Declining IHD mortality in Central Europe, 2000–2023: trends, disparities and risk factors

Background Ischemic heart disease (IHD) remains a leading cause of mortality in Central Europe despite long-term declines. This study examines trends in mortality alongside persistent inequalities and modifiable risk factors. Methods Data from the Global Burden of Disease Study 2023 were used to analyse age-standardised IHD mortality rates (per 100,000) in Central Europe between 2000 and 2023. Trends were assessed using percentage change and estimated annual percentage change (EAPC). Mortality was analysed by country and sex. Selected modifiable risk factors were evaluated using attributable mortality estimates. Results Between 2000 and 2023, IHD mortality declined by 41.3%, from 224.4 to 131.6 per 100,000 (EAPC −2.3% per year). Declines occurred across all countries; however, substantial inequalities persisted, with more than a two-fold difference between the highest (e.g., Serbia, Hungary, Slovakia, Bulgaria) and lowest rates (Slovenia) in 2023. Mortality remained consistently higher in men than in women (170.1 vs 102.2 per 100,000), with no clear convergence over time. The largest contributions to mortality were attributable to high systolic blood pressure, high LDL cholesterol, smoking, high body mass index, high sodium intake, and ambient particulate matter pollution. The relative importance of these risk factors remained largely unchanged over time. Conclusions Despite substantial declines in IHD mortality in Central Europe, marked and persistent inequalities remain between countries and sexes. The continued dominance of modifiable cardiometabolic risk factors highlights the need to strengthen population-level prevention strategies to reduce the remaining burden and narrow disparities. Key messages • Ischemic heart disease mortality in Central Europe declined substantially between 2000 and 2023, but large inequalities between countries and sexes persist. • Modifiable cardiometabolic risk factors, particularly high blood pressure and LDL cholesterol, remain the dominant drivers of mortality, indicating missed opportunities for prevention.