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Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990-2023
Journal article   Peer reviewed

Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990-2023

Catherine P. Benziger, Benjamin Stark, Catherine O. Johnson and Gregory A. Roth
JAMA cardiology, 42455550
15 Jul 2026
DOI: https://doi.org/10.1001/jamacardio.2026.2435
PMID: 42455550
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC13373740/View
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Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology
QuestionHow have the burden of ischemic heart disease (IHD) mortality in the US and the influence of its risk factors changed between 1990 and 2023?FindingsPer the results of this systematic analysis, there were an estimated 473 000 IHD deaths in the US in 2023, indicating the age-standardized mortality rate decreased by 58.7% since 1990. IHD deaths attributable to high body mass index (BMI) and high fasting plasma glucose (FPG) increased by 12.5% and 10.5% since 1990, respectively.MeaningModifiable risk factors are a major cause of IHD in the US, with increasing contributions attributable to high BMI and high FPG; addressing barriers to reducing risk exposure is essential to lessen IHD mortality. ImportanceIschemic 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.ObjectiveTo estimate the burden of IHD death attributable to risk factors in the US from 1990-2023.Design, Setting, and ParticipantsThe 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.ExposureTwelve metabolic, behavioral, and environmental risk factors.Main Outcomes and MeasuresThe 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.ResultsIn 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 RelevancePer 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. This systematic analysis of the Global Burden of Disease Study 2023 estimates the burden of ischemic heart disease death attributable to risk factors in the US from 1990 to 2023.

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