Trends and projections of ischemic heart disease burden in the Belt and Road countries and China from 1990 to 2021: a study based on the 2021 global burden of disease

To assess the burden of ischemic heart disease (IHD) in Belt and Road Initiative countries from 1990 to 2021 and to predict future trends. Utilizing data from GBD 2021, we analyzed incidence, mortality, and other indicators using Joinpoint analysis, NetDrift methodology, age-period-cohort models, and Bayesian Age-Period-Cohort (BAPC) predictive modeling. In 2021, China bore the heaviest IHD burden with an incidence of 7.3 million cases and a mortality rate of 1.96 million. The United Arab Emirates experienced over a tenfold increase in incidence/prevalence rates, while Djibouti saw a fivefold rise in deaths/DALYs. Uzbekistan’s standardized incidence rate increased by 107.2%, and Lesotho’s mortality rate rose by 78.7%. A higher proportion of affected individuals were male or aged over 60 years; aging populations and demographic growth emerged as primary driving factors. Low/medium-low SDI regions exhibited significant potential for improvement; emerging risks included renal insufficiency and low grain diets. Projections indicate that by 2046, the number of IHD cases in China may exceed 14,410,378 individuals, highlighting a severe prevention and control challenge. The burden of IHD demonstrates regional disparities characterized by the interplay between traditional risk factors and emerging threats. It is recommended to establish a stratified governance framework that enhances cross-national data sharing and facilitates the transfer of digital health technologies to optimize cardiovascular disease prevention strategies.