Background <p>High body mass index (HBMI) is a major global public health challenge, with its rapid rise contributing significantly to the increase in cardiovascular diseases. This study aimed to assess the global burden of ischemic heart disease (IHD) attributable to HBMI (IHD-HBMI), analyzing variations based on age, sex, income level, sociodemographic status, and health systems using secondary modeled estimates from the Global Burden of Disease (GBD) 2021 study.</p> Methods <p>This study reported the deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of IHD-HBMI. The research focused on numbers and age-standardized rates over the period from 1990 to 2021. All age-standardized rates were reported per 100,000 population.</p> Results <p>From 1990 to 2021, the global age-standardized DALYs rate for IHD-HBMI decreased by 7.7% from 300.8 in 1990 to 277.7 in 2021. Similarly, the age-standardized death rate (ASDR) declined by 15.0% from 13.8 in 1990 to 11.7 in 2021. Among World Bank income regions, the lower-middle-income and low-income regions experienced the most significant increases in the age-standardized DALYs rate and ASDR for IHD-HBMI, respectively. In 2021, males had a higher burden from IHD-HBMI compared to females. The burden of IHD-HBMI was found to increase with age, peaking in those aged 95&#xa0;years and older (95 +). Moreover, limited health systems had the most pronounced increases in the age-standardized DALYs and death rates for IHD-HBMI from 1990 to 2021. Summary exposure value for HBMI increased substantially (70.9%), contrasting with declining IHD-HBMI age-standardized rates. Burdens varied by sociodemographic index.</p> Conclusion <p>Over the past 32&#xa0;years, the global number of cases of IHD-HBMI has increased, with persistent disparities across regions with different income levels. This trend emphasizes the need for cost-effective strategies and interventions, especially in low-income regions.</p>