Deaths from coronary artery disease have fallen, but more progress is within reach
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- Global Burden of Disease study found U.S. ischemic heart disease deaths fell by more than half from 1990 to 2023, published Wednesday in JAMA Cardiology using National Vital Statistics System data.
- 88.8% of 2023 coronary artery deaths — roughly 419,000 of 473,000 — were linked to modifiable risk factors; co-author Gregory Roth of the University of Washington said 80–90% of cases are preventable.
- Smoking-related deaths dropped 33.3% and particulate air pollution deaths dropped 74.9% since 1990, but BMI rose 12.5% and blood glucose rose 10.5%, fueling diabetes and the newly named cardiovascular-kidney-metabolic syndrome.
- High blood pressure (47.2%), diet (38.6%), and LDL cholesterol (28.5%) drove nearly half of 2023 heart disease deaths; progress on risk factors has stalled since 2010.
- Kentucky, Tennessee, West Virginia, Mississippi, and Arkansas posted the highest death rates, while Massachusetts, Oregon, Hawaii, Colorado, and Minnesota saw the lowest; Massachusetts, New Jersey, and Minnesota recorded the steepest declines (63%+ since 1990).
- Former FDA Commissioner Robert Califf, writing in an accompanying editorial, warned that "the recent swing in policy to emphasize individual choice over public health" could reverse progress and flagged a shortage of primary care and CKM specialists.
- Northwestern's Sadiya Khan, who was not involved in the study, urged a comprehensive approach — food environment, safe green spaces for exercise, and affordable access to medications including newer obesity drugs.
Why it matters: The 88.8% preventable share means roughly 419,000 Americans died in 2023 from risk factors that public policy and clinical practice already know how to modify; the geographic clustering in Appalachian and Deep South states shows where structural interventions — tobacco policy, food environment, primary care access — would have to land hardest to close the gap.
