{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:33:49Z","timestamp":1791250429525,"version":"4.1.0"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"unspecified","delay-in-days":91,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiovascular diseases (CVDs) are the leading cause of death globally, with increasing prevalence and mortality rates. The COVID-19 pandemic has exacerbated CVD-related morbidity and mortality, particularly in vulnerable populations. Peru, a country with significant socioeconomic disparities and one with the highest COVID-19 mortality rates worldwide, experienced a dramatic rise in CVD deaths during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of the COVID-19 pandemic on CVD mortality in Peru, comparing pre-pandemic (2017\u20132019)\u2009and pandemic periods (2020\u20132021), and to describe the distribution of CVD deaths by age, sex and region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational study analysed data from Peru\u2019s National Death Information System from 2017 to 2021. CVD-related deaths were categorised by type (acute coronary syndrome, heart failure, arrhythmia, heart attack and stroke), age, sex and region. Statistical analyses included one-way analysis of variance, paired t-tests and geographical mapping using ArcGIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 28 197 CVD deaths were recorded, with 8821 in the pre-pandemic period and 19\u2009376 during the pandemic (p&lt;0.001). Deaths due to heart attack and stroke increased 1.7 (3551 vs 6017, p=0.016) and 62.7 (109 vs 6833, p&lt;0.001) times, respectively. The &gt;80\u2009age group accounted for the highest proportion of deaths (44.7\u201348.4%), followed by the 60\u201380\u2009age group. Males exhibited higher mortality than females across all years. Heart attack was the leading cause of death, peaking in 2020 (3148 (36.8%) and 2626 (30.7%)). Stroke-related deaths surged in 2021 (32.7% males, 30.1% females). Regionally, Lima and Arequipa had the highest CVD mortality rates, with Lima reporting the highest stroke (23.9%) and arrhythmia (54.8%) deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The COVID-19 pandemic significantly increased CVD mortality in Peru, with marked rises in heart attack and stroke-related deaths. Older adults and males were disproportionately affected. Regional disparities highlight the need for targeted interventions in high-burden areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003729","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:15:32Z","timestamp":1775146532000},"page":"e003729","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Increase in cardiovascular deaths during the COVID-19 pandemic in Peru: a 5-year analysis of the national death system"],"prefix":"10.1136","volume":"13","author":[{"given":"Jeel","family":"Moya-Salazar","sequence":"first","affiliation":[{"name":"GRINA, Faculty of Medicine, Universidad Se\u00f1or de Sip\u00e1n, Chiclayo, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhonny","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro de Salud Mancora, Piura, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen A","family":"Mar\u00edn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro de Salud Puca Cruz, Huancayo, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila B","family":"Palomino-Leyva","sequence":"additional","affiliation":[{"name":"Department of Medicine, Puesto de Salud Anra, Ancash, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosario","family":"La Torre","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro de Salud PNP de Nazca, Ica, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betsy","family":"Ca\u00f1ari","sequence":"additional","affiliation":[{"name":"GRINA, Faculty of Medicine, Universidad Se\u00f1or de Sip\u00e1n, Chiclayo, Peru"},{"name":"Qualitative Unit, Nesh Hubbs, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"Peralta-Hilario","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital Nacional Alberto Sabogal Sologuren, Callao, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4750-7496","authenticated-orcid":false,"given":"Eliane A","family":"Goicochea-Palomino","sequence":"additional","affiliation":[{"name":"Faculty of Health Science, Universidad Tecnologica del Peru, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Pardo-Villarroel","sequence":"additional","affiliation":[{"name":"Laboratorio de Planificaci\u00f3n Territorial, Facultad de Recursos Naturales, Departamento de Ciencias Ambientales, Universidad Cat\u00f3lica de Temuco, Rudecindo Ortega, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Uribe-Veloso","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias, Universidad San Sebasti\u00e1n, Concepci\u00f3n, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026090204551018000_13.1.e003729.1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"2026090204551018000_13.1.e003729.2","doi-asserted-by":"crossref","first-page":"I","DOI":"10.21470\/1678-9741-2022-0954","article-title":"The Need for Creating a Unified Knowledge of Cardiovascular Diseases in Latin America","volume":"37","author":"Urina-Jassir","year":"2022","journal-title":"Braz J Cardiovasc Surg"},{"key":"2026090204551018000_13.1.e003729.3","doi-asserted-by":"crossref","DOI":"10.5334\/gh.1123","article-title":"Equity and Prevention of Cardiovascular Diseases in Latin America and the Caribbean","volume":"17","author":"Ramos","year":"2022","journal-title":"Glob Heart"},{"key":"2026090204551018000_13.1.e003729.4","doi-asserted-by":"crossref","DOI":"10.29333\/ejgm\/14160","article-title":"Inequality in the distribution of resources and health care in the poverty quintiles: Evidence from Peruvian comprehensive health insurance 2018-2019","volume":"21","author":"Huarachi","year":"2024","journal-title":"Electron J Gen Med"},{"key":"2026090204551018000_13.1.e003729.5","doi-asserted-by":"crossref","first-page":"399","DOI":"10.17843\/rpmesp.2021.383.7804","article-title":"Incidence rate of stroke in Peru","volume":"38","author":"Bernab\u00e9-Ortiz","year":"2021","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"2026090204551018000_13.1.e003729.6","unstructured":"World Health Organization . 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