Trends and Disparities in Myocardial Infarction-Related Mortality in Older Hyperlipidemic Patients in the US Population, 1999–2020

Hyperlipidemia is a major risk factor for myocardial infarction (MI), yet trends and disparities in MI-related mortality among older adults in the United States are poorly understood. This study aimed to examine temporal trends and demographic disparities in MI-related mortality among adults aged ≥65 years. Death certificate data from the CDC WONDER database (1999–2020) were analyzed using ICD-10 codes for MI (I21–I22) and hyperlipidemia (E78.0–E78.9). Age-adjusted mortality rates (AAMR) per 100,000 were calculated, and temporal trends were evaluated using Joinpoint regression. Among 90,568 MI-HL deaths, men comprised 55%. AAMR increased from 6.4 in 1999 to 11.9 in 2020, with the steepest rise between 1999–2005 (APC 7.40%). Men consistently had higher AAMRs than women (2020: 16 vs 8.8). Whites had the highest overall AAMR (10.0), followed by Blacks (9.4) and Hispanics (7.8). Age-stratified mortality was highest in those ≥85 (21.4), followed by 75–84 (11.6) and 65–74 (6.0). Significant geographic variation existed, with states in the top 90th percentile (Vermont, Rhode Island, South Dakota, Ohio) showing nearly fourfold higher AAMRs than those in the lowest 10th percentile (Nevada, Alabama, Connecticut, Georgia). MI-related mortality with hyperlipidemia shows marked demographic and geographic disparities among older U.S. adults. Men, Whites, the oldest age groups, and residents of certain states and non-metropolitan areas are at greatest risk. Enhanced screening, preventive strategies, and equitable access to care are essential to reduce disparities and improve cardiovascular outcomes.