Nearly 90% of ischemic heart disease (IHD) deaths in 2023 in the U.S. were attributable to modifiable risk factors, led by high systolic blood pressure (SBP), dietary risks and high LDL-C, according to data from the Global Burden of Disease Study 2023 (GBD 2023), published July 15 in JAMA Cardiology.

Using mortality records and other epidemiological data from GBD 2023, Catherine P. Benziger, MD, MPH, FACC; Gregory A. Roth, MD, MPH, FACC; and colleagues identified approximately 473,000 deaths from IHD in 2023.

Of those deaths, 89% were attributable to 12 modifiable metabolic, behavioral and environmental risk factors. High SBP, dietary risks and high LDL-C were the leading contributors, accounting for 47%, 39% and 29% of IHD deaths, respectively.

High BMI and high fasting plasma glucose showed the largest increases in their contribution to IHD deaths since 1990, rising by 55% and 39%, respectively. Over the same period, smoking and particulate matter pollution showed the greatest decreases in attributable burden, declining by 33% and 75%.

Although total IHD deaths declined by 59% since 1990, the pace of improvement has slowed in recent years, with deaths declining by only 21% between 2010 and 2023 (19% in men and 25% in women).

"While exposure changes for high SBP and high LDL-C are not decreasing IHD deaths, increased high FPG and BMI are increasing [U.S.] IHD risk," write Benziger, et al., on the slowing decline. They suggest that "viewing atherosclerosis and IHD as a lifetime continuum and targeting modifiable risk factors via early detection provide an opportunity to delay or reverse early atherosclerosis and subsequent IHD manifestations."

To that end, "it is well within our technical capacity to reignite efforts to overcome the stalled reduction in IHD death and disability," writes Robert M. Califf, MD, MACC, in an accompanying editorial. "More effective policies that help make healthy choices affordable and practicable, combined with more effective use of generic medicine, would change our current trajectory for the better."