Modifiable risk factors accounted for 88.7% (95% UI 83.4-92.5%) of US ischemic heart disease deaths in 2023, led by high systolic blood pressure, dietary risks, and high LDL-C.
Observational
Yes
Nearly 90% of ischemic heart disease deaths in the US are attributable to modifiable risk factors, emphasizing the critical need for population-level interventions targeting blood pressure, diet, and cholesterol.
Importance: Ischemic 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. Objective: To estimate the burden of IHD death attributable to risk factors in the US from 1990-2023. Design, Setting, and Participants: The 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. Exposure: Twelve metabolic, behavioral, and environmental risk factors. Main Outcomes and Measures: The 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. Results: In 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 Relevance: Per 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.
“Reductions in IHD mortality in the US have slowed, especially in younger populations. Past declines in IHD mortality in the US are unlikely to resume without further reduction of these leading risk factors.”
This highly-cited GBD 2023 analysis in JAMA Cardiology details the slowing decline in IHD mortality in the US, attributing the majority of deaths to modifiable risks like high blood pressure and diet.
Benziger et al. (2026) conducted an observational in Ischemic heart disease. Modifiable risk factors was evaluated on IHD death rates per 100 000 persons, counts, and attributable risks from 1990-2023 by age, sex, and US state. Modifiable risk factors accounted for 88.7% (95% UI 83.4-92.5%) of US ischemic heart disease deaths in 2023, led by high systolic blood pressure, dietary risks, and high LDL-C.
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