{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:54:16Z","timestamp":1790927656224,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005851","name":"Shahid Beheshti University of Medical Sciences","doi-asserted-by":"publisher","award":["43010067"],"award-info":[{"award-number":["43010067"]}],"id":[{"id":"10.13039\/501100005851","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004366","name":"Tabriz University of Medical Sciences","doi-asserted-by":"publisher","award":["75123"],"award-info":[{"award-number":["75123"]}],"id":[{"id":"10.13039\/501100004366","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ischemic heart disease (IHD) remains a leading cause of mortality and disability worldwide. Using Global Burden of Disease (GBD) 2021 estimates, this study provides an integrated assessment of IHD burden across the Middle East and North Africa (MENA) region from 1990 to 2021, highlighting temporal trends, inter\u2010country heterogeneity, sociodemographic index (SDI)\u2010related patterns, and attributable risk factors by sex and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of GBD 2021 estimates for the 21 countries and territories in MENA. We assessed prevalence, deaths, and disability\u2010adjusted life years (DALYs), reporting counts and age\u2010standardized rates per 100,000 population with 95% uncertainty intervals (UIs). This framework allowed direct comparison of temporal change, cross\u2010country variation, development\u2010related gradients, and modifiable risk attribution within a single regional analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2021, the age\u2010standardized prevalence of IHD in MENA was 6404.8 per 100,000 (95% UI: 5872.0\u20137041.1), with an age\u2010standardized mortality rate of 202.8 (95% UI: 180.6\u2013223.7) and DALY rate of 4023.2 (95% UI: 3581.7\u20134507.5). Although age\u2010standardized death and DALY rates declined from 1990 to 2021, the burden remained substantial and unevenly distributed. Kuwait had the highest age\u2010standardized prevalence [7806.4 (95% UI: 7141.6\u20138556.3)] and Turkey the lowest [5365.9 (95% UI: 4895.5\u20135874.7)]. Saudi Arabia had the largest increase in age\u2010standardized prevalence [17.1% (95% UI: 11.4\u201323.0)], whereas Turkey had the largest decrease [\u221211.9% (95% UI: \u221217.3 to \u22126.9)]. DALY rates increased progressively with age for both sexes, and IHD burden showed an inverse, non\u2010linear relationship with SDI. The leading contributors to IHD DALYs were elevated systolic blood pressure [49.6%], elevated LDL cholesterol [39.6%], and exposure to ambient particulate matter pollution [28.2%].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite reductions in age\u2010standardized mortality and DALY rates, IHD remains a major public health challenge in MENA, with substantial cross\u2010country variation and a large contribution from modifiable risks. By integrating temporal trends, inter\u2010country heterogeneity, SDI\u2010related patterns, and attributable risk factors, this study provides novel evidence for prioritizing prevention efforts across the region. These findings support context\u2010specific prevention strategies prioritizing hypertension control, lipid management, and improved access to cardiovascular prevention and treatment, alongside action to reduce air pollution exposure; implementation should be tailored to national risk profiles, disease trends, and health\u2010system capacity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72886","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:30:56Z","timestamp":1785047456000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ischemic Heart Disease in the Middle East and North Africa, 1990\u20132021: An Integrated Analysis of Temporal Trends, Country\u2010Level Variation, SDI Patterns, and Risk Factors"],"prefix":"10.1002","volume":"9","author":[{"given":"Nahid","family":"Karamzad","sequence":"first","affiliation":[{"name":"Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-9072","authenticated-orcid":false,"given":"Saeid","family":"Safiri","sequence":"additional","affiliation":[{"name":"Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran"},{"name":"Department of Genetics and Bioengineering Yeditepe University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-5565","authenticated-orcid":false,"given":"Amir","family":"Ghaffari Jolfayi","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center, Rajaie Cardiovascular, Medical, and Research Center Iran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4747-5639","authenticated-orcid":false,"given":"Seyed Ehsan","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0668-0978","authenticated-orcid":false,"given":"Fatemeh","family":"Amiri","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Rahmanian","sequence":"additional","affiliation":[{"name":"Student Research Committee, School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7920-6818","authenticated-orcid":false,"given":"Mark J. 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