Burden of Ischemic Heart Disease and Its Attributable Risk Factors From 1990 to 2021, and Forecasts Till 2050: A comparative Analysis of Low Versus High Socio-demographic Index (SDI) Regions

Ischemic heart disease (IHD) is the leading cause of mortality among noncommunicable diseases globally. We evaluated the influence of sex, risk factors, and the sociodemographic index (SDI) on the burden of IHD. We used data from the Global Burden of Disease (GBD) 2021 project to analyze age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life-year rates (ASDR) for IHD across high- and low-SDI regions. We used Joinpoint regression to evaluate temporal trends using annual percentage changes (APCs). We forecasted point-estimate through 2050 using autoregressive integrated moving average models. In 2021, IHD burden was greater in low-SDI than high-SDI regions, with ASIR 444.6 versus 195.6, ASMR 116.4 versus 58.4, and ASDR 2,464.1 versus 1,134.0 per 100,000 population, respectively. Between 1990 and 2021, high-SDI regions demonstrated reductions in ASIR (43%; AAPC -1.81), ASMR (63%; AAPC -3.22), and ASDR (61%; AAPC -3.06). In contrast, low-SDI regions showed only modest declines in ASIR (6%; AAPC -0.23), ASMR (3%; AAPC -0.05), and ASDR (8%; AAPC -0.26). Forecasts suggested a gradual increase in ASMR and ASDR in high-SDI regions by 2050, whereas low-SDI regions were projected to remain high-burden despite gradual declines. Women experienced greater improvements than men in high-SDI regions, with limited progress in low SDI-regions. Men consistently exhibited higher IHD burden across all measures. Metabolic risks (i.e., blood pressure and LDL cholesterol, were the dominant contributors across both SDI strata). In conclusion, despite declining rates in high-SDI regions, low-SDI regions showed only modest and inconsistent improvement, with persistent sex disparities and substantial metabolic risk-attributable burden.