Global, regional, and national burden of ischemic heart disease in young and middle-aged population from 1990 to 2021.

Early-onset ischemic heart disease (IHD) is an emerging global health concern. Quantifying its burden and key risk factors is essential for effective prevention and control. This study utilizes the data from Global Burden of Disease Study 2021 to analyze the burden of IHD in young and middle-aged population (15-49 years old), including prevalence, incidence, deaths and disability-adjusted life years (DALYs) from 1990 to 2021. Attributable risk factors were assessed across different sex and region, and trends were analyzed using age-standardized rate (ASR) and average annual percentage change (AAPC). In 2021, the ASR of prevalence and incidence showed an increasing trend, with AAPCs of 0.26% (95% confidence interval [CI], 0.24% to 0.29%) and 0.23% (95%CI, 0.09% to 0.38%), respectively; the ASR of mortality and DALYs showed a decreasing trend, with AAPCs of -0.67 (95%CI, -0.91% to -0.44%) and - 0.64 (95%CI, -0.87% to -0.42%).The highest burden were observed in countries with low-middle socio-demographic index. Gender differences were observed, with men generally bearing a higher burden. Dietary risks were identified as the most significant risk factors. The burden of early-onset IHD remains a major health challenge, with significant region and gender disparities. The burden needs to be addressed through targeted public health policies.