National and Subnational Trends in Ischemic Heart Disease Burden in Iran, 1990–2023: A Systematic Review

Background Ischemic heart disease (IHD) remains a major cause of morbidity and mortality in Iran, but evidence is dispersed across model‐based estimates, population studies, registries, hospital surveillance, and death‐registration data. We synthesized national and subnational evidence on IHD burden in Iran from 1990 to 2023. Methods PubMed/MEDLINE and Scopus were searched through August 15, 2026, supplemented by Google Scholar and citation searching. Eligible studies reported incidence, prevalence, mortality, hospitalization, case fatality, post‐myocardial infarction survival, or burden‐of‐disease measures. Model‐based and empirical evidence were synthesized separately, overlapping data sources were mapped, and findings were narratively synthesized because of heterogeneity. Results Fifty‐two reports representing 35 evidence‐source families were included. Within GBD 2019, age‐standardized IHD mortality declined from 285.7 to 163.6 per 100 000 between 1990 and 2019, incidence from 898.3 to 829.1, and prevalence from 6250.6 to 6198.5 per 100 000, while incident cases increased from 218 181 to 593 001. Successive GBD vintages also showed declining age‐standardized mortality but were not directly comparable because of modeling differences. Empirical studies generally showed higher coronary event rates in men, while Isfahan surveillance and the Iranian MI Registry indicated higher short‐term post‐MI case fatality among women. Burden increased with age, provincial variation was substantial, and urban‐rural patterns were inconsistent. Hospital surveillance suggested improving short‐term outcomes. Conclusions Successive GBD analyses estimated substantial declines in age‐standardized IHD mortality, while absolute burden remained large and differences persisted by age, sex, geography, and data source. Stronger prevention and geographically representative surveillance are needed.