Global, Regional, and National Time Trends in Mortality for Ischemic Heart Disease, 1990-2019: An Age-Period-Cohort Analysis for the Global Burden of Disease 2019 Study.

Background: Ischemic heart disease (IHD) is the leading cause of mortality and disability worldwide. This study aimed to investigate global trends in IHD mortality across 204 countries and territories over the past 30 years and explore the influence of age, period, birth, and cohort effects on mortality. Methods: IHD mortality data were retrieved from the Global Burden of Disease (GBD) 2019 study. Temporal trends in the number of deaths, all-age mortality rates, and age-standardized mortality rates were assessed across countries grouped by sociodemographic index (SDI) quintiles. To quantify changes over time, we fitted age-period-cohort (APC) models and derived overall annual percentage changes (net drift) and age-specific annual percentage changes (local drift). The APC model was then used to distinguish the independent effects of age, period, birth, and cohort on IHD mortality trends. Results: The annual global IHD deaths increased from 5.70 million (95% uncertainty interval (UI): 5.41-5.90) to 9.14 million between 1990 and 2019 (95% UI: 8.40-9.74). All-age mortality rates also rose significantly, with a notable shift in deaths toward older populations (≥70 years). The global net drift in IHD mortality declined by 1.10% annually (95% confidence interval (CI): -1.17% to -1.04%), with high-SDI countries experiencing the greatest decline (-2.84%, 95% CI: -3.05% to -2.64%). Age, period, and birth cohort effects manifested a general declining trend. The largest positive net drift was observed in the Philippines (3.60%, 95% CI: 3.33%-3.86%). Key global risk factors included hypertension, elevated low-density lipoprotein cholesterol, ambient particulate matter pollution, and smoking. However, low temperatures were the leading environmental risk factor in high-SDI countries. Conclusions: From 1990 to 2019, the global burden and temporal trends for IHD mortality varied substantially across SDI quintiles, sex, geographic regions, and countries. These disparities underscore the need for region-specific, risk-differentiated, and cost-effective interventions to prevent and manage IHD. Moreover, strengthening primary healthcare, improving health system responsiveness, and enhancing health promotion and prevention efforts are critical, especially in regions where IHD mortality remains stable or is increasing.