Metabolic Risk Factors and Ischemic Heart Disease: A Secondary Analysis of the Global Burden of Disease Study on 32-Year Trends in the United States Publisher



Bastan MM ; Heidariforoozan M ; Jafary H ; Behnoush AH ; Khalaji A ; Malekpour MR ; Nejadghaderi SA
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Introduction: Cardiovascular health in the U.S. has worsened over the past decade due to slowed declines in disease burden, rising risk factors, and increasing heart disease among young people. This study quantifies the burden of ischemic heart disease (IHD) using the Global Burden of Disease (GBD) 2021 data to update prior literature. Methods: We analyzed IHD burden and its metabolic risk factors in the U.S. using GBD 2021. Incidence, prevalence, disability-adjusted life years (DALYs), and death rates were assessed by age and sex, comparing trends between 1990 and 2021 using joinpoint regression analysis. Results: In 2021, IHD incidence, prevalence, DALYs, and deaths were 967989.8 (95% uncertainty interval, 814313.0 to 1134212.0), 8655573.8 (7305087.1 to 10307536.7), 8751736.2 (8013896.5 to 9182127.6), and 493222.0 (432450.6 to 527138.6), respectively. Joinpoint regression analysis revealed the deceleration in decline of IHD incidence, DALYs, and deaths when comparing the trends in latest segments. Metabolic risk factors contributed to 6892410.0 (6087090.3 to 7561854.9) DALYs and 388461.8 (328984.6 to 433353.4) deaths in 2021. High systolic blood pressure and high low-density lipoprotein cholesterol were the top risk factors. Joinpoint regression analysis revealed the deceleration in decline of burden of IHD attributable to metabolic risk factors when comparing the trends in latest segments. This deceleration was more pronounced for high body-mass index (BMI) and fasting plasma glucose. Conclusion: IHD rates in the U.S. were declining but slowing due to persistent metabolic risk factors. The deceleration in risk factor decline, particularly high BMI and fasting plasma glucose, undermines cardiovascular health progress. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.