Over 88% of Ischemic Heart Disease Deaths Attributed to Modifiable Risks

More than 254 million people around the world are living with ischemic heart disease, the buildup of plaque in the arteries that reduces blood flow to the heart. A new study published in JAMA Cardiology shows that while U.S. deaths from the condition have fallen by 58.7% since 1990, an alarming 88.7% of all ischemic heart disease deaths in 2023 were tied to risk factors that individuals and health systems can change.

Researchers tracked U.S. data from 1990 through 2023 and found that the top contributors remain high systolic blood pressure (47.2%), dietary risks (38.6%) and high LDL cholesterol (28.5%). Gregory Roth, MD, of the University of Washington, noted that these risks often cause no symptoms and go unnoticed. “We want to highlight that [ischemic heart disease] is preventable and its risks are modifiable,” he said.

The most concerning trend is the shift in what drives mortality. Deaths attributable to high body mass index (BMI) rose 12.5% over the period, while those linked to high fasting blood sugar climbed 10.5%. Experts not involved in the work, including Ramon Alfonso, MD, of Baptist Health Miami, and interventional cardiologist James Chen, MD, of MemorialCare Saddleback Medical Center, said the findings align with what they see daily: smoking’s contribution has declined, but obesity and diabetes have taken its place.

The study also highlights wide variation among U.S. states, suggesting that some regions have already found effective strategies that others could adopt. “Comparing states helps us to see what can be accomplished in reducing mortality,” added Roth.

From Smoking to Sugar: The Evolving Face of Cardiovascular Risk

The study’s most powerful message is not simply that heart disease remains the leading cause of death, but that the vast majority of those deaths are avoidable with tools already available. The drop in smoking-related mortality proves that public health campaigns and clinical interventions work. However, the rapid rise of BMI- and glucose-driven deaths signals that the U.S. has replaced one set of preventable risks with another—a shift with deep consequences for healthcare spending, workforce health and insurance risk pools.

The Shifting Burden of Preventable Heart Disease

For three decades, declines in smoking, better cholesterol management and wider use of blood-pressure medication drove down ischemic heart disease deaths. Yet the new data show that dietary patterns and metabolic health are now the dominant forces. High fasting blood sugar, often a precursor to diabetes, alone accounted for an increasing share of mortality, and the 12.5% jump in BMI-related deaths reflects the obesity epidemic’s toll. Because these conditions frequently cluster—hypertension, dyslipidemia and insulin resistance—the challenge is compounding, not just additive.

What It Means for the U.S. Healthcare System

For insurers and large employers, the numbers translate directly into cost. Ischemic heart disease is among the most expensive chronic conditions, driving hospitalizations, revascularization procedures and long-term medication use. When almost nine out of ten deaths stem from modifiable risks, the gap between current prevention efforts and what is possible becomes a financial statement line. State-level variation further suggests that some health systems are already achieving better outcomes; scaling those successes could bend the cost curve nationally.

From Mass Campaigns to Individual Action

The study reinforces that screening for asymptomatic risks—blood pressure, LDL cholesterol, BMI and fasting glucose—must become more systematic. Public health agencies and primary care networks have the evidence to double down on dietary interventions and diabetes prevention programs, but access and adherence remain weak points. The fact that the largest increases are in risks tied to nutrition and weight points directly to food environments, socioeconomic disparities and the need for policies that go beyond the clinic.

What the Study Means for Patients, Payers and Policymakers

For Individuals

  • Know your numbers: regular blood pressure checks, cholesterol panels, and fasting glucose tests catch the silent risks that cause 88.7% of heart disease deaths.
  • Dietary change yields outsized benefits: with dietary risks linked to 38.6% of deaths, shifting toward a heart-healthy eating pattern is one of the highest-impact steps a person can take.
  • Weight and blood sugar matter even more now: the 12.5% and 10.5% increases in BMI- and glucose-related deaths make weight management and diabetes screening urgent priorities.

For Healthcare Providers

  • Embed prevention into every visit: because high blood pressure and elevated LDL cause no symptoms, opportunistic screening is the only way to close the detection gap.
  • Direct attention to the metabolic trio—obesity, prediabetes and dyslipidemia—which is now driving mortality more than traditional risk factors did a generation ago.

For Insurers and Large Employers

  • The 12.5% rise in BMI-related heart deaths signals a growing claims tail; wellness and diabetes prevention programs with demonstrated returns should be scaled, not cut.
  • Use the state-level variation highlighted by the study to benchmark your covered populations: if some regions achieve markedly lower mortality, their approaches can inform network design and benefit mandates.

For Policymakers

  • The data offer a clear playbook: replicate the policies and community interventions of top-performing states to narrow the preventable mortality gap.
  • Invest in food and built-environment policies that address the upstream drivers of the rising BMI- and glucose-related burden, which the study shows is accelerating.