JMIR Publications

ABSTRACT

Background:

Although ischemic heart disease (IHD) is the leading cause of death among non-communicable diseases (NCDs) worldwide, data on current epidemiological patterns and associated risk factors are lacking.

Objective:

This study assessed global, regional, and national trends in IHD mortality and attributable risks since 1990.

Methods:

Mortality data were obtained from the Global Burden of Disease 2019 Study. We utilized age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to > 95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level.

Results:

There were 9.14 (8.40 to 9.74) million IHD-related deaths across 204 countries and territories in 2019, accounting for 19.72% of global NCDs-related deaths. The global age-standardized mortality rate for IHD decreased by 30.8% (-34.83 to -27.17) over the past 30 years. Globally, the age-period-cohort model estimated a net drift of IHD mortality of -1.15% (95% CI -1.21 to -1.09), ranging from -2.89% (-3.07 to -2.71) in high socio-demographic index (SDI) region to -0.24% (-0.32 to -0.16) in low-middle SDI region. The greatest improvement in IHD mortality occurred in the Republic of Korea (high SDI) with net drift -6.06% (-6.23 to -5.88), followed by nations from 5 high SDI (Denmark, Norway, Estonia, Netherlands, and Ireland) and 2 high-middle SDI nations (Israel and Bahrain) with net drift < -5.00%. Aging is an independent risk factor for mortality from IHD, with sex differences in period and cohort risks across lower income countries. Although metabolic risks were the leading variables for mortality from IHD worldwide in 2019, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks, and smoking and high-sodium diet mainly in males.

Conclusions:

IHD mortality remains a leading health problem requiring the health care system to focus on this problem. Preventive measures should be prioritized to deal with metabolic, behavioral, and environmental risks.