Sex Disparities in Ischemic Heart Disease in South Asia

Figure 1. Trends in ASMR for IHD (2005 vs 2021) Trends in age-standardized mortality rates (ASMRs) per 100,000 inhabitants for ischemic heart disease (IHD), stratified by country and sex, comparing 2005 and 2021 using GBD (Global Burden of Disease) 2021 data. Mortality rates are represented by crosses, with purple indicating 2005 and red representing 2021. Horizontal lines denote the third quartile of ASMR for 2005 (purple) and 2021 (red). Arrows indicate the direction of change: upward arrows for increasing mortality trends and downward arrows for declining mortality trends.

Figure 2. Trends in ASPR for IHD (2005 vs 2021) Trends in age-standardized prevalence rates (ASPRs) of IHD, stratified by country and sex, comparing 2005 and 2021 based on GBD 2021 data. Prevalence rates are represented by crosses, with purple indicating 2005 and red representing 2021. Horizontal lines denote the third quartile of prevalence for 2005 (purple) and 2021 (red). Arrows indicate the direction of change: upward arrows for increasing prevalence and downward arrows for decreasing prevalence. Other abbreviation as in Figure 1.

Figure 3. Trends in IHD Mortality Normalized by Prevalence (2005 vs 2021) Trends in IHD mortality normalized by its prevalence (ASMR to ASPR index), stratified by country and sex, from 2005 to 2021 using GBD 2021 data. The index is represented by crosses, with purple denoting 2005 and red representing 2021. Horizontal lines indicate the third quartile of the index for 2005 (purple) and 2021 (red). Arrows depict the direction of change: upward arrows for an increasing ASMR-to-ASPR index and downward arrows for a decreasing index. Abbreviations as in Figures 1 and 2.

Figure 4. Women-to-Men Risk Ratio Change, Prevalence-Normalized (2005 vs 2021) Changes in the women-to-men risk ratio for IHD mortality, adjusted for its prevalence (ASMR-to-ASPR index), across South Asian countries from 2005 to 2021, using GBD 2021 data. The left panel displays risk ratios, with a red vertical line at 1.0, indicating equal mortality risk between sexes. Data points positioned to the right suggest higher mortality risk in women, whereas those to the left indicate higher mortality risk in men. The right panel presents maps showing the percentage increase in mortality risk, with darker shades representing greater increases over time. Abbreviations as in Figures 1 and 2.

Figure 5. Women-to-Men Risk Ratios Attributable to Behavioral and Metabolic Risk Factors Women-to-men risk ratios for IHD mortality linked to behavioral and metabolic risk factors in South Asia, using GBD 2021 data. Red circles represent risk ratios, with grey horizontal line representing 95% uncertainty intervals. The red vertical line at 1.0 indicates equal mortality between sexes. BMI = body mass index; LDL = low-density lipoprotein; other abbreviations as in Figures 1 and 2.

Figure 6. Women-to-Men Risk Ratios Attributable to Dietary Risk Factors Women-to-men risk ratios for mortality linked to dietary risk factors in South Asia, based on GBD 2021 data. The ratios highlight sex-specific differences in mortality attributable to dietary factors, including low vegetable and fiber intake. Risk factors are grouped with countries color-coded for clarity. Abbreviation as in Figure 1.

Central Illustration. Sex Disparities in IHD Mortality in South Asia Regional sex disparities in ischemic heart disease (IHD) mortality across South Asia from 2005 to 2021, using Global Burden of Disease data. Shown are age-standardized mortality-to-prevalence ratios (ASMR-to-ASPR index), with maps showing that women in Pakistan consistently experienced higher mortality risk compared with men. Z-score analysis identified high systolic blood pressure and low vegetable and fiber intake as major contributors to excess mortality in Pakistani women. These findings underscore the importance of targeted dietary and metabolic interventions. Arrows indicate relationships between concepts. Darker map shading reflects higher relative mortality risk. Purple highlights key risk factors identified in Z-score analysis.