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.
Level 3 - non-randomized controlled study
Population-level comparative risk assessment and epidemiologic modeling study, graded by design analogy.
PubMed 42455550 · doi:10.1001/jamacardio.2026.2435
What was done
Using data from the Global Burden of Disease Study 2023 (GBD 2023), researchers evaluated trends in ischemic heart disease (IHD) mortality and attribution to 12 metabolic, behavioral, and environmental risk factors across US states from 1990 to 2023. IHD death rates were estimated using ensemble modeling on vital statistics and epidemiologic data, risk exposures were modeled via Bayesian meta-regression, and relative risks were estimated using the Burden of Proof framework across age, sex, and state strata.
What was found
In 2023, there were 473,000 IHD deaths (95% uncertainty interval [UI], 414,000-510,000) in the US, reflecting a 58.7% (95% UI, 56.8%-61.0%) decline in the age-standardized mortality rate since 1990. Between 2010 and 2023, IHD death rates declined by 19.0% (95% UI, 15.0%-22.9%) in males and 24.5% (95% UI, 20.3%-29.7%) in females. Modifiable risk factors accounted for 88.7% (95% UI, 83.4%-92.5%) of IHD deaths in 2023. The leading individual contributors were high systolic blood pressure (47.2%; 95% UI, 36.4%-57.0%), dietary risks (38.6%; 95% UI, 17.2%-56.8%), and high LDL cholesterol (28.5%; 95% UI, 19.3%-39.6%). Attributable burden increased substantially since 1990 for high body mass index (+54.5%; 95% UI, 41.8%-66.3%) and high fasting plasma glucose (+38.8%; 95% UI, 11.5%-81.1%), whereas attributable burden decreased for smoking (-33.3%; 95% UI, 23.6%-41.7%) and particulate matter pollution (-74.9%; 95% UI, 46.7%-88.8%).
Why it matters
Nearly nine in ten US ischemic heart disease deaths remain attributable to modifiable risk factors. While overall mortality and smoking-related burdens have declined, rising burdens from obesity and elevated blood glucose pose worsening public health challenges.
Limits
Findings rely on statistical modeling and aggregated secondary datasets rather than direct individual-level longitudinal tracking. Attributable risk estimations depend on modeling assumptions and counterfactual exposure definitions. Specific state-by-state variations and precise sample sizes were not reported in the abstract.
Cited by
- context Food- and diet-related chronic disease kills over one million people annually in the United States.