AimThis　study　aimed　to　estimate　the　distribution　of　and　changes　in　the　global　burden　of　ischaemic　heart　disease　(IHD)　attributable　to　high　body　mass　index　(BMI)　and　low　physical　activity　(PA)　from　1990　to　2021.MethodsData　on　deaths,　disability-adjusted　life　years　(DALYs)　and　age-standardized　rates　for　IHD　attributable　to　high　BMI　and　low　PA　were　extracted　from　the　Global　Burden　of　Disease　2021　study.　Temporal　trends　by　gender,　region　and　Socio-Demographic　Index　(SDI)　were　analysed　using　joinpoint　regression.　Decomposition,　health　inequality　analysis　and　Bayesian　model　were　utilized.ResultsFrom　1990　to　2021,　global　DALYs　and　deaths　for　IHD　attributable　to　high　BMI　and　low　PA　nearly　doubled,　despite　a　decline　in　age-standardized　DALYs　([average　annual　percent　change　(AAPC)　=　-0.26,　95%　uncertainty　interval　(95%　UI):　-0.45,　-0.07),　(AAPC　=　-1.03,　95%　UI:-1.18,　-0.88])　and　deaths　rates　([AAPC　=　-0.53,　95%　UI:　-0.72,　-0.33],　[AAPC　=　-1.13,95%　UI:　-1.34,　-0.92]),　respectively.　The　burden　of　IHD　due　to　high　BMI　was　predominantly　seen　in　males,　while　low　PA　was　more　prevalent　in　females.　Significant　regional　and　national　variation　was　observed,　with　the　burden　shifting　from　high　SDI　regions　to　middle　or　low　SDI　regions.　Population　growth　and　aging　have　exacerbated　this　burden.　Health　inequities　have　shown　improvement　between　1990　and　2021.　Projections　for　the　next　15　years　suggest　rising　global　age-standardized　DALYs　and　death　rates　of　IHD　attributable　to　high　BMI,　while　those　attributable　to　low　PA　may　decrease.ConclusionsSince　1990,　the　global　and　regional　impact　of　IHD　attributable　to　high　BMI　and　low　PA　remains　significant,　with　disparities　by　gender,　age,　region　and　SDI.　Countries　should　implement　effective　measures　to　control　BMI　and　promote　PA　to　reduce　the　IHD　burden.