Ischaemic heart disease in the Baltic nations: latest insights into disease epidemiology

Background Ischaemic heart disease (IHD) imposes a significant global health and socioeconomic burden due to the associated morbidity, long-term complications, and mortality. Therefore, it is of paramount significance to evaluate the temporal trends in the epidemiology and disease burden of IHD as it enables risk stratification and implementation of health policy measures to address the resulting burden. Purpose To evaluate the temporal trends in the epidemiology and disease burden of IHD in the Baltic nations over the period 1990-2023. Methods Temporal trends in the incidence, mortality and Disability-adjusted Life Years (DALY) of IHD in Estonia, Lativa, and Lithuania were evaluated by retrieving the age-standardised incidence rate (ASIR), age-standardised morality rate (ASMR), and age-standardised DALY rate (ASDR) for the period of 1990-2023 from the Global Burden of Disease database. Joinpoint regression analysis was performed to calculate the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC). Results Over the period 1990-2023, a statistically significant decline in IHD ASIR was observed across the 3 nations with the highest decline noted in Estonia with an AAPC of -3.50 (95%CI -3.53 to -3.48, p<0.001), followed by Lativa (AAPC -2.68, 95%CI -2.70 to -2.65, p<0.001) and Lithuania (AAPC -2.16 , 95%CI -2.19 to -2.13, p<0.001). Stratification by gender revealed a statistically significant decline in IHD ASIR was observed in both males and females across the 3 nations, with the latter experiencing a higher degree of decline in the ASIR. Mortality wise, a statistically significant decrease in IHD ASMR was noted across the 3 nations with a highest decline in observed in Estonia with an AAPC -4.34 (95%CI -4.43 to -4.25, p<0.001), followed by Lativa (AAPC -2.34, 95%CI -2.40 to -2.27, p<0.001), and Lithuania (AAPC -2.04, 95%CI -2.10 to -1.97, p<0.001). Similarly to the temporal trends in IHD, stratification by gender revealed a statistically significant decline in the ASMR in both males and females, with the latter experiencing a higher degree of decline. Furthermore, a statistically significant decline in IHD ASDR was observed across the 3 nations with the highest decline noted in Estonia (AAPC -4.36, 95%CI -4.46 to -4.25, p<0.001), followed by Lativa (AAPC -2.40, 95%CI -2.47 to -2.33, p<0.001). Conclusion During the period 1990-2023, the baltic nations experienced a significant decline in the incidence, burden and mortality of IHD. These findings warrant further evaluation to determine the underlying factors associated with this decline.