Abstract
<title>Abstract</title> <p>Background Although ischemic heart disease (IHD) mortality has declined among older adults in high-income countries, younger populations might be facing a less favorable cardiometabolic risk landscape. We examined global, regional, and socio-demographic trends in early-onset IHD (ages 15–49 years) from 1990 to 2023. Methods Estimates of deaths, incidence, and disability-adjusted life years (DALYs) for IHD in individuals aged 15–49 were extracted from the Global Burden of Disease Study 2023. Truncated age-standardized rates (15–49 years) and estimated annual percentage changes (EAPCs) with 95% confidence intervals were calculated for the world and across Socio-demographic Index (SDI) quintiles. Results Early-onset IHD accounted for 19.1 million DALYs (95% UI: 17.2–21.1) and 675 000 deaths (95% UI: 608 000–742 000) worldwide in 2023. The global age-standardized mortality rate declined modestly (EAPC − 0.39%, 95% CI: −0.45 to − 0.33); absolute DALYs, however, rose 34% from 1990. In high-SDI regions, the mortality decline appears to have plateaued after 2010 (EAPC − 0.04%, 95% CI: −0.12 to + 0.04), while low-middle SDI regions experienced a sustained increase (EAPC + 0.62%, 95% CI: +0.51 to + 0.73). Males accounted for 73.8% of early-onset IHD deaths globally. Conclusions These observations suggest that early-onset IHD could be an escalating global challenge, marked by a diverging burden between high-SDI and lower-SDI settings. Renewed, age-targeted prevention and metabolic screening for adults under 50 may be urgently warranted.</p>