Unequal survival after ischaemic heart disease in Eastern Europe: a sex-specific GBD 2023 analysis

AIMS: Sex disparities in ischaemic heart disease (IHD) outcomes are well documented in Western Europe, but remain poorly characterized across Eastern Europe, a region marked by substantial mortality inequalities. We aimed to determine whether population-level case fatality among individuals living with IHD differed by sex in Eastern Europe and to identify modifiable risk factors associated with disparities. METHODS AND RESULTS: We analysed sex-specific estimates from the Global Burden of Disease 2023 study for seven Eastern European countries. Age-standardized IHD mortality and prevalence rates were combined to derive mortality-to-prevalence ratios (MPRs) as a measure of population-level case fatality. Risk factor-attributable mortality was similarly normalized to prevalence. Estonia, which had the lowest MPRs (men 3.00%; women 1.77%), served as the benchmark for Z-score analyses (|Z| ≥ 1.96 = P < 0.05). In 2011, women in 5 of 6 countries had higher MPRs than Estonian women (Z = 2.25-4.35), whereas men showed excess MPRs in only 3 countries (Z = 2.29-3.18). By 2023, all 6 countries showed higher female MPRs than Estonia (Z = 3.27-5.14). In men, excess MPRs persisted in Latvia, the Russian Federation and Ukraine (Z = 2.48-3.16) and emerged in Belarus (Z = 4.79) but remained non-significant in Lithuania and the Republic of Moldova.Female-specific benchmark signals were observed for high fasting plasma glucose in Belarus and the Republic of Moldova, and for high systolic blood pressure in Lithuania, the Republic of Moldova, and the Russian Federation. CONCLUSIONS: Pronounced sex disparities in IHD population-level case fatality persist across Eastern Europe. Lithuania and the Republic of Moldova showed the most consistent female disadvantage. Excess female population-level case fatality was most consistently associated with key modifiable risk factors.