Abstract: Background Metabolic risk factors have become a primary driver of the increasing burden of cardiovascular diseases（CVDs） in China.Objective To assess the temporal trends of CVD burden attributable to metabolic risk factors in China from 1990 to 2021 and project the future burden through 2035 using the BAPC model. Methods Based on data from the Global Burden of Disease Study 2021（GBD 2021），we quantified the contributions of level 1 and major level 2 risk factors（e.g.，high blood pressure，air pollution，smoking，high LDL cholesterol，and dietary risks） to CVD mortality and disability-adjusted life years（DALYs） using the population attributable fraction（PAF） method. Joinpoint regression was applied to estimate the average annual percent change（AAPC） of CVD burden attributable to metabolic factors from 1990 to 2021. A Bayesian age-period-cohort（BAPC） model was used to project future burden trends from 2022 to 2035. Results From 1990 to 2021，the age-standardized DALY rate of CVDs attributable to metabolic factors declined by 4.3%（3 927.3 per 100 000 to 3 756.4 per 100 000），while the mortality rate increased by 24.9%（169.3 per 100 000 to 211.5 per 100 000）. In 2021，metabolic factors accounted for 68.6% of CVD-related DALYs and 70.1% of CVD deaths. Elevated systolic blood pressure remained the leading risk factor，contributing 53.3% and 55.4% to DALYs and deaths，respectively. Among the four main metabolic risks，high body mass index（BMI） showed the most significant increase，with the attributable DALY rate rising from 281.04 to 396.09 per 100，000（AAPC=1.08%，P<0.000 1），and the mortality rate increasing from 13.73 per 100 000 to 18.80 per 100 000（AAPC=1.00%，P<0.000 1）. In contrast，the burden associated with high fasting plasma glucose and high LDL cholesterol changed minimally，with most AAPCs showing no statistical significance. Age-and sex-stratified analyses indicated the heaviest burden among older males，with widening gender differences at older ages.Projections based on the BAPC model suggest a continued decline in CVD burden by 2035: for males，the mortality rate is projected to decrease from 291.97 per 100 000 to 183.33 per 100 000 and the DALY rate from 5 296.99 per 100 000 to 3 274.07 per 100 000; for females，mortality is projected to decline from 149.26 to 103.00 per 100，000 and DALYs from 2 863.17 per 100 000 to 1 814.15 per 100 000. A clear downward inflection point is expected around 2030 in males，while a steady decline is projected for females. All model predictions had mean absolute percentage errors（MAPE） below 2%，indicating high predictive accuracy. Conclusion High BMI and high blood pressure remain the predominant metabolic risk factors for CVDs in China. The projected burden attributable to these risks is expected to continue rising，with males and older adults experiencing a higher burden. Younger adults are increasingly affected by BMI-related risks，highlighting the need for targeted，stratified prevention strategies.

Key words: Cardiovascular disease, Metabolic risk factors, Global Burden of Disease, DALYs, Mortality, Projection

摘要： 背景 代谢因素已成为中国心血管疾病（CVD）负担持续上升的主要驱动。目的 评估1990—2021年中国归因于代谢风险因素的CVD负担变化趋势，并利用BAPC模型预测2022—2035年前的发展态势。方法 基于GBD 2021数据库，采用人群归因分值（PAF）法量化一类风险因素和主要二类风险因素（高血压、空气污染、吸烟、高低密度脂蛋白胆固醇、饮食相关风险等）对CVD死亡与伤残调整生命年（DALYs）的贡献。通过Joinpoint回归分析1990—2021归因于代谢因素的CVD年变化趋势，并计算出主要代谢因素归因负担的年均变化百分比（AAPC），最后结合贝叶斯年龄-周期-队列（BAPC）模型预测2022—2035年的负担趋势。结果 1990—2021年，中国归因于代谢因素的CVD年龄标化DALYs率下降4.3%（3 927.3/10万至3 756.4/10万），死亡率上升24.9%（169.3/10万至211.5/10万）。2021年，代谢因素对CVD的DALYs和死亡PAF分别为68.6%和70.1%，高血压始终为首位致病因素，其DALYs和死亡的归因分值（PAF）分别为53.3%和55.4%。四种主要代谢因素中，高体重指数相关负担增速最显著，其归因DALYs率由281.04/10万人上升至396.09/10万人（AAPC=1.08%，P<0.000 1），死亡率由13.73/10万人增至18.80/10万人（AAPC=1.00%，P<0.000 1）相比之下，高空腹血糖和高低密度脂蛋白胆固醇相关负担变化幅度较小，DALYs率和死亡率在此期间变动不大，且大多数AAPC差异无统计学意义。性别与年龄分层结果显示，高龄男性人群负担最重，性别差异随年龄增长而扩大。基于BAPC模型的预测显示，至2035年CVD负担将呈持续下降趋势：男性死亡率将由2022年的291.97/10万降至2035年的183.33/10万，女性由149.26/10万降至103.00/10万；男性DALYs率将由5296.99/10万降至3274.07/10万，女性由2863.17/10万降至1814.15/10万。预测显示男性人群在2030年前后出现明显下降拐点，女性则呈持续平稳下降趋势，四项指标的平均绝对百分比误差（MAPE）均低于2%，预测精度较高。结论 高BMI与高血压为主要代谢风险因素，预测显示其归因负担或持续上升，男性与老年人群负担更重，中青年BMI相关风险突出，应加强分层防控。

关键词: 心血管疾病, 代谢因素, 全球疾病负担, DALYs, 死亡率, 预测