Regional Heterogeneity in Ischemic Heart Disease and Ischemic Stroke Burden in Europe, 1990–2023: GBD 2023 and Complementary Mendelian Randomization Evidence

Figures

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  FIGURE 1. Geographic distribution and comparative burden of ischemic heart disease (IHD) and ischemic stroke (IS) in Europe in 2023. Map panels display age‐standardized incidence patterns, and the country‐level matrix summarizes comparative burden. Spearman correlations between IHD and IS age‐standardized rates are reported in Results Section 3.1 and Supporting Information S1: Table 15. (A) Age‐standardized incidence rate (ASIR) of ischemic heart disease (IHD) per 100,000 population. (B) ASIR of ischemic stroke (IS) per 100,000 population. (C) Country‐level comparison of IHD and IS ASIR percentile categories, classified as consistent, IHD‐dominant, or IS‐dominant. (D) Joint distribution of countries across IHD and IS ASIR percentile categories, with cell values indicating the number of countries.

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  FIGURE 2. Average annual percent change (AAPC) in age‐standardized IHD and IS burden, 1990–2023. Point estimates and 95% CIs are shown for ASPR, ASIR, ASMR, and ASDR in Central, Eastern, and Western Europe. Detailed joinpoint segments and APC estimates are provided in Supporting Information S1: Tables 5–8 and Supporting Information S1: Figure 7.

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  FIGURE 3. Exploratory relationship between Socio‐demographic Index (SDI) and age‐standardized IHD and IS burden in Central, Eastern, and Western Europe, 1990–2023. Curves describe regional trajectories across SDI values and are interpreted as ecological patterns. Panels (A–D) show the relationships between the Socio‐demographic Index (SDI) and age‐standardized prevalence, incidence, mortality, and disability‐adjusted life‐year (DALY) rates, respectively, for ischemic heart disease (IHD). Panels (E–H) show the corresponding relationships for ischemic stroke (IS), in the same order. All rates are expressed per 100,000 population.

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  FIGURE 4. GBD 2023 risk‐factor attribution profiles for IHD and IS in Europe in 1990 and 2023. Panels show IHD and IS, respectively, in Central Europe (A, B), Western Europe (C, D), and Eastern Europe (E, F). Within each panel, DALY and mortality attributable fractions are displayed for 1990 on the left and 2023 on the right. Risk factors were included separately for each outcome according to GBD availability; the inventory is provided in Supporting Information S1: Table 13. Risk‐specific attributable fractions may overlap and are not additive.

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  FIGURE 5. Complementary two‐sample Mendelian randomization estimates for selected cardiometabolic traits and (A) IHD and (B) overall IS. The primary estimator was inverse‐variance weighted MR. The blood‐pressure exposure represents genetic liability to high blood pressure (OpenGWAS ebi‐a‐GCST90013966). ORs and 95% CIs are shown alongside instrument counts and p values. p < 0.0083 was the Bonferroni‐corrected threshold for six primary comparisons.