The average age of death from ischemic heart disease varies by nearly 30 years globally. New findings show which countries perform best.

Ischemic heart disease is a leading killer in many regions, accounting for more than one out of every 10 deaths globally. This disease occurs when the heart is deprived of blood and oxygen because the arteries leading to the heart become narrow and blocked. When the blood flowing to the heart is cut off, the cells that keep the heart beating die, causing a heart attack. Now, researchers have developed an additional way to evaluate how well countries are addressing this challenge – by looking at the average age at which people die from ischemic heart disease.  

Around the world, the average age at death from ischemic heart disease varies widely, ranging from age 57 to 85. The sheer scale of these differences across countries is staggering. There are many factors that affect the average age at death from ischemic heart disease, ranging from the resources available in the country (how easy it is to access lifesaving health care) to the nation’s demographics (number of younger people versus older people living there). Other things that affect these trends include people’s day-to-day exposure to risk factors that increase the risk of dying from ischemic heart disease, such as high blood pressure, high cholesterol, lead exposure, air pollution, and smoking. 

Based on the average age of death from ischemic heart disease, the countries with the best survivorship included Switzerland (high-income GBD super-region) and Puerto Rico (Latin America and the Caribbean super-region). China had the highest average age of death from ischemic heart disease in the super-region of Southeast Asia, East Asia, and Oceania, while Türkiye had the best performance in the super-region of North Africa and the Middle East. Additional research is needed to understand why each of these countries and territories performs well in comparison to other locations in their super-regions. One possible reason could be linked to health insurance coverage. A study in the US of people with living with risk factors for cardiovascular disease (i.e., high blood sugar, high cholesterol, and diabetes) found that those with health insurance were more likely to receive preventive treatment than people without health insurance. The study also found that mortality rates were lower among people with health insurance compared to those without insurance. 

In China, more than 95% of the population has health insurance, and Switzerland has a mandatory health insurance policy, with subsidies available to people with low incomes. In Puerto Rico, more than 90% of people have health insurance. Türkiye implemented a universal health insurance scheme starting in 2012. 

Ways to prevent ischemic heart disease

There are many opportunities to help prevent people from dying from ischemic heart disease, including in countries with few resources. The top risk factor for ischemic heart disease globally is high blood pressure. According to a recent study led by Dr. Gregory Roth, a professor in the Division of Cardiology and the Director for the Program in Cardiovascular Health Metrics at IHME, the most effective treatment available is a combination pill that contains two or three blood pressure–lowering medications. The World Health Organization first added combination pills to the list of Essential Medicines – a list of the minimum necessary medications for a health care system – in 2023. People’s ability to access and pay for these medications remains a challenge, especially in countries with fewer financial resources. Encouragingly, however, a trial conducted in 47 rural communities in China and India indicated that community health workers can successfully screen for high blood pressure and deliver blood pressure–lowering medications, even in remote areas. 

“The sooner that you can diagnose and treat high blood pressure, the better,” said Dr. Christian Razo, an acting assistant professor at IHME and an expert on the topic. “Even when a person’s blood pressure is only slightly elevated, it increases the chance of developing ischemic heart disease, with the risk rising up to four-fold as their blood pressure goes up.” 

In the ranking of global risk factors, high cholesterol ranks second after high blood pressure. Expanding access to cholesterol-lowering medications, known as statins, is essential to help prevent death and poor health from ischemic heart disease. Unfortunately, this treatment reaches few of the people who need it. A study conducted in 41 low- and middle-income countries found that approximately just one out of every ten eligible people use this medication. 

Broadening access to lifesaving medication is essential for addressing ischemic heart disease, as is strengthening the entire health system.  

“To reduce early death from ischemic heart disease, it is vital to improve health care, including training health workers to better screen and diagnose ischemic heart disease and the risk factors associated with it, such as high blood pressure and high cholesterol,” said Dr. Roth.  In addition, he emphasized the importance of enhancing emergency treatment, hospital care, and surgical treatment for this condition. 

Another leading risk factor for ischemic heart disease is lead exposure. Lead can cause plaque to build up in the arteries, increasing the risk of heart disease. In addition to ischemic heart disease, lead contributes to intellectual disability and chronic kidney disease. “Lead exposure has decreased a lot since countries stopped adding it to gasoline,” said Dr. Michael Brauer, an affiliate professor at IHME and a professor in the School of Population and Public Health at the University of British Columbia. “Unfortunately, many people continue to be exposed to it through paint in older houses, drinking water, and food and consumer products,” he said. Dr. Brauer noted that battery recycling, electronic waste, and artisanal mining frequently pollute the environment with lead, which ends up in people’s bloodstreams, raising their risk for a variety of different health problems. 

In Ogijo, Nigeria, an industrial area in the southwest that hosts the largest number of battery recycling plants in the country, a recent investigation found that many people living next to and working in battery recycling factories had hazardous levels of lead in their blood. The New York Times and The Examination (a non-profit newsroom) conducted the research in collaboration with Sustainable Research and Action for Environmental Development (a Nigerian non-governmental organization) and the University of Ibadan. Researchers also identified that soil in farms and playgrounds next to factories was contaminated with lead. In response to the investigation, the Nigerian government shut down the battery recycling factories and is collecting additional blood samples from residents to test for lead poisoning. In addition, government officials are gathering samples from the soil and air to identify lead pollution.  

Looking at the average age at which people are dying from ischemic heart disease highlights vast differences across countries, with the average age of death varying by 28 years. Some countries are performing much better than others, which may be tied to access to health care. There are many ways for countries to address ischemic heart disease, especially through identifying and treating people living with high blood pressure and high cholesterol and reducing people’s exposure to lead. There are concrete steps that governments can take to lengthen lives and reduce poor health in both high- and low-resource settings.