Changes in Cardiometabolic Risk Factors and Ischaemic Heart Disease Mortality Between 2000 and 2015: A Global Ecological Analysis

Background and Objectives: To assess whether country-level changes in major cardiometabolic risk factors were associated with concurrent changes in age-standardized death rates (ASDR) from ischaemic heart disease (IHD) and stroke between 2000 and 2015. Materials and Methods: We conducted a multinational ecological analysis using harmonized data from WHO, NCD-RisC, and the World Bank across 157 countries (n = 157). Absolute changes in systolic blood pressure, obesity, diabetes, and total cholesterol were standardized to z-scores. Linear regression models examined change–change associations, adjusting for income group and behavioral factors. Income-stratified and quartile-based analyses were performed. Results: Between 2000 and 2015, IHD and stroke mortality declined, while obesity and diabetes increased. In adjusted models, change in total cholesterol showed the most consistent association with change in IHD ASDR (β = 13.09, 95% CIs = 4.58–21.60, p = 0.003), whereas the other risk factors did not show consistent independent associations. Significant associations were confined to high- and upper middle-income countries, where change in total cholesterol was associated with IHD mortality. Conclusions: Changes in total cholesterol showed the most consistent correspondence with concurrent changes in IHD mortality at the country level, whereas other cardiometabolic risk factors showed less consistent patterns. These patterns were observed mainly in high- and upper–middle-income countries, suggesting heterogeneity by socioeconomic context.