Key result
Modifiable risk factors account for ~94% of IHD deaths in lower-middle-income countries, driven by high SBP.
Why the study?
Ischemic heart disease imposes the greatest disease burden globally, especially in low- and middle-income countries, but the specific risk-attributable burden across these countries needed examination.
Observational
Yes
The burden of ischemic heart disease attributable to modifiable risk factors remains extremely high in low- and middle-income countries, driven primarily by high systolic blood pressure, high LDL cholesterol, and poor diet.
May inform modifiable risk prioritization across LMICs; leaves open optimal targets amid wide country variation.
Background Ischemic heart disease (IHD) imposes the greatest disease burden globally, especially in low- and middle-income countries (LMICs). We aim to examine the population-attributable fraction and risk-attributable death and disability-adjusted life years (DALYs) for IHD in 137 low- and middle-income countries. Methods and Results Using comparative risk assessment framework from the 2019 Global Burden of Disease study, the population-attributable fraction and IHD burden (death and DALYs) attributable to risk factors in low-income countries, lower-middle-income countries (LMCs), and upper-middle-income countries were assessed from 2000 to 2019. In 2019, the population-attributable fraction (%) of IHD deaths in relation to all modifiable risk factors combined was highest in lower-middle-income countries (94.2; 95% uncertainty interval, 91.9-96.2), followed by upper-middle-income countries (93.5; 90.4-95.8) and low-income countries (92.5; 90.0-94.7). There was a >13-fold difference between Peru and Uzbekistan in age-standardized rates (per 100 000) of attributable death (44.3 versus 660.4) and DALYs (786.7 versus 10506.1). Dietary risks accounted for the largest proportion of IHD's behavioral burden in low- and middle-income countries, primarily attributable to diets low in whole grains. High systolic blood pressure and high low-density lipoprotein cholesterol remained the 2 leading causes of DALYs, with the former topping the list in 116 countries, while the latter led in 21 of the 137 countries. Compared with 2000 to 2010, the increases in risk-attributable deaths and DALYs among upper-middle income countries were slower from 2010 to 2019, while the trends in low-income countries and lower-middle income countries were opposite. Conclusions IHD's attributable burden remains high in low- and middle-income countries. Considerable heterogeneity was observed among different income-classified regions and countries.
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A 2021 study conducted an observational in Ischemic heart disease. Modifiable risk factors was evaluated on Population-attributable fraction of IHD deaths in relation to all modifiable risk factors combined in lower-middle-income countries (95% CI 91.9-96.2). Modifiable risk factors accounted for 94.2% (95% UI 91.9-96.2) of ischemic heart disease deaths in lower-middle-income countries in 2019, driven primarily by high systolic blood pressure.
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