AIMS: The three key and direct risk factors for the significant health issue prevalent worldwide, ischaemic heart disease(IHD), are high fasting plasma glucose (HFPG), high low-density lipoprotein (HLDL) and high systolic blood pressure (HSBP) in metabolic syndrome (MetS). A comprehensive study is essential to present the most recent global epidemiological trends. METHODS: IHD data attributable to HFPG, HLDL and HSBP (3H) were obtained from the Global Burden of Disease Study (GBD) 2021. The absolute burden was manifested in the number of death cases and disability-adjusted life years (DALY). The relative burden was quantified through the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR). Estimated annual percentage change (EAPC) was used to measure trends. RESULTS: HSBP caused the greatest IHD burden, followed by HLDL, which was much higher than HFPG. The IHD burden associated with HLDL and HSBP were more alike and notably different from HFPG. From 1990 to 2021, ASDR for HSBP and HLDL-related IHD generally declined, with the EAPC of -1.28 (95% CI: -1.34, -1.23) and -1.38 (95% CI: -1.44, -1.33). But the trend was less pronounced for HFPG-related IHD, with the EAPC of -0.90 (95% CI: -2.25, 0.46). The absolute burden was higher in men under 80 and peaked 5-10 years earlier than women. Compared to HSBP and HLDL, HFPG caused a significant increase in burden in low-middle and low socio-demographic index (SDI) regions. The high-middle SDI region, which originally had the highest burden, showed a clear downward trend after 2005 and was gradually overtaken by the low-middle region. Eastern Europe, Central Asia, North Africa and the Middle East had the highest burden among the regions with the same SDI level in Europe, Asia and Africa. CONCLUSION: The HFPG-related IHD burden should be managed differently from HSBP and HLDL. Particular attention should be paid to men, older age groups and regions with low-middle SDI.