Abstract Body: Introduction: Ischemic heart disease (IHD) remains one of the leading causes of morbidity and mortality worldwide, with physical inactivity identified as a key modifiable risk factor. This is the first ever study estimating the burden of IHD attributable to low physical activity (LPA) including first 2 years of COVID-19 pandemic.

Method: Using Standardized GBD 2021 methodology, we estimated deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) due to IHD attributable to LPA stratified by age, sex, year and location across the 204 Countries and territories from 1990-2021. Non-fatal health outcomes were estimated using cause of death ensemble model (CODEm). Results are shown in absolute counts, unadjusted and age-standardized rate per 100,000.

Results: From 1990-2021, the average annual percentage change (AAPC) the absolute death count rose by 2.00%, 1.79% for DALYs, 2.81% for YLDs, and 1.77% for YLLs. The highest increase in APC was observed in deaths among countries with a middle socio-demographic index at 2.06%, followed by DALYs at 1.60%. According to health system grouping levels, the highest death rate in 2021 was observed in countries with advanced health systems at 4.38 per 100,000 (95% UI: 1.8-7.3). Over the last three decades, males continued to show a higher burden compared to females, with APCs in deaths of 1.10% for males versus 0.74% for females, 0.89% for DALYs versus 0.65%, and 0.88% for YLLs versus 0.64%.

Conclusion: Deaths due to IHD accounted for 2.58% of all IHD related deaths globally in 2021. Our findings underscore the need for public health strategies that address the complex socio-technological landscape influencing physical activity levels and suggest pathways for integrating more movement into daily life to mitigate the IHD burden. The need for action is urgent if we are to reverse the trends that have placed so many at risk in our increasingly sedentary world.