Almost nine in 10 deaths from ischemic heart disease in the United States are associated with modifiable risk factors, according to a new study published in JAMA Cardiology. While overall mortality from the disease has declined substantially over the past three decades, researchers warn that obesity and high blood sugar are becoming increasingly important drivers of cardiovascular deaths.
Ischemic heart disease, also known as coronary artery disease, is caused by the buildup of plaque inside the coronary arteries, reducing blood flow to the heart. It remains the leading cause of death worldwide and affected an estimated 254 million people globally in 2021.
Researchers analyzed data from the Global Burden of Disease 2023 study, examining trends in ischemic heart disease deaths and exposure to 12 modifiable risk factors between 1990 and 2023. These included metabolic factors such as high LDL cholesterol, elevated blood pressure, obesity, and high fasting blood glucose, as well as behavioral factors like smoking, alcohol consumption, physical inactivity, and environmental exposures including air pollution and lead.
The analysis showed that 473,000 people died from ischemic heart disease in the United States in 2023, representing a 58.7% decline in mortality compared with 1990. Nevertheless, researchers estimated that 88.7% of these deaths were still attributable to preventable risk factors.
The strongest contributors to ischemic heart disease mortality in 2023 were high systolic blood pressure, responsible for 47.2% of deaths, followed by poor diet (38.6%) and high LDL cholesterol (28.5%).
Although smoking-related cardiovascular deaths have declined over the past three decades, obesity-related factors have moved in the opposite direction. Deaths associated with high body mass index (BMI) increased by 12.5%, while those linked to high fasting blood glucose rose by 10.5% since 1990, making them the fastest-growing contributors to ischemic heart disease mortality.
Researchers emphasize that these findings highlight the importance of prevention. Many cardiovascular risk factors develop without noticeable symptoms, making regular screening essential for early detection and treatment.
Cardiologists not involved in the study say the findings reflect what they observe in everyday clinical practice. They note that while significant progress has been made in reducing smoking-related cardiovascular risk, rising rates of obesity and diabetes now represent some of the greatest challenges to further reducing heart disease.
Experts recommend maintaining a healthy body weight, following a heart-healthy diet low in saturated fats and ultra-processed foods, engaging in regular physical activity, controlling blood pressure, LDL cholesterol and blood glucose levels, and avoiding tobacco use. They stress that coordinated efforts by individuals, healthcare systems, and public health authorities will be essential to further reduce the burden of ischemic heart disease.
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