Nearly 90% of heart disease deaths in 2023 were linked to factors that can be changed, with high blood pressure, poor diet, and high cholesterol leading the list. A new study analyzing over 30 years of data highlights how these specific elements contribute to mortality from ischemic heart disease. This condition involves heart damage caused by narrowed arteries reducing oxygen and blood flow, according to the American Heart Association. In 2023, high blood pressure was the biggest contributor to these deaths, accounting for 47% of cases, followed by diet at around 39%, and high cholesterol at 28.5%.
The research, published in JAMA Cardiology, assessed 12 modifiable risk factors ranging from alcohol consumption to air pollution. Using statistical models, the team determined how each factor contributed to death rates across the United States. This analysis relied on death records and a broad set of epidemiologic data from across the country to estimate mortality from ischemic heart disease.
Despite the prevalence of these risks, the study uncovered positive long-term trends. Since 1990, deaths from ischemic heart disease have fallen by 58.7%. During the 33 years analyzed, deaths attributable to tobacco and air pollution exposure also decreased. However, the top three mortality risk factors remained consistent throughout the entire period. Additionally, researchers found that obesity and high blood sugar are becoming increasingly important drivers of heart disease mortality. Nupur Shah, M.D., a cardiologist at Atlantic Health, explains that this shift shows the growing impact of metabolic health on heart disease.
Understanding the physiological mechanisms behind these risk factors is essential for prevention. High blood pressure, also known as hypertension, occurs when the heart must work harder than normal to pump blood, placing unnecessary stress on blood vessel walls that can cause tiny tears over time. Sanjeev Kumar Gulati, M.D., executive deputy director and chief of cardiovascular medicine at Baptist Health South Florida Heart and Vascular Care, explains that hypertension causes the heart to become enlarged and arteries to become stiffer, which can lead to artery blockages. Dr. Shah adds that high blood pressure damages blood vessels over time, accelerates plaque buildup, and increases strain on the heart.
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Dietary choices play a similarly critical role. A diet containing excess sodium and ultra-processed foods, combined with a lack of fresh fruits, vegetables, and whole grains, promotes hypertension, inflammation, and insulin resistance. Dr. Gulati notes that these conditions all lead to increased coronary artery disease. Cholesterol levels are equally vital; high low-density lipoprotein (LDL) cholesterol, known as “bad” cholesterol, can accelerate the development of atherosclerosis. Dr. Gulati explains that this condition involves plaque building up in the arteries, progressively restricting blood flow to the heart over time. Dr. Shah warns that when these plaques rupture, they can cause heart attacks or sudden cardiac death.
To mitigate these risks, experts recommend specific lifestyle adjustments. Keeping blood pressure in check involves regular monitoring—perhaps with an at-home device—and treating hypertension early. Dr. Gulati notes that while prescription medication is often used, exercising and cutting sodium intake can also help. Experts frequently recommend heart-healthy diets like the Mediterranean or DASH plans, which emphasize fruits, vegetables, whole grains, legumes, nuts, and healthy fats while limiting sodium and ultra-processed foods. Routine cholesterol testing is also advised to ensure levels stay in check. If needed, doctors can prescribe cholesterol-lowering medications like statins, says Dr. Shah.
Furthermore, maintaining a healthy weight, staying active, avoiding tobacco, and controlling diabetes or pre-diabetes are all vital steps. Addressing modifiable risk factors as early as possible is the most effective way to prevent ischemic heart disease. Dr. Gulati emphasizes the need to focus education on children and young adults to combat these issues, suggesting that people should work with their cardiologist to create a plan early in life. Dr. Shah cautions that it is easy to brush aside warnings when feeling healthy, noting that many people feel well until they experience a heart attack. Consequently, she stresses that prevention and routine screening are critical.
