Objectives: To report the ischemic heart disease (IHD) burden and its risk factors among adults aged 70 and older in Iran in terms of sex, at both the national and provincial levels, from 1990 to 2019. Design: Systematic analysis. Outcome Measures: The modelled point prevalence of IHD, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) were reported using data obtained from the Global Burden of Disease (GBD) 2019 study, as counts and standardized rates, along with their related 95% uncertainty intervals (UIs). Results: In 2019, IHD had a point prevalence of 52886.4 per 100000 population for adults aged 70 and above in Iran, which was 7.5% higher than that in 1990, and a death rate of 1932.9, which was 22.0% lower than that in 1990. In 2019, the number of DALYs attributed to IHD was 820.4 thousand with a rate of 23630.9, which was 33.7% lower than that in 1990. Furthermore, Golestan and Tehran with rates of 32484.6 and 12752.5 had the largest and smallest DALY rates in those aged 70 and above in Iran, respectively. The highest point prevalence, death, and DALY rates for both sexes, were found in the 95+age group. In 2019, the Iran DALY rate was lower than the Middle East and North Africa region rate in all age groups in males and females, except for the 90-94 and 95+age groups in females. Nationally, systolic blood pressure (SBP) (47.8%), low-density lipoprotein (LDL) cholesterol (36.2%), and fasting plasma glucose (FPG) (35.3%) had the three highest attributable DALYs. Conclusions: Currently, the burden of IHD in Iran is considered a pressing public health issue, indicating the urgent need for effective public health interventions. Further investigations are, therefore, needed to discover causes for the high prevalence of IHD in the country and to develop better strategies for effective prevention and controlling it.