Background <p>High sodium diet is a significant modifiable risk factor for cardiovascular diseases, and is closely associated with ischemic heart disease (IHD) and hypertensive heart disease (HHD). There is considerable heterogeneity in the sodium-related cardiac diseases across China, G20, and Southeast Asian countries. Examining and contrasting the data from these regions can provide a basis for developing effective prevention and control strategies for IHD and HHD. Therefore, this study aims to evaluate the temporal trends, driving factors, and future projections of these diseases to test the hypothesis of distinct regional and demographic disparities.</p> Methods <p>Based on the Global Burden of Disease (GBD) 2023 database, populations from China, G20 and Southeast Asian countries from 1990 to 2023 were included, focusing on high sodium diet-related hypertensive heart disease (HNaD-HHD) and high sodium diet-related ischemic heart disease (HNaD-IHD). Statistical methods including Joinpoint regression and ARIMA predictive analysis were used to analyze the distribution and trends of core indicators such as disease Deaths and disability-adjusted life years (DALYs), quantify the driving factors and conduct future burden prediction.</p> Results <p>The age-standardized rates (ASRs) of death-related burden (Deaths/DALYs/years of life lost, YLLs) for both diseases generally showed a declining trend, while the absolute numbers continued to rise. The burden of HNaD-HHD presented a steady decline characteristic, whereas HNaD-IHD burden showed fluctuations with significant heterogeneity, and China was identified as a core region for HNaD-IHD risk. In addition, the years lived with disability (YLDs) of HNaD-HHD in China showed an upward trend. The disease burden in males was significantly higher than that in females (the male-to-female ratio was about 1.5-2.0). The remission of HNaD-HHD burden was mainly driven by epidemiological changes, while the increase of HNaD-IHD burden was mainly attributed to population growth and aging. Predictive results indicated that the characteristics of “declining or plateauing standardized rates” and “rising absolute numbers” may coexist for a long time.</p> Conclusions <p>There are significant differences in the burden characteristics and driving factors of the two types of sodium-related heart diseases, with obvious regional and population heterogeneity. This study provides precise evidence-based support for developing targeted prevention and control strategies for high sodium diet and salt-reduction interventions in different regions.</p>