Contributions of diet and lifestyle to sex differences in ischaemic heart disease burden in Central Europe: an analysis of the Global Burden of Disease Study 2023

Background Central Europe carries a substantial global burden of ischaemic heart disease (IHD). We aimed to quantify sex-specific differences in IHD case-fatality across 13 Central European countries and to examine the contribution of metabolic, behavioural, and dietary risk factors to these disparities. Methods We analysed Global Burden of Disease (GBD) data on IHD from 1990 to 2023 across 13 Central European countries. Population-level case-fatality was assessed using sex-specific age-standardised mortality-to-prevalence ratios (MPRs). Mortality attributable to specific risk factors was normalised to prevalence to derive a case-fatality index (CFI). Z-scores (≥1.96) quantified the significance of sex differences. Associations with gross national income (GNI) per capita were evaluated using Pearson correlation. Findings In 2023, there were 6.71 million prevalent IHD cases in the region, of whom 3.01 million (44.8%) were women. From 2011 to 2023, regional MPRs declined from 4.49% to 4.37% in men (2.6% relative decrease) and from 4.59% to 4.42% in women (3.7% relative decrease). However, statistically significant sex disparities persisted in 2023: women had higher MPRs in Croatia (Z = 5.55), Serbia (Z = 2.55), and Czechia (Z = 2.18), whereas men had higher MPRs in Poland (Z = −2.55). Higher GNI per capita was associated with lower MPRs (r = −0.76; p=0.003). Elevated systolic blood pressure and physical inactivity were prominent (Z > 1.96) contributors to excess female case-fatality, while tobacco use disproportionately (Z > 2.58) affected men, particularly in Poland. Dietary risks contributed to sex disparities: women demonstrated higher CFIs for low intake of fruits, nuts/seeds, vegetables, and seafood omega-3 in several high-disparity countries, while male excess was limited to high sodium and low whole-grain intake in isolated settings. Interpretation Despite overall improvements, significant sex inequalities in IHD case-fatality persist in Central Europe. Differential burdens of metabolic, behavioural, and dietary risks are associated with these disparities, underscoring the importance of sex-specific and country-specific prevention approaches to reduce avoidable cardiovascular mortality. Funding None.