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Introduction The purpose of this study is to investigate the trends of the burden of ischemic heart disease (IHD) in the Eastern Mediterranean Region (EMR) countries from 1990 to 2019. Method Prevalence, disability-adjusted life years (DALYs), death, DALYs attribution risk factors, healthcare access and quality index (HAQ), and universal health care (UHC) were extracted from the database of the Global Burden of Disease study (GBD) for the EMR countries. Data stratification is based on the social demographic index (SDI). Cardiac rehabilitation data was obtained from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and other information was e obtained by an advanced search of individualized countries’ data. Result IHD age-standardized prevalence increased from 4.96% to 5.31% in the EMR from 1990-2019 while it decreased at the global level. In the EMR, the trend of age-standardized IHD death and DALYs rates decreased by 11.39% and 15.36% between 1990 and 2019 respectively, however, both rates were higher than the global rates. The burden of IHD in males was higher than females. The highest decrease of IHD age-standardized prevalence, death and DALYs rate in the EMR countries occurred in Bahrain (-3.72%, -64.95%and-69.08%, respectively). However, the most increase of prevalence happened in Oman with a change of 14.40% and for death and DALY rates was in Pakistan (29.62% and 31.93%, respectively) in the studied period. The top three attributed risk factor to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particular matter pollution. The 29-year trend of an attributed risk factor to IHD DALYs in the EMR (1990-2019) showed that the two factors of high fasting plasma glucose (64.03%) and high BMI (23.39%) had an increasing trend, respectively. Conclusion Our results showed an increased trend of the prevalence of IHD in the EMR that requires well planned prevention and treatment strategies. Developing and implementing programs to address the risk factors through health promotion and education, preventive programs, and medical care should be a priority for countries in this region.