The rate of deaths from ischemic heart disease related to obesity nearly tripled in the U.S. over a two-decade span, according to new research. The rate for men more than tripled.

Black adults, middle-aged men, and people living in the Midwest and non-metropolitan areas had the highest rates in 2020, the study found.

Ischemic heart disease occurs when narrowed arteries reduce the flow of blood and oxygen to the heart muscle. This can lead to a heart attack.

"Obesity is a serious risk factor for ischemic heart disease, and this risk is going up at an alarming rate along with the increasing prevalence of obesity," the study's lead researcher Dr. Aleenah Mohsin said in a news release. She is a postdoctoral research fellow at Brown University in Providence, Rhode Island.

Obesity also contributes to other risk factors for heart disease, including high cholesterol, high blood pressure, Type 2 diabetes and sleep disorders.

The findings were to be presented at the American Heart Association's Scientific Sessions in Chicago. They are considered preliminary until full results are published in a peer-reviewed journal.

Researchers analyzed age-adjusted data from 226,267 deaths attributed to obesity-related ischemic heart disease. The data from the Centers for Disease Control and Prevention's WONDER database was collected from 1999 to 2020. Overall, the rate of heart disease deaths associated with obesity increased by about 180%. Researchers also looked into whether specific demographics – race, age, gender or place of residence – had higher death rates.

For all men, the rate jumped from 2.1 deaths per 100,000 people in 1999 to 7.2 in 2020 – a 243% increase. For men ages 55 to 64, the rate increased 165%, from 5.5 deaths per 100,000 people in 1999 to 14.6 in 2020.

For women, the rate went from 1.6 deaths per 100,000 people in 1999 to 3.7 in 2020 – a 131% increase.

Compared to other races, Black adults had the highest death rate at 3.93 per 100,000 people in 2020.

Researchers also found that the Midwest – Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin – had the highest rate at 3.3 deaths per 100,000 people in 2020. Non-metropolitan areas had a higher death rate than urban areas: 4 deaths per 100,000 versus 2.9.

Mohsin said the researchers expected an increase in obesity-related ischemic heart disease deaths, but they did not anticipate the magnitude – especially among middle-aged men.

"The racial disparities, particularly the higher rates of death among Black individuals, were also striking and suggest that social and perhaps environmental factors may also be playing a significant role," said Mohsin, adding that the findings underscore the need to explore the causes of the disparities. "Understanding these factors is the first step in identifying and designing more effective public health interventions."

The researchers acknowledged that they did not measure non-fatal cases of heart disease, which means the analysis may underestimate the true impact of obesity. Certain factors, including income, education and access to health care, also are not available in the CDC WONDER database.

The increase in obesity-related ischemic heart disease deaths might also be the result of greater awareness, Dr. Sadiya S. Khan said in the news release. Khan is an associate professor of cardiology, medical social sciences and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

"It may just be that people are more aware of obesity as a risk factor or are more likely to treat obesity, and, therefore, it is more likely to be included on death certificates, which were the basis of these data," said Khan, who was not involved in the new research. "The important thing is that we know we need to do more to identify, manage and treat obesity-related risk."

Mohsin encouraged people, particularly those in high-risk groups, to take steps to manage their weight and reduce their risk of heart disease. "Lifestyle changes are key, such as eating healthier, exercising regularly and working with health care professionals to monitor heart health."

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