Abstract
BACKGROUND: High trans-fatty acid (TFA) intake is a major modifiable risk factor for cardiovascular disease (CVD), especially in older adults. This study aimed to assess global trends and health inequalities in CVD burden attributable to high TFA intake from 1990 to 2021 and project future patterns through 2036. METHODS: Using data from the Global Burden of Disease (GBD) Study 2021, we analyzed age-standardized mortality rates (ASMR), disability-adjusted life years (ASDR), and inequality indicators across 204 countries and territories. Age-Period-Cohort (APC) models and Bayesian projections were applied to estimate future trends. RESULTS: Globally, ASMR and ASDR attributable to high TFA intake declined by 69 and 68%, respectively, from 1990 to 2021. The most significant reductions were observed in high-SDI regions, where comprehensive TFA bans and public health policies were implemented. In contrast, the absolute burden remains high in low- and middle-SDI countries due to limited policy enforcement and dietary interventions. Socioeconomic inequalities narrowed over time, but vulnerable populations still face elevated risks. Projections indicate a continued global decline in CVD burden attributable to TFA through 2036, though widening uncertainties reflect demographic and policy challenges. CONCLUSION: While global progress in reducing TFA-related CVD burden is evident, persistent disparities and emerging risks in low-resource settings underscore the need for global elimination of industrial TFA, strengthened health systems, and targeted strategies to protect high-risk groups.