Unequal survival after ischaemic heart disease in Eastern Europe: a sex-specific GBD 2023 analysis

Abstract Aims Sex disparities in ischaemic heart disease (IHD) outcomes are well documented in Western Europe but remain poorly characterized across Eastern Europe a region marked by substantial mortality inequalities. We aimed to determine whether population-level case fatality among individuals living with IHD differed by sex in Eastern Europe and to identify modifiable risk factors associated with disparities. Methods and results We analysed sex-specific estimates from the Global Burden of Disease 2023 study for seven Eastern European countries. Age-standardized IHD mortality and prevalence rates were combined to derive mortality-to-prevalence ratios (MPRs) as a measure of population-level case fatality. Risk factor-attributable mortality was similarly normalized to prevalence. Estonia, which had the lowest MPRs (men 3.00%; women 1.77%), served as the benchmark for Z-score analyses (|Z| ≥ 1.96 = P Conclusions Pronounced sex disparities in IHD population-level case fatality persist across Eastern Europe. Lithuania and the Republic of Moldova showed the most consistent female disadvantage. Excess female population-level case fatality was most consistently associated with key modifiable risk factors.