The crisis continues: Nearly 90% of deaths from ischemic heart disease could have been prevented
High cholesterol and other modifiable risk factors are responsible for a vast majority of deaths from ischemic heart disease (IHD) in the United States, according to a new analysis published in JAMA Cardiology.[1] There has been progress in recent decades, researchers noted, but there is still a lot of work to do.
“U.S. IHD mortality declined between 1980 and 2010 due to improved prevention and treatment,” wrote first author Catherine P. Benziger, MD, a cardiologist with Essentia Health, and colleagues. “Since 2010, this trend has slowed or reversed in most states due to plateaus in risk factor improvements, shifting risk factor exposures and fewer treatment advances.”
To learn more about the current state of this trend, Benziger et al. reviewed data from the Global Burden of Disease Study 2023. Overall, the group found that there were 473,000 IHD-related deaths in the United States in 2023. This is a significant improvement in many ways; IHD mortality was down 58.7% from 1990 to 2023 and down 19% from 2010 to 2023. However, the team’s research also identified a number of statistics that show just how much more work there is still to do when it comes to combatting these modifiable risks.
One key takeaway from this analysis is the fact that modifiable risks were responsible for 88.7% of deaths from IHD. The encouraging news is that 127,000 fewer IHD deaths were linked to modifiable risk factors in 2023 than in 1990—and that comes at a time where the U.S. population has increased and grown older. Tobacco use, lead exposure and air pollution were all associated with a significantly lower number of IHD deaths in 2023, highlighting progress the country has made over the years.
The less encouraging news is the fact that some metabolic risks are on the rise, including high body mass index (BMI) and high fasting plasma glucose.
“Current guidelines recommend screening at age 35 years and sooner if overweight or obesity is present, yet less than half of eligible U.S. adults report glucose testing, potentially due to issues including healthcare access, clinician guideline familiarity or patient care-seeking practices,” the authors wrote. “Glycemic and blood pressure control among U.S. patients with diabetes declined from the late 2000s onwards after a decade of progress in the late 1990s to early 2000s.”
Benziger and colleagues noted that high BMI and fasting plasma glucose have been identified in other parts of the world as well. The hope is that certain policy improvements—including improved patient access to care and affordable medications to treat these risk factors—can bring about change.
“Recent recommendations emphasize a shift toward targeting underlying IHD mechanisms, with a particular focus on early detection and treatment of atherosclerosis,” the authors wrote. “Studies from the U.S. and Sweden show that even those at low risk of IHD may have subclinical atherosclerosis, particularly at younger ages. Viewing atherosclerosis and IHD as a lifetime continuum and targeting modifiable risk factors via early detection provides opportunity to delay or reverse early atherosclerosis and subsequent IHD manifestations.”
If these risk factors are not effectively addressed, the group concluded, “past declines in IHD mortality in the U.S. are unlikely to resume.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.