Objective To compare and analyze the characteristics and trends of ischemic heart disease burden between China and the world, and to provide evidence for effective prevention and control measures in China.

Methods The death and disability-adjusted life years (DALY) of ischemic heart disease in China and the world were obtained from the GBD 2021 database. The average annual percentage of change (AAPC) was estimated by the Joinpoint regression model to reflect the time trend. Bayesian age-period-cohort model was constructed for prediction.

Results From 1990 to 2021, the age-standardized death rate of ischemic heart disease in China increased from 94.14/100 000 in 1990 to 110.91/100 000 in 2021, and the increase rate (17.81%) and AAPC (0.49% (95%CI: 0.23%−0.75%) were higher than the global level. The age-standardized DALY rate increased from 1771.13/100 000 in 1990 to 1856.51/100 000 in 2021, both lower than the global level in the same period, but the increase (4.82%) and AAPC 0.11% (95%CI: −0.09%−0.32%) were higher than the global level. The burden of ischaemic heart disease and its increase rate in men were higher than in women in China and globally. From 1990 to 2021, age-the standardized mortality rate and DALY rate of both men and women in the world showed a downward trend, while in China, only women showed a certain downward trend, while men still increased significantly. The burden of ischemic heart disease increased with age. In the next 15 years, the age-standardized death rate and DALY rate of ischemic heart disease in China and the world are on a downward trend.

Conclusion From 1990 to 2021, the age-standardized mortality rate and DALY rate of ischemic heart disease in China increased from being lower than the global level to being significantly higher than the global level, and the rate of increase exceeded the global average. The burden was heavier among men than among women. It is predicted that the age-standardized mortality rate and DALY rate in China and globally will decline in the next 15 years. Given that the burden of ischemic heart disease in China remains relatively severe, coupled with the increasingly prominent problem of population aging, relevant departments should continuously formulate and optimize prevention and control measures, especially for the male population, and adopt targeted measures to significantly reduce the disease burden of ischemic heart disease.