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Journal Article Ahead of print 4 citations

PubMed: 42455550 DOI: 10.1001/jamacardio.2026.2435

Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990-2023: A Systematic Analysis for the Global Burden of Disease Study 2023.

JAMA Cardiol

Authors: Catherine P Benziger, Benjamin Stark, Catherine O Johnson, Gregory A Roth, Catherine P Benziger, Benjamin A Stark, Catherine O Johnson, Shady Abohashem, Syed Anees Ahmed, Ziyad Al-Aly, Mohammed A Alsabri, Catherine M Antony, Aleksandr Y Aravkin, Demelash Areda, Michelle L Bell, Michael Brauer, Gerald Chi, Michael H Criqui, Xiaochen Dai, Ojas Prakashbhai Doshi, Rajkumar Prakashbhai Doshi, Abdel Rahman E'mar, Muhammed Elhadi, Laszlo Göbölös, Demewoz Haile, Jeffrey J Hebert, Mehdi Hemmati, Ramzi Ibrahim, Samuel Berchi Kankam, Rami S Kantar, Jagdish Khubchandani, Min Seo Kim, Ruth W Kimokoti, Adnan Kisa, Michail Kokkorakis, Ashish Kumar, Xuefeng Liu, Lei Lv, Morteza Mahmoudi, Yosef Manla, Ramon Martinez-Piedra, Sammer Marzouk, George A Mensah, Tomislav Mestrovic, Ted R Miller, Ali H Mokdad, Vincent Mougin, Ahmad Mustafa, Mahmoud Nassar, Zuhair S Natto … and 26 other authors

Affiliations

  • Heart and Vascular Center, Essentia Health, Duluth, Minnesota.
  • Institute for Health Metrics and Evaluation, University of Washington, Seattle.
  • Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle.
  • Division of Cardiology, University of Washington, Seattle.
  • Cardiovascular Research Center, Massachusetts General Hospital, Boston.
  • Department of Radiology, Harvard University, Boston, Massachusetts.
  • Brody School of Medicine, East Carolina University, Greenville, North Carolina.
  • Department of Research and Development, Washington University in St Louis, St Louis, Missouri.
  • Clinical Epidemiology Center, US Department of Veterans Affairs, St Louis, Missouri.
  • Department of Emergency Medicine, Sana'a University, Sanaa, Yemen.
  • Pediatric Emergency Medicine Department, Drexel University, Philadelphia, Pennsylvania.
  • Department of Applied Mathematics, University of Washington, Seattle.
  • College of Art and Science, Ottawa University, Surprise, Arizona.
  • School of the Environment, Yale University, New Haven, Connecticut.
  • School of Health Policy and Management, Korea University, Seoul, South Korea.
  • School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
  • Division of Cardiovascular Medicine, Harvard University, Boston, Massachusetts.
  • Department of Family Medicine and Public Health, University of California, San Diego, La Jolla.
  • Independent Consultant, Bridgewater, New Jersey.
  • Department of Cardiology, Hackettstown Medical Center, Hackettstown, New Jersey.
  • Newton Medical Center, Sparta, New Jersey.
  • Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio.
  • College of Medicine, Korea University, Seoul, South Korea.
  • Houston Methodist Hospital, Houston, Texas.
  • Department of Cardiac Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
  • Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
  • Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.
  • School of Allied Health, Murdoch University, Murdoch, Western Australia, Australia.
  • Department of Medicine, MedStar Health, Washington, DC.
  • Department of Medicine, Georgetown University, Washington, DC.
  • Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
  • T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
  • The Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University, New York.
  • Department of Public Health, New Mexico State University, Las Cruces.
  • Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
  • Massachusetts General Hospital, Boston.
  • Health and Healing Research, Education, and Service, Boston, Massachusetts.
  • Millennium Prevention, Westwood, Massachusetts.
  • School of Health Sciences, Kristiania University College, Oslo, Norway.
  • Department of International Health and Sustainable Development, Tulane University, New Orleans, Louisiana.
  • Department of Medicine, Harvard University, Boston, Massachusetts.
  • Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
  • Department of Quantitative Health Science, Case Western Reserve University, Cleveland, Ohio.
  • Department of Clinical Data Science and Evidence, Novo Nordisk, Plainsboro, New Jersey.
  • Radiology and Precision Health Program, Michigan State University, East Lansing.
  • Department of Internal Medicine, Eisenhower Health, Palm Desert, California.
  • Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC.
  • Medical Scientist Training Program, Northwestern University, Chicago, Illinois.
  • Center for Translation Research and Implementation Science, US National Institutes of Health, Bethesda, Maryland.
  • Department of Medicine, University of Cape Town, Cape Town, South Africa.
  • University Centre Varazdin, University North, Varazdin, Croatia.
  • College of Human Medicine, Michigan State University, Flint.
  • Department of Cardiology, Northwell Health, Staten Island, New York.
  • Division of Endocrinology and Diabetes, University of Vermont, South Burlington.
  • Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract

IMPORTANCE

Ischemic heart disease (IHD), the leading cause of death in the US, is predominantly due to modifiable risk factors. Estimates of IHD mortality attributable to risk factors provide evidence for health policy decision-making.

OBJECTIVE

To estimate the burden of IHD death attributable to risk factors in the US from 1990-2023.

DESIGN, SETTING, AND PARTICIPANTS

The Global Burden of Disease Study 2023 (GBD 2023) used vital records and a broad set of epidemiologic data to estimate IHD death rates, risk factor exposure, and relative risk curves for risk-outcome pairs for 1990-2023 for the general population. Data analysis was performed from October 2024 to December 2025.

EXPOSURE

Twelve metabolic, behavioral, and environmental risk factors.

MAIN OUTCOMES AND MEASURES

The primary outcomes were IHD death rates per 100 000 persons, counts, and attributable risks from 1990-2023 by age, sex, and US state. Estimates include 95% uncertainty intervals (UI). IHD death rates were estimated using ensemble modeling methods. Risk exposures were estimated using bayesian meta-regression methods. Relative risks were estimated following the Burden of Proof framework.

RESULTS

In 2023, there were 473 000 IHD deaths (95% UI, 414 000-510 000) in the US, a decrease of 58.7% (95% UI, 56.8%-61.0%) in age-standardized rate since 1990. Between 2010 and 2023, there was a 19.0% decrease (95% UI, 15.0%-22.9%) for males and a 24.5% decrease (95% UI, 20.3%-29.7%) for females in IHD death rates. High systolic blood pressure (SBP), dietary risks, and high low-density lipoprotein cholesterol (LDL-C) were the leading risk factors for IHD deaths in 2023, accounting for 47.2% (95% UI, 36.4%-57.0%), 38.6% (95% UI, 17.2%-56.8%), and 28.5% (95% UI, 19.3%-39.6%) of IHD deaths, respectively. Increased exposure to several risk factors substantially increased their attributable burden for IHD deaths in 2023, with high fasting plasma glucose (FPG) increasing 38.8% (95% UI, 11.5%-81.1%) and high body mass index (BMI) increasing 54.5% (95% UI, 41.8%-66.3%) since 1990. Smoking and particulate matter pollution had the greatest decrease in attributable IHD mortality since 1990, at 33.3% (95% UI, 23.6%-41.7%) and 74.9% (95% UI, 46.7%-88.8%), respectively.

CONCLUSION AND RELEVANCE

Per the results of this systematic analysis of GBD 2023, a total of 88.7% (95% UI, 83.4%-92.5%) of IHD deaths were attributable to modifiable risk factors in the US in 2023, with high SBP, dietary risks, and high LDL-C being the greatest contributors. High BMI and high FPG showed the largest attribution increases, while exposure to other risks did not increase significantly for the population.

MeSH

Myocardial Ischemia, Mortality, Heart Diseases, Cholesterol, Ldl, Heart, Cardiovascular Diseases, Global Burden Of Disease, Risk Factors, Cost Of Illness