Ischemic Heart Disease in the Middle East and North Africa, 1990-2021: An Integrated Analysis of Temporal Trends,...

Ischemic heart disease (IHD) remains a leading cause of mortality and disability worldwide. Using Global Burden of Disease (GBD) 2021 estimates, this study provides an integrated assessment of IHD burden across the Middle East and North Africa (MENA) region from 1990 to 2021, highlighting temporal trends, inter-country heterogeneity, sociodemographic index (SDI)-related patterns, and attributable risk factors by sex and age.

We conducted a secondary analysis of GBD 2021 estimates for the 21 countries and territories in MENA. We assessed prevalence, deaths, and disability-adjusted life years (DALYs), reporting counts and age-standardized rates per 100,000 population with 95% uncertainty intervals (UIs). This framework allowed direct comparison of temporal change, cross-country variation, development-related gradients, and modifiable risk attribution within a single regional analysis.

In 2021, the age-standardized prevalence of IHD in MENA was 6404.8 per 100,000 (95% UI: 5872.0-7041.1), with an age-standardized mortality rate of 202.8 (95% UI: 180.6-223.7) and DALY rate of 4023.2 (95% UI: 3581.7-4507.5). Although age-standardized death and DALY rates declined from 1990 to 2021, the burden remained substantial and unevenly distributed. Kuwait had the highest age-standardized prevalence [7806.4 (95% UI: 7141.6-8556.3)] and Turkey the lowest [5365.9 (95% UI: 4895.5-5874.7)]. Saudi Arabia had the largest increase in age-standardized prevalence [17.1% (95% UI: 11.4-23.0)], whereas Turkey had the largest decrease [-11.9% (95% UI: -17.3 to -6.9)]. DALY rates increased progressively with age for both sexes, and IHD burden showed an inverse, non-linear relationship with SDI. The leading contributors to IHD DALYs were elevated systolic blood pressure [49.6%], elevated LDL cholesterol [39.6%], and exposure to ambient particulate matter pollution [28.2%].

Despite reductions in age-standardized mortality and DALY rates, IHD remains a major public health challenge in MENA, with substantial cross-country variation and a large contribution from modifiable risks. By integrating temporal trends, inter-country heterogeneity, SDI-related patterns, and attributable risk factors, this study provides novel evidence for prioritizing prevention efforts across the region. These findings support context-specific prevention strategies prioritizing hypertension control, lipid management, and improved access to cardiovascular prevention and treatment, alongside action to reduce air pollution exposure; implementation should be tailored to national risk profiles, disease trends, and health-system capacity.