AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Global Progress Masks Rising Obesity-Attributable Ischemic Heart Disease Risk in Lower and Middle Income Populations: A Global Burden of Disease Analysis, 2013 to 2023
By Patel J, patel V
Background: Ischemic heart disease (IHD) is the leading cause of global mortality, and high body mass index (BMI) is a major modifiable contributor. Whether the rising obesity-attributable IHD burden reflects worsening risk or demographic change, and whether progress has been shared equally across populations, remains unclear. Hypothesis: We hypothesized that increases in obesity-attributable IHD burden were driven primarily by population growth and aging, while age-standardized risk diverged across socioeconomic strata. Methods: Using Global Burden of Disease 2023 estimates, we analyzed deaths and disability-adjusted life-years (DALYs) from IHD attributable to high BMI among adults aged 25 years and older from 2013 to 2023, stratified by sex, age, five Socio-demographic Index (SDI) quintiles, and world regions. We calculated counts, age-standardized rates, and annual percentage change (APC), and partitioned changes in deaths into population growth, aging, and risk components using Das Gupta decomposition. Results: Global deaths attributable to high BMI increased from 753,868 to 936,234 (+24.2%), and DALYs increased 24.2%. However, the age-standardized death rate declined 5.5%. Decomposition attributed the increase to population growth (+70%) and aging (+61%), partially offset by a decline in risk (-32%). Despite this overall improvement, trends diverged sharply across socioeconomic strata: age-standardized mortality declined 15.0% in High-SDI populations but rose in Middle-SDI (+13.4%), Low-middle-SDI (+14.5%), and Low-SDI (+23.8%) populations. The lowest-SDI populations, historically the lowest risk, converged toward high-SDI levels (low-to-high rate ratio of 0.44 to 0.64), while the highest absolute rate in 2023 occurred in Middle-SDI populations (27.0 per 100,000). Progress also slowed over time: the age-standardized rate declined 0.8% annually during 2013-2018 but plateaued thereafter (+0.1% annually, 2018-2023), driven by worsening trends in lower- and middle-SDI populations. Men had a 1.5-fold higher mortality rate than women, and men aged 50 to 69 years accounted for 30% of the global increase in deaths. Years of life lost comprised 94% of DALYs. Conclusions: The global rise in obesity-attributable IHD burden was driven by population growth and aging rather than worsening per-capita risk. However, this progress was unequally shared: age-standardized risk continued to decline in high-SDI settings but rose across lower- and middle-SDI populations, and overall improvement stalled after 2018, with middle-aged men emerging as major contributors. These findings identify lower- and middle-SDI populations and middle-aged men as priorities for obesity-directed cardiovascular prevention and equitable access to effective obesity therapies.