Abstract Body (Do not enter title and authors here): Background: Obesity is a significant risk factor for ischemic heart disease (IHD) with increasing prevalence denoted in the recent decade. This study examines the temporal trends in obesity-related IHD mortality in the U.S. from 1999 to 2020.

Methods: We used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple cause of death database to analyze obesity related IHD mortality in adults ≥ 25 years old. We examined IHD as the underlying cause and obesity as a contributing cause. Age-adjusted mortality rates (AAMRs) and Crude mortality rates (CMRs) per 100,000 persons were calculated. Joinpoint regression was used to assess the trends and calculate annual percent change (APC) to examine trends overall, and across demographic (age, sex, race) and geographic regions.

Results: A total of 139,644 obesity-related IHD deaths were identified. Overall, AAMR increased from 1.92 in 1999 to 4.69 in 2020. AAMRs showed a consistent rise between 1999 and 2018 (APC: 4.00 [95% CI: 2.85 to 4.44]), followed by a marked increase from 2018 to 2020 (APC: 9.87 [95% CI: 4.46 to 12.75]). AAMR was higher in males (3.79) than females (2.10). Black populations had the highest AAMR (4.06), followed by White populations (2.08) and Hispanic/Latino populations (1.94). Older adults (age 65+ years old) had the highest CMR (5.73), followed by middle-aged adults (age 45-64 years old, CMR: 4.31) and young adults (age 25-44 years old, CMR: 0.73). AAMR was higher in nonmetropolitan areas (3.47) compared to metropolitan areas (2.78). States in the top 90th percentile for AAMR were Vermont, Oklahoma, California, North Dakota, and Colorado, while those in the bottom 10th percentile were South Carolina, Massachusetts, Utah, Connecticut, and Alabama.

Conclusion: Obesity-related IHD has increased drastically in the U.S. throughout the study period. Further research is needed to comprehend these trends and to help develop preventative tactics.