Abstract
BACKGROUND: Ischemic heart disease (IHD) remains a significant global health challenge despite advancements in prevention and treatment. This study aims to comprehensively analyze global IHD mortality trends from 1990 to 2021 and projections for 2036, to support evidence-based decision-making for IHD prevention and management strategies across diverse contexts. METHODS: Using data from the Global Burden of Disease Study 2021, we conducted multi-level analyses of IHD mortality trends: globally, across socio-demographic index (SDI) quintiles, 21 Global Burden of Disease (GBD) regions, and 204 countries. We performed age-period-cohort (APC), decomposition, risk factor, and frontier analysis. Bayesian APC modeling was used for projections to 2036. RESULTS: The global age-standardized mortality rate (ASMR) for IHD decreased from 1990 to 2021 (EAPC: -1.301%, net drift: -1.1%) despite a 67.5% increase in total deaths. APC analysis revealed exponential growth in IHD mortality rates with age, with the inflection point at 62.5 years in low SDI regions and 77.5 years in high SDI regions. High SDI regions demonstrated significant period and cohort effects. Frontier analysis showed that Nauru and Ukraine were the countries with the highest effective differences. Decomposition analysis identified population growth and aging as primary factors increasing IHD mortality. High systolic blood pressure remained the leading global risk factor, with increasing contributions from high fasting plasma glucose and high body-mass index, especially in high SDI regions. Projections indicate continued global ASMR decrease by 2036, but with concerning increases in Eastern Europe and some African regions. CONCLUSIONS: This study reveals the complex global landscape of IHD, emphasizing that high SDI regions should focus on comprehensive care for older adults and managing metabolic risk factors such as diabetes and obesity, while low and middle SDI regions need to strengthen healthcare systems and implement early prevention strategies. Regions projecting mortality increases require urgent attention and interventions. HIGHLIGHTS: What is new?: Global IHD age-standardized mortality rates decreased from 1990 to 2021 (EAPC: -1.301%, net drift: -1.1%), despite a 67.5% increase in total deaths, reflecting advancements in care and ongoing challenges of population aging and growth.APC analysis showed exponential growth in IHD mortality rates with age across all SDI regions, with low SDI regions' inflection point 15 years earlier than high SDI regions, suggesting prioritization of comprehensive care for the elderly in high SDI areas.Decomposition analysis showed South Asia and East Asia experienced the largest increases in IHD deaths, with epidemiological changes contributing to death increases rather than reductions, underscoring the need for effective policies to address population growth and aging in these rapidly developing regions.High systolic blood pressure remains the leading global risk factor for IHD, with increasing contributions from high fasting plasma glucose and high body-mass index, especially in high SDI regions.Projections indicate continued global ASMR decrease by 2036, but with concerning increases in Eastern Europe and some African regions, particularly Southern Sub-Saharan Africa, necessitating targeted interventions.What are the clinical implications?: High SDI regions should focus on comprehensive care for the elderly and managing metabolic risks like hypertension, diabetes, and obesity.Low and middle SDI regions need to strengthen healthcare systems and implement early prevention to combat rising IHD mortality.Regions with projected increases, such as Eastern Europe and Southern Sub-Saharan Africa, require urgent policy interventions and resource allocation to address disparities and improve preventive care access.