Global Trends in Ischemic Heart Disease Mortality from 1990 to 2021 and 2036 Projections: Insights from GBD 2021 Data.

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: