Abstract Body (Do not enter title and authors here): Introduction: Ischemic Heart Disease (IHD) is the primary cause of morbidity and mortality across Southeast Asia, East Asia, and Oceania. Although there has been a lack of comprehensive studies on the burden of IHD attributable to air pollution, this study is the first to estimate its impact over the last three decades, including the initial two years of the COVID-19 pandemic.

Method: Using global burden of disease tool, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) due to IHD attributable to Air pollution by age, sex, year across the SEA, EA, and Oceania from 1990-2021.

Results: From 1990 to 2021, the annual percentage change (APC) in total deaths due to ambient particulate matter pollution increased by 112% (95% UI: 79-151%), with DALYs rising by 77% (51-108%) and YLDs by 106% (91-120%). The age-standardized mortality rate (ASMR) increased by 124%, and DALYs rate by 102%. Timor-Leste observed the highest APC in ASMR at 329%, followed by China at 147%, while the highest DALYs rate was also in Timor-Leste at 321%, followed by the Solomon Islands at 141%. The highest number of deaths was recorded in the 80–84-year-old age group with 148,592, and DALYs were highest in the 70-74 age group at 2.2 million due to IHD attributable to AP in 2021. Males experienced a higher burden compared to females over the last three decades, with a total percentage change in deaths at 168% vs. 130%, YLDs at 128% vs. 153%, and YLLs at 112% vs. 73%.

Conclusion: Urgent action is crucial to combat the escalating burden IHD due to AP in Southeast Asia, East Asia, and Oceania. Public stakeholders and policy makers must implement robust strategies to slash particulate matter pollution and protect public health.