###### Abstract  
Ischemic heart disease (IHD) morbidity and mortality indices, along with medical intervention rates, were analyzed among Mediterranean countries, Croatia, Slovenia, Italy, and France, in the pre-COVID period. Standardized IHD incidence and prevalence rates from 1990 and mortality rates from 1985 were obtained from the Global Burden of Disease Study 2017 and Health for All databases. Coronary artery bypass graft (CABG) and transluminal coronary angioplasty (TCA) rates in the 2011-2019 period were obtained from Eurostat. Trends were estimated with Joinpoint regression analysis. IHD mortality rates range from 13.6 to 74.3 for females and from 37.8 to 126.03 for males. IHD mortality rates in Croatia were 5.6-fold higher among females and 3.3-fold higher among males compared to France. All countries decreased standardized IHD prevalence and incidence rates, although the magnitude varied. The high-to-low ratio, Croatia vs. Spain, was 3.5-fold for CABG and 3.2-fold for TCA. Slovenia, as opposed to Croatia, reduced the gap for all medical indicators except for relatively high prevalence rates. Despite a significant rise in medical interventions in Croatia, ineffective clinical and public health initiatives have led to only modest declines in IHD mortality rates over the past decade.  
s 2024 14 2581  
of ischemic heart disease (IHD), the most common form of CVD, declined in developed countries: in 2000, it comprised about one-third of IHD mortality rates recorded in the 1960s [1]. Nevertheless, the burden and magnitude of IHD mortality varies across EU country members. Western, Northern, and Southern European countries experienced a steady decline compared to Central-Eastern European (CEE) countries. Although gaps in healthcare indicators are narrowing between new EU country members and the EU average, the total life expectancies in Croatia and neighboring Slovenia are still below the EU average (81.3 years), at 78.6 years, and 81.6 years, respectively [2]. Croatia, the last country member to join the EU in 2013, is still undergoing a multifaceted transformation process of socioeconomic and cultural convergence towards Western Europe. Still, health issues remain undervalued and insufficiently researched. The burden of disease is generally higher, and a large proportion of all deaths is attributable to behavioral risk factors [3; 4]. More than half of the IHD mortality reduction is estimated to be attributable to the risk factors and the rest to medical and surgical interventions [5]. However, EU country members have different CVD prevention strategies and rates of medical interventions. Thus, Croatia has not conducted comprehensive epidemiological research, and an efficient CVD control and prevention strategy is still under development [6; 7]. The CVD burden in Croatia, regardless of its Mediterranean lifestyle heritage and negative IHD mortality trend over the past two decades, remains higher compared to the EU average and other Mediterranean countries. Although these countries have been historically considered as low-risk cardiovascular regions, they have different burdens and dynamics of IHD mortality [8; 9; 10].  
The aim of the study is to assess the differences in trends of SDR, standardized incidence rate (SIR), and standardized prevalence rate (SPR) of IHD as well as rate of interventions for coronary artery bypass graft (CABG) and transluminal coronary angioplasty (TCA) between new (Slovenia and Croatia) and old EU country members and Mediterranean countries (Spain, Italy, and France).