The global burden of ischemic heart disease attributable to trans fatty acid in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Ischemic heart disease (IHD) remains the leading global cause of mortality. This study aims to quantify the spatiotemporal trends, socioeconomic disparities, and future burden of trans fatty acid (TFA)-attributabfle IHD from 1990 to 2023. Using Global Burden of Disease Study 2023 data, we extracted deaths, age-standardized mortality rates (ASMRs), disability-adjusted life-years (DALYs), and age-standardized DALY rates (ASDRs) for TFAs-attributable IHD across 204 countries/territories. DALYs combined years of life lost and years lived with disability to quantify total health loss. Outcomes were presented as counts and age-standardized rates per 100,000 population with 95% uncertainty intervals, stratified by age, sex, socio-demographic index (SDI), and region. Bayesian Age-Period-Cohort modeling projected ASMR and ASDR through 2050. TFAs contributed to 389.2 thousand (20.9–760.5 thousand) IHD deaths globally in 2023. Since 1990, global ASMR and ASDR declined by 45.7% (− 63.8 to − 1.4%) and 46.6% (− 64.2 to − 22.0%), respectively, masking profound geographical inequities. The burden was concentrated in Eastern Europe and South Asia, with stagnation in middle-SDI regions and the highest burden in low-middle-SDI regions. Males exhibited consistently higher burdens. Projections indicated decelerating declines approaching a plateau by 2050. Global reductions in TFA-attributable IHD mask complex inequities, with disproportionate burdens in Eastern Europe and South Asia, and variable progress across SDI nations. Accelerating progress in these regions requires implementation of WHO REPLACE strategies, including mandatory limits on industrial TFAs and front-of-pack warning labels. Our population-level findings provide a foundation for future genomic studies of genetic susceptibility to TFA-induced cardiovascular disease.