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. 2025 Apr 25:13:1563631.
doi: 10.3389/fpubh.2025.1563631. eCollection 2025.

Global, regional, and national burden and risk factors of ischemic heart disease, 1990-2021: an analysis of the global burden of disease study

Quankai Cheng #  1 , Sheng Zhou #  1 , Haicheng Zhong  2 , Ziming Wang  1 , Chang Liu  1 , Jingjing Sun  1 , Jie Deng  1
Affiliations

Global, regional, and national burden and risk factors of ischemic heart disease, 1990-2021: an analysis of the global burden of disease study

Quankai Cheng et al. Front Public Health. .

Abstract

Background: With a rapidly growing and aging world population, ischemic heart disease (IHD) remains a major burden. This study aimed to reassess the prevalence trend of IHD from 1990 to 2021 from multiple dimensions to improve the shortcomings of the existing studies and provide a solid scientific basis for policymakers.

Methods: This study extracted data on the prevalence, incidence, mortality, disability-adjusted life years (DALYs), and associated risk factors of IHD from the global burden of disease (GBD) 2021 study. Descriptive, decomposition, and risk factor analyses were used to provide insights into the epidemiologic patterns of IHD from 1990 to 2021 and project the burden of IHD from 2022 to 2045. Potential differences in burden and risk factors based on age, sex, 21 GBD geographic regions, five social development index (SDI) regions, and 204 countries are highlighted.

Results: Globally, the age-standardized prevalence rate (ASPR) of IHD is increasing, while the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) are decreasing. ASPR, ASIR, ASMR, and ASDR were highest in the low-middle SDI regions and lowest in the high SDI regions. ASMR and ASDR were highest in Nauru and lowest in Portugal. Men had an overall heavier burden of IHD than women; the 65-69 age group had the largest burden, and those aged >95 years had the highest crude incidence rate. In addition, the burden of IHD was negatively correlated with SDI across regions and countries, while decomposition analyses suggest that the main reasons for the current increase in the burden of IHD are aging and population growth. Risk factors have changed relatively little over the 32 years, with metabolic risk still ranking first. We forecast that the absolute burden of IHD will continue to increase till 2045; however, ASIR, ASMR, and ASDR will gradually decline.

Conclusion: From 1990 to 2021, the global burden of IHD generally increased and varied across regions, sex, and age groups. Due to increasing population growth and aging, there is an urgent need for strategically directed measures to reduce the burden of IHD.

Keywords: decomposition analysis; forecast; global burden of disease; ischemic heart disease; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Trends in age-standardized prevalence (ASPR), age-standardized incidence (ASIR), age-standardized mortality (ASMR) and age-standardized disability-adjusted life years rate (ASDR) for ischemic heart disease from1990 to 2021.
Figure 2
Figure 2
Crude prevalence rate of IHD by sex, age group, and SDI, 1990 and 2021. IHD, ischemic heart disease; SDI, sociodemographic index.
Figure 3
Figure 3
Age-sex-specific numbers and crude rates of IHD burden by SDI region in 2021. (A) Crude prevalence rate for IHD; (B) Crude incidence rate for IHD; (C) Crude morality rate for IHD; and (D) Crude DALYs rate for IHD. IHD, ischemic heart disease; DALYs, Disability-Adjusted Life Years; SDI, sociodemographic index.
Figure 4
Figure 4
Global map of age-standardized prevalence, incidence, mortality, and DALYs rate for IHD in 2021. (A) Age-standardized of prevalence rate; (B) Age-standardized of incidence rate; (C) Age-standardized of mortality rate; (D) Age-standardized of DALYs rate. IHD, ischemic heart disease; DALYs, Disability-Adjusted Life Years.
Figure 5
Figure 5
Trends in age-standardized prevalence, incidence, mortality, and DALYs rate for IHD from 1990 to 2021 (EAPC). (A) Age-standardized of prevalence rate; (B) Age-standardized of incidence rate; (C) Age-standardized of mortality rate; (D) Age-standardized of DALYs rate. IHD, ischemic heart disease; EAPC, estimated annual percentage change; DALYs, Disability-Adjusted Life Years.
Figure 6
Figure 6
Decomposition analysis of changes in IHD prevalence, incidence, mortality, and DALYs by SDI region from 1990 to 2021. (A) Decomposition analysis of changes in prevalence of IHD; (B) Decomposition analysis of changes in incidence of IHD; (C) Decomposition analysis of changes in mortality of IHD; and (D) Decomposition analysis of changes in DALYs of IHD. IHD, ischemic heart disease; DALYs, Disability-Adjusted Life Years; SDI, sociodemographic index.
Figure 7
Figure 7
Ranking of risk factors contributing to the global and regional ASDR for IHD. (A) 1990; (B) 2021. IHD, ischemic heart disease; ASDR, age-standardized disability-adjusted life years rate.
Figure 8
Figure 8
Forecasts of the global burden of ischemic heart disease from 2022 to 2045. (A) Number of cases and ASR projections for prevalence; (B) Number of cases and ASR projections for incidence; (C) Number of cases and ASR projections for mortality; (D) Number of cases and ASR projections for DALYs. ASR, age-standardized rate; DALYs, disability-adjusted life-years; ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate.
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