National and Subnational Trends in Ischemic Heart Disease Burden in Iran, 1990-2023: A Systematic Review.

In 30 seconds

This systematic review synthesized national and subnational evidence on ischemic heart disease (IHD) in Iran from 1990 to 2023, including model-based estimates and empirical studies. Across 52 reports, GBD 2019 estimates showed that age-standardized IHD mortality fell from 285.7 to 163.6 per 100 000 between 1990 and 2019. However, incident cases rose from 218 181 to 593 001, and absolute burden remained substantial. Findings also indicated variation by age, sex, and province, with empirical studies generally reporting higher coronary event rates in men and some surveillance data showing higher short-term post-MI case fatality among women.

Key findings

• GBD 2019 age-standardized IHD mortality declined from 285.7 to 163.6 per 100 000 between 1990 and 2019.
• Over the same period, estimated incident cases increased from 218 181 to 593 001.
• Empirical studies generally found higher coronary event rates in men, while some data indicated higher short-term post-MI case fatality among women.
• Burden increased with age, provincial variation was substantial, and urban-rural patterns were inconsistent.

Why it matters

The review shows that declining age-standardized mortality does not mean the overall IHD burden has diminished: incident cases increased, and substantial differences remain across age groups, sexes, and provinces. These patterns matter for interpreting national trends and for identifying where prevention and surveillance may need greater attention. The separation of model-based and empirical evidence also highlights the importance of understanding how data sources shape estimates.

What to keep in mind

Evidence was heterogeneous, so findings were synthesized narratively rather than pooled. Successive GBD estimates were not directly comparable because of modeling differences, and urban-rural patterns were inconsistent.