Ischemic Heart Disease in G20 Countries: Forecasted Burden and Regional Disparities Based on GBD 2023 Estimates

Ischemic heart disease (IHD) remains the leading cause of mortality and disability in the G20, yet member states exhibit heterogeneous epidemiological transitions. Comparative assessments with long-term projections are essential to inform cardiovascular strategies.

To comprehensively evaluate the temporal trends, regional disparities, risk factors, and future projections of ischemic heart disease burden across G20 countries using GBD 2023 estimates.

Using Global Burden of Disease (GBD) 2023 estimates, we quantified IHD incidence, mortality, and disability-adjusted life years (DALYs) across G20 members from 1990 to 2023. Temporal patterns were evaluated using estimated annual percentage change (EAPC) and Joinpoint regression. Modifiable risks were assessed using population attributable fractions. ARIMA and Bayesian age-period-cohort (BAPC) models projected IHD burden through 2050. Determinants of DALYs were examined using XGBoost with SHAP interpretability.

In 2023, the G20 reported 8.52 million IHD cases and 5.81 million deaths. Age-standardized incidence (ASIR) and mortality (ASMR) declined overall (EAPC -1.61 and -1.49), although incidence increased in women aged 15-49 years, and mortality rebounded modestly after prior declines. The absolute burden was largest in India and China, while Russia had the highest ASIR, ASMR, and age-standardized DALY rates. High systolic blood pressure was the dominant modifiable risk, while particulate matter and lead exposure emerged as prominent environmental contributors. Projections indicate continued ASIR declines overall, though Japan is projected to experience a peak again around 2032. Age was the strongest determinant of DALYs, with a consistent male disadvantage.

The G20 has achieved substantial but uneven reductions in IHD burden, with early signs of reversal, demographic pressures, and expanding environmental risks. Targeted, stage-specific cardiovascular strategies will be required to sustain progress and reduce disparities through mid-century.