Sex Disparities in Ischemic Heart Disease in South Asia: The Role of Dietary Factors.

Abstract

Background: South Asia bears the highest global burden of ischemic heart disease (IHD). Understanding variations in IHD outcomes by sex, income level, and country can inform targeted public health strategies.

Objectives: This study aimed to analyze sex-specific trends in IHD prevalence and mortality across South Asia.

Methods: We conducted a cross-sectional analysis using Global Burden of Disease (GBD) study data from 2005 and 2021. Age-standardized mortality rates (ASMRs) for IHD and age-standardized prevalence rates (ASPR) were estimated for 5 South Asian countries (Bangladesh, Bhutan, India, Nepal, and Pakistan). The ASMR-to-ASPR index was calculated to assess the risk of death among individuals with IHD. Sex-based comparisons were performed using Z-scores with a 95% confidence threshold (Z = 1.96).

Results: In all countries, men exhibited higher ASMR values than women (average: 167 vs 102 in 2005 and 190 vs 112 in 2021). The ASMR-to-ASPR index was higher in women than men only in Pakistan, in 2005 (4.3% vs 2.9%, respectively) and 2021 (4.4% vs 3.1%, respectively), indicating greater mortality risk among women with IHD. Z-score analysis comparing Bhutan (lowest female ASMR) and Pakistan (highest) revealed differences in deaths attributable to high systolic blood pressure (Z score: 3.30), low vegetable intake (Z score: 2.02), and low fiber intake (Z score: 2.00). These differences were not observed in men.

Conclusions: Mortality among people with IHD remains high across South Asia, with sex disparities in outcomes observed primarily in Pakistan. Leading risk factors for IHD mortality among women include high systolic blood pressure and low intake of vegetables and fiber.