Risk-Attributable Burden of Ischemic Heart Disease in 137 Low- and Middle-Income Countries From 2000 to 2019

Background Ischemic heart disease (IHD) imposes the greatest disease burden globally, especially in low- and middle-income countries (LMICs). We aim to examine the population-attributable fraction and risk-attributable death and disability-adjusted life years (DALYs) for IHD in 137 low- and middle-income countries. Methods and Results Using comparative risk assessment framework from the 2019 Global Burden of Disease study, the population-attributable fraction and IHD burden (death and DALYs) attributable to risk factors in low-income countries, lower-middle-income countries (LMCs), and upper-middle-income countries were assessed from 2000 to 2019. In 2019, the population-attributable fraction (%) of IHD deaths in relation to all modifiable risk factors combined was highest in lower-middle-income countries (94.2; 95% uncertainty interval, 91.9-96.2), followed by upper-middle-income countries (93.5; 90.4-95.8) and low-income countries (92.5; 90.0-94.7). There was a >13-fold difference between Peru and Uzbekistan in age-standardized rates (per 100 000) of attributable death (44.3 versus 660.4) and DALYs (786.7 versus 10506.1). Dietary risks accounted for the largest proportion of IHD's behavioral burden in low- and middle-income countries, primarily attributable to diets low in whole grains. High systolic blood pressure and high low-density lipoprotein cholesterol remained the 2 leading causes of DALYs, with the former topping the list in 116 countries, while the latter led in 21 of the 137 countries. Compared with 2000 to 2010, the increases in risk-attributable deaths and DALYs among upper-middle income countries were slower from 2010 to 2019, while the trends in low-income countries and lower-middle income countries were opposite. Conclusions IHD's attributable burden remains high in low- and middle-income countries. Considerable heterogeneity was observed among different income-classified regions and countries.