Three decades of global ischemic heart disease burden: Trends, disparities, and drivers from 1990 to 2021.

Ischemic heart disease (IHD) remains a leading global health burden influenced by demographic transitions, socioeconomic disparities, and modifiable risk factors. Comprehensive analyses of global patterns are crucial to inform public health interventions. Using data from the Global Burden of Disease study 2021, we assessed global, regional, and national trends in IHD burden (1990-2021). Age-standardized rates of incidence, prevalence, mortality, and disability-adjusted life-years were evaluated. Trends were analyzed using estimated annual percentage change, age-period-cohort models, Bayesian forecasts, risk-factor attribution, decomposition analyses, health inequality, and frontier efficiency analyses. From 1990 to 2021, global IHD prevalence nearly doubled despite stable age-standardized rates, driven by population aging and growth. Eastern Europe exhibited consistently high disease burdens compared to sub-Saharan Africa. Significant gender disparities persisted, with higher burdens among males. High blood pressure, low-density lipoprotein cholesterol, and dietary risks dominated globally. Although age-standardized incidence and mortality declined, especially in high-sociodemographic index countries, absolute numbers increased due to demographic momentum. Forecasts suggest continued increases in absolute cases and deaths through 2035 despite declining standardized rates.Despite reductions in age-standardized IHD burden, substantial disparities persist. Future strategies should address demographic drivers, expand preventive efforts in lower-sociodemographic index regions, and enhance health system efficiency.