Projected trends in ischemic heart disease mortality among patients with multiple myeloma in the United States: A forecast analysis through 2035.

e19544 Background: With progress in the treatment of multiple myeloma (MM), survival has improved significantly, and long-term mortality is being transferred to causes other than malignancy. Ischemic heart disease (IHD) has become a major cause of death in MM patients, influenced by aging, common cardiovascular risk factors, treatment outcomes. While earlier population-based studies had shown decreasing IHD mortality in the early 2020s, recent results suggest that these trends have attenuated with remaining sex, race, age, geographic disparities. The trend of mortality from IHD in MM remains unclear. We are attempting to predict national and subgroup-specific trends in IHD mortality among MM patients in the United States up to 2035. Methods: Using CDC WONDER multiple-cause-of-death data from 1999–2023, previously estimated age-adjusted mortality rates (AAMRs) and Joinpoint-derived annual percent changes were used to construct log-linear forecast models. Projections were generated for 2024–2035 overall and stratified by sex, race/ethnicity, age group, and U.S. region. Forecasts incorporated observed post-2018 trend attenuation to account for emerging plateau or reversal patterns. Outcomes are reported as projected AAMRs per million population. Results: Under base-case projections, overall IHD-related mortality among MM patients is expected to stabilize rather than continue declining, with AAMRs plateauing between 4.8–5.2 per million by 2035. Male patients are projected to maintain substantially higher mortality than females, with the sex gap narrowing minimally over time. Black patients are forecasted to experience the highest absolute IHD mortality burden through 2035, with projected AAMRs remaining nearly 1.6–1.8× higher than those of White patients. The ≥85-year age group is expected to account for an increasing proportion of IHD-related deaths, driven by improved MM survivorship. Regionally, the Northeast is projected to continue demonstrating the highest mortality rates, with limited convergence across U.S. regions. Conclusions: Using this national forecasting analysis, we predict IHD–attributed deaths will plateau in patients with MM through 2035 instead of continuing to decrease. Disparate outcomes by sex, race, age, and geography will likely endure, but with greater mortality among male ,Black patients, and an increasing burden in older age group. These data highlight the importance of incorporating CVD risk screening and targeted prevention strategies into long-term survivorship care in patients with MM, particularly high-risk groups. Observed and projected AAMR of IHD among patients with MM. Population Group Observed AAMR 2023 Projected AAMR 2030 Projected AAMR 2035 Overall 4.9 5.0 5.1 Male 8.3 8.5 8.7 Female 2.5 2.6 2.6 Black 9.1 9.4 9.6 White 5.3 5.4 5.5 Hispanic 4.1 4.0 4.0 Age ≥85 years 22.8 24.5 26.1 Northeast 6.4 6.6 6.8