Abstract Body (Do not enter title and authors here): Background: High fasting plasma glucose (HFPG) is a major metabolic risk factor driving the global burden of cardiovascular disease (CVD). However, temporal trends in HFPG-attributable CVD burden across Socio-Demographic Index (SDI) levels remain underexplored, particularly with updated estimates from the Global Burden of Disease (GBD) 2021 study.

Objective: To assess global, regional, and SDI-specific trends in CVD burden attributable to HFPG from 1990 to 2021.

Methods: We analyzed HFPG-attributable CVD mortality and disability adjusted life years (DALYs) using GBD 2021 data. Trends were evaluated using annual percentage change (APC) in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR), by SDI, location, and sex.

Results: From 1990 to 2021, globally, the APC for ASMR declined by 13% and for ASDR by 8%. Female ASMR decreased more sharply (−18%) than male ASMR (−9%). The greatest reduction in APC for ASMR and ASDR was observed in Singapore, while the highest increase occurred in Lesotho. APC for ASMR rose in low-middle SDI countries, followed by low SDI countries, whereas the largest declines were noted in high SDI countries, followed by high-middle SDI countries. In 2021, deaths were highest among individuals aged 80–84 years, while DALYs peaked in those aged 70–74 years.

Conclusion: In 2021, deaths due to ischemic heart disease and stroke attributable to HFPG accounted for 14.97% and 11.61%, respectively. While high and high-middle SDI countries have achieved substantial gains, low and low-middle SDI countries continue to face rising challenges. These findings highlight the need for region-specific public health policies to reduce the disproportionate impact of HFPG-related cardiovascular disease.