Trends in ischemic heart disease among females in low-and middle-income countries from 1990 to 2019

Background: Ischemic heart disease (IHD) is a major contributor to mortality in low-and middle-income-countries (LMICs). However, trends in IHD in females in LMICs are not well described. Methods: We analyzed the Global Burden of Disease (GBD) Study from 1990 to 2019 for males and females with IHD from the ten most-populous LMICs (India, Indonesia, Pakistan, Nigeria, Ethiopia, Philippines, Egypt, Vietnam, Iran, and Afghanistan). Results: In females, IHD incidence increased from 950,000 cases/year to 1.6 million/year, IHD prevalence increased from 8 million to 22.5 million (181% increase) and IHD mortality from 428,320 to 1,040,817 (143% increase). IHD accounted for 6.2% of all deaths among females in 1990, doubling to 13.2% in 2019. IHD mortality for each country increased with the greatest shift in AAPC seen in the Philippines (5.8%, 95% CI 5.4–6.1) and India (3.7%, 95% CI 3.0–4.4). Notably, reductions in ASMR were greater for males than females in Afghanistan, Iran, Egypt, Ethiopia and Nigeria. (all p < 0.001). Conclusions: The burden of IHD among females in LMIC has increased considerably in LMICs from 1990 to 2019. While the ASMR from IHD across most countries is declining, this was not uniformly noted. Furthermore, several countries noted lesser improvement in ASMR among females compared to males.