The evolving burden of ischemic heart disease in China, 1990-2023: Three decades of trends, risk factors, and future challenges

• From 1990 to 2023, the absolute number of ischemic heart disease cases and deaths in China nearly tripled, although age-standardized rates declined. • Population aging was the dominant driver, accounting for over 120% of the increase in disability-adjusted life years (DALYs), while epidemiological changes mitigated mortality and DALY rates. • High systolic blood pressure remained the leading risk factor, responsible for nearly 20 million DALYs, followed by lead exposure and high LDL cholesterol. • Significant sex and age disparities were observed, with a higher burden in middle-aged men but a shift towards higher prevalence and mortality in older women. • Projections to 2035 indicate an overall decline in total burden but a continued rise in cases among adults aged 60 and older. Ischemic heart disease represent a critical and growing public health challenge in China, against a backdrop of rapid demographic and epidemiological transitions. This comprehensive analysis aims to analyze the evolving burden, risk factors, and demographic drivers of ischemic heart disease in China from 1990 to 2023 to inform targeted policy and clinical interventions. Using data from the Global Burden of Disease 2023 study, we systematically examined ischemic heart disease prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors in China. A Bayesian Age-Period-Cohort model was applied for future predictions. From 1990 to 2023, the absolute number of ischemic heart disease prevalence cases in China increased by 174.95%, deaths by 173.76%, and DALYs by 100.02%. However, age-standardized mortality and DALY rates declined, indicating improvements in cardiovascular health management. Significant disparities were observed: males generally bore a higher burden, though females had higher prevalence after age 75 and higher mortality after 80. Decomposition analysis identified population aging as the primary driver, accounting for 124.46% of the increase in DALYs, while epidemiological changes mitigated mortality and DALY rates. High systolic blood pressure was the leading risk factor, followed by lead exposure and high LDL cholesterol. Smoking and dietary risks also contributed substantially. Projections to 2035 suggest an overall decline in total burden but a continued rise in cases among adults aged 60 and older. The findings highlight the urgent need for enhanced, equitable prevention strategies focusing on blood pressure control, environmental health, tobacco regulation, and dietary interventions, alongside integrated, patient-centered care models tailored to the aging population and gender-specific vulnerabilities of ischemic heart disease in China.