Diet and unequal burdens of ischaemic heart disease in Central Europe: insights from the global burden of disease study
T Rahaman, L Badimon, E Cenko, S S Anand, O Manfrini, B Merkley, D Milicic, N Townsend, V Vaccarino, M Gulati, C P Gale, R BugiardiniAbstract
Background
Central Europe bears a substantial global burden of ischaemic heart disease (IHD), yet sex-specific differences in case fatality remain insufficiently characterised. Understanding these disparities across countries and income levels is essential for designing effective public health strategies.
Purpose
To evaluate sex disparities in IHD case fatality and their association with metabolic and dietary risk factors in Central Europe using data from the Global Burden of Disease (GBD) 2023 study.
Methods
We analysed GBD data on IHD from 1990 to 2023 across 13 Central European countries. To assess population-level case fatality, we combined sex-specific age-standardised mortality and prevalence rates to produce mortality-to-prevalence ratios (MPRs). The MPR quantifies excess mortality risk among affected individuals, offering insights into disease severity and healthcare effectiveness. Similarly, mortality attributable to specific risk factors was normalised to prevalence to derive a case fatality index (CFI). Z-scores (threshold: ±1.96, 95% confidence level) quantified the significance of sex differences. Associations with gross national income (GNI) per capita were evaluated using Pearson correlation.
Results
In 2023, there were 6·71 million prevalent IHD cases in the region, of whom 3·01 million (44·8%) were women. From 2011 to 2023, regional MPRs declined by 2·6% in men and 3·7% in women. Significant sex disparities persisted in 2023: women had higher MPRs in Croatia, Czechia, and Serbia, while men had higher MPRs in Poland. Metabolic risks, particularly high systolic blood pressure, were a leading contributor to excess case fatality in women, with a significant effect in Croatia. Dietary risks also played a role: women showed higher CFIs for low intake of protective foods (fruits, nuts/seeds, vegetables, seafood omega-3s) in several countries, whereas men showed excesses for high sodium and low whole-grain intake in isolated settings. Physical inactivity consistently imposed a greater burden on women, while tobacco use disproportionately affected men. In Poland, the lack of a significant sex disparity in physical inactivity, metabolic, and protective dietary risk factors left the male excess burden from tobacco use unopposed.
Conclusion
Despite overall improvements, significant sex inequalities in IHD case fatality persist in Central Europe. These disparities reflect divergent risk profiles, with metabolic and dietary vulnerabilities disproportionately affecting women, while tobacco exposure remains a major contributor among men. The uneven distribution of metabolic, dietary, and behavioural risks underscores the urgent need for targeted, sex- and country-specific policies to reduce preventable deaths. Reducing avoidable IHD deaths in the region will require tailored interventions that address the female burden of inactivity, poor diet, and metabolic risk, alongside continued efforts to curb tobacco use among men.