ObjectiveTo assess the burden of ischemic heart disease attributable to low physical activity and high body mass index among the population aged 60 years and above in China from 1990 to 2023, and to predict the changing trends of the corresponding burden from 2024 to 2038, so as to lay a theoretical foundation for formulating comprehensive prevention and control measures. MethodsWe utilized the estimated annual percentage change (EAPC) to analyze the trends in disability-adjusted life years (DALYs) and mortality burden of ischemic heart disease attributable to high body mass index and low physical activity among the elderly population in China, along with exploring sex and age-group differences in the related burden. Furthermore, the Bayesian age-period-cohort model was employed for predictive analysis. ResultsEAPC analyses indicated that the age-standardized mortality rate (ASMR) and age-standardized DALYs rate of ischemic heart disease attributable to low physical activity and high body mass index among the Chinese elderly population increased from 1990 to 2023. Regarding sex differences, the burden caused by low physical activity was more severe in elderly females, while the burden attributed to high body mass index was heavier in elderly males. During the projection period, only the ASMR due to low physical activity in elderly males was expected to present a decreasing trend, while all other types of burdens were forecast to rise. ConclusionThe burden of ischemic heart disease attributable to the above two modifiable risk factors continues to escalate among the elderly population in China. Therefore, it is necessary to implement precision prevention and control strategies ranging from the macro level to the individual level, with full consideration of sex heterogeneity, so as to alleviate the disease burden effectively.