BMI, Fasting Plasma Glucose Lead Ischemic Heart Disease Mortality in US

Modifiable risk factors like body mass index (BMI) and fasting plasma glucose (FPG) are still a leading cause of ischemic heart disease (IHD) mortality in the US, according to a recent analysis for the Global Burden of Disease (GBD) 2023 Study.¹

The GBD aims to provide comprehensive and systematic analyses of causes of death worldwide over a broad period. The 2023 edition of the GBD focused on enhancing clinicians’ understanding of the relationship between age and cause of death, ultimately including 292 individual causes of death for each year from 1990 to 2023.²

The present analysis follows a notable decline in IHD mortality in the US between 1980 and 2010, attributed largely to improved prevention and treatment. However, the trend has largely reversed due to shifting risk factor exposures and plateaus in risk factor improvements. This trend is not uniform across the US – smoking, for instance, despite significant declines since 2000, still remains highly prevalent in some populations.¹

“To examine IHD and associated risk factor trends, we analyzed death records and all available data on population risk exposure and their causal associations with IHD as part of the Global Burden of Disease 2023 Study (GBD),” Catherine Benziger, MD, director of research at Essentia Health Heart and Vascular Center, and colleagues wrote. “Our aim is to provide evidence that can guide public health interventions and health policy decision-making.”¹

Benziger and colleagues used the inaugural GBD year of 1990 as the baseline, identifying IHD deaths via the US National Vital Statistics System using International Classification of Disease (ICD) codes. Risk factors attributed to IHD burden were divided into the following major categories:

• Metabolic, including high systolic blood pressure, high LDL-C, high BMI, high FPG, and kidney dysfunction
• Behavioral, including tobacco, alcohol consumption, diet, and physical activity
• Environmental, including particulate matter pollution, lead exposure, and temperature.¹

Benziger and colleagues performed decomposition analysis via Das Gupta’s method, assessing drivers of change in IHD mortality over time. Additionally, age standardization was conducted using the direct method with GBD standard population, with uncertainty intervals reflecting the 2.5th and 97.5th percentiles from 250 posterior distribution draws. Risks and outcomes were aggregated by their level in GBD-developed hierarchies to represent 4 distinct levels of increasing granularity.¹

The team found that, in 2023, 473,000 IHD deaths occurred nationally, with an age-standardized rate of 75.4 (95% CI, 66.7-81.2) per 100,000. From 1990 to 2023, the age-standardized mortality rate decreased by 58.7% (95% CI, 56.8-61.3%) nationally. The decline slowed after 2010, reaching 20.5% (95% CI, 17.4-23.9%) reduction by 2023.¹

High systolic blood pressure, dietary risks, and high LDL-C were recorded as the leading risk factors for IHD mortality in 2023, attributed to 47.2% (95% CI, 36.4-57%), 38.6% (95% CI, 17.2-56.8%), and 28.5% (95% CI, 19.3-39.6%) of deaths, respectively. Additionally, Benziger and colleagues found that high FPG increased by 38.8% (95% CI, 11.5-81.1%) and high BMI increased by 54.5% (95% CI, 41.8-66.3%) since 1990. Additionally, smoking and particulate matter pollution decreased the most in attributable IHD mortality since 1990, with changes of 33.3% (95% CI, 23.6-41.7%) and 74.9% (95% CI, 46.7-88.8%), respectively.¹

“Reductions in IHD mortality in the US have slowed, especially in younger populations,” Benziger and colleagues wrote. “Past declines in IHD mortality in the US are unlikely to resume without further reduction of these leading risk factors.”¹

References

1. Benziger CP, Stark B, Johnson CO, et al. Modifiable risk factors and attributable ischemic heart disease mortality in US states, 1990-2023. JAMACardiology. Published online July 15, 2026. doi:10.1001/jamacardio.2026.2435

2. Naghavi M, Kyu H, A B et al. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 2025; 406, 1811-1872. DOI: 10.1016/S0140-6736(25)01917-8