Abstract 4145182: Decadal Shifts in Metabolic Risk Factors Associated Ischemic Heart Disease Mortality Trends: Insights from Global Burden of Disease Study 1990-2021

Background: Ischemic heart disease (IHD) continues to be a major contributor to global mortality. Metabolic risk factors are known to be the leading drivers of IHD burden. Our study aims to explain the trends in Metabolic Risk Factors (MRF) associated IHD mortality by utilizing Global Burden of Disease Study data spanning over three decades from 1990 to 2021. Method: MRF associated IHD mortality rates in the United States from 1990 to 2021 were sourced from the Global Burden of Diseases 2021 database. Monte Carlo permutation analysis utilizing JointPoint Regression Software (version 4.9.0.1, NCI) was employed to estimate the time trends, using annual percentage change (APC) and average annual percentage change (AAPC) metrics. Initially, these trends were assessed for the overall population. Analysis was then stratified by gender, evaluating age-adjusted rates separately for males and females. Further stratification involved, assessing age-specific trends within two distinct age groups: younger adults (20-54 years) and older adults (>55 years). Results: A statistically significant decline in overall mortality was noted, with a moderate decline occurring during the decade 1990 to 2001 (APC= -2.2, p<0.000001), the most substantial decrease during the decade 2001 to 2010 (APC = -4.91, p < 0.000001), and the least decline from 2010 to 2021 (APC = -1.64, p < 0.000001). There was no statistically significant difference in mortality trends between males and females (AAPC difference= -0.14, p = 0.1177). Age-specific analysis revealed a significantly greater decline in mortality among older adults (AAPC = -2.80, p < 0.000001) compared to younger adults (AAPC = -1.32, p < 0.000001). Conclusion: Significant decline in metabolic risk factors associated IHD mortality from 1990 to 2021 could be attributed to improved medical interventions and public health strategies, particularly during the decade of 2001 to 2010. The subsequent slower decline from 2010 to 2021 suggests potential limitations in the reach or efficacy of these interventions over time. These findings underscore the need for continued focus on age-specific interventions and public health strategies to further reduce metabolic risk factors associated IHD mortality.