Regional Heterogeneity in Ischemic Heart Disease and Ischemic Stroke Burden in Europe, 1990–2023: GBD 2023 and Complementary Mendelian Randomization Evidence
Haoyang Hu, Ming Li, Siyuan Zhang, Hong Zhao, Yang Liu, Fei YangABSTRACT
Background
Ischemic heart disease (IHD) and ischemic stroke (IS) remain major contributors to health loss in Europe, with regional heterogeneity. Comparisons of burden, attributable risks, and genetic evidence remain limited.
Methods
Global Burden of Disease (GBD) 2023 estimates for Central, Eastern, and Western Europe from 1990 to 2023 were analyzed. Age‐standardized prevalence, incidence, mortality, and disability‐adjusted life‐year rates were summarized; temporal trends were assessed by Joinpoint regression and 2023 cross‐country concordance by Spearman correlation. GBD risk profiles were compared between 1990 and 2023. Complementary Mendelian randomization (MR) evaluated high blood pressure, fasting glucose, and low‐density lipoprotein cholesterol (LDL‐C).
Results
Eastern Europe had the highest 2023 burden. IHD and IS rates were positively concordant across countries (Spearman ρ = 0.681–0.820; all p < 0.001), and regional 1990–2023 average annual percent changes were negative. High systolic blood pressure and high LDL‐C remained leading GBD‐attributable risks. In MR, genetic liability to high blood pressure was associated with IHD (odds ratio [OR] = 1.354, 95% confidence interval [CI] 1.281–1.433) and IS (OR = 1.351, 95% CI 1.295–1.409), and LDL‐C with IHD (OR = 1.610, 95% CI 1.508–1.719); these met the Bonferroni threshold. Fasting glucose showed nominal evidence for IHD, whereas fasting glucose and LDL‐C showed no statistically significant associations with overall IS.
Conclusions
IHD and IS burdens declined across Europe, but regional inequalities persisted. GBD attribution and MR provide complementary evidence; cardiometabolic risks remain central, while genetic associations differ between IHD and overall IS.