr Ricardo Jorge Porto Portugal; EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional Porto Portugal

Institute of Atmospheric Physics Czech Academy of Sciences Prague Czech Republic; Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

School of Public Health and Social Work Queensland University of Technology Brisbane Australia; National Institute of Environmental Health Chinese Center for Disease Control and Prevention Beijing China

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