What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic heart disease. Intervention: Time period (1990-2021) vs. 1990 baseline. Primary outcome: Age-standardized prevalence rate (ASPR) of ischemic heart disease per 100,000 persons (EAPC 0.46, 95% CI 0.42-0.5).

October 14, 2025Frontiers in Cardiovascular Medicine1 citationsOpen Access

Global, regional, and national burden of ischemic heart disease in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2021: a systematic analysis of global burden of disease study 2021

WSWeijing SunThe University of Kansas Cancer Center PLPeijie LiGuangxi University QNQianqian NiNanjing University of Chinese Medicine

Key Result

Between 1990 and 2021, the global age-standardized prevalence rate of ischemic heart disease in youths and young adults increased from 164.242 to 195.157 per 100,000 persons (EAPC 0.46).

Study Design

Type

Observational

Structured PICO

What are the global trends and risk factors for ischemic heart disease burden among youths and young adults aged 15-39 years from 1990 to 2021?

Population

Global population of youths and young adults aged 15-39 years assessed for ischemic heart disease burden across 204 countries and territories from 1990 to 2021.

Outcome

Trends in age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years (DALYs) of ischemic heart disease from 1990 to 2021.hard clinical

While IHD-related mortality and DALYs in youths and young adults have decreased globally from 1990 to 2021, prevalence and incidence have increased, highlighting the need for targeted prevention strategies focusing on high LDL-C, smoking, and high systolic blood pressure.

Main Result

Effect estimate: EAPC 0.46 (95% CI 0.42-0.5)

Absolute Event Rate: 195.157% vs 164.242%

Limitations

Prevalence, incidence, mortality, and DALYs in low and middle SDI countries may be underestimated due to sparse or incomplete data.
Asymptomatic and mild nature of IHD in youths may introduce bias in the causal distribution of IHD in the GBD database.
Interactions between IHD comorbidities and risk factors for young people remain unknown.
The EAPC model assumes a constant exponential trend and may mask more complex, non-linear temporal patterns.
The predictive model is limited to forecasting the burden trend of IHD by gender, leaving future trends across different regions and age groups unclear.

Abstract

Background: Ischemic heart disease (IHD) remains a global public health challenge. This study explores global trends in IHD burden among youths and young adults aged 15-39 years from 1990 to 2021. Methods: Data were obtained from the 2021 Global Burden of Disease (GBD) study. Estimated annual percentage change was used to assess trends in age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years (DALYs). Risk factors were analyzed globally and by socio-demographic index (SDI) regions. Bayesian age-period-cohort models predicted trends over the next 30 years. Results: From 1990 to 2021, IHD-related mortality and DALYs declined overall, while prevalence and incidence increased. The largest increases in ASPR, ASIR, ASMR, and DALY rates were observed in middle-SDI regions. Geographically, Asia bore the heaviest burden, whereas high-income North America showed the greatest decreases in prevalence and incidence. In 2021, Oceania had the highest IHD-related deaths and DALYs, with Lesotho exhibiting the greatest rise in ASMR and DALY rates. The IHD burden rose with age, peaking in the 35-39 years group, and was higher in males. Major risk factors included high low-density lipoprotein cholesterol, smoking, and high systolic blood pressure. Projections suggest a global decline in IHD burden, with decreasing incidence and deaths across both sexes by 2050. Conclusions: While mortality and DALYs have decreased over the past 30 years, prevalence and incidence of IHD in youths and young adults have increased. The burden is projected to decline, emphasizing the need for targeted interventions, particularly in males aged 35-39 years, based on regional epidemiological patterns and risk factors.

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