Abstract Body (Do not enter title and authors here): Introduction:
Ischemic heart disease (IHD) is characterized by reduced blood flow to the heart muscle due to narrowing or blockage of the coronary arteries. This leads to chest pain, shortness of breath, and can result in heart attacks.

Objectives:
This study aims to analyze and compare trends in disability-adjusted life years (DALYs) and age-adjusted mortality rates (AAMR) due to IHD in the United States and globally, while also focusing on risk factors like high systolic blood pressure, high LDL cholesterol levels and smoking from 1991 to 2021.

Methods:
We gathered data estimates on AAMR and DALYs related to risk factors in the United States and globally, including gender-specific data, from 1991 - 2021 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) database. We computed age-adjusted rates per 100,000 individuals and determined the annual percent change (APC) with a 95% confidence interval. Trends over this period were analyzed using the Joinpoint Regression Program.

Results:
The analysis revealed declining trends of DALYs and AAMR in both America and globally although the negative trend has been steeper in United States for both DALYs (AAPC -2.62) and AAMR (AAPC -2.70) as compared to DALYs (AAPC 1.10) and AAMR (AAPC 1.21) globally. Conversely, the trend associated with high systolic blood pressure, high LDL cholesterol and smoking as risk factors showed declining pattern with DALYs AAPC of -3.26, -3.20 and -3.50 respectively and AAMR’s AAPC of -3.29, -3.45 and -3.62 respectively across the US while the global AAPC values for DALYs were -1.17, -1.24, -1.72 respectively and for AAMR were -1.33, -.45, 1.74 respectively. The DALYs and AAMR for males and females across the US and globally showed similar declining trends with the trend being steeper in the US than globally. In the US, the AAPC values for DALYs for males and females were -2.6 and -2.7 and for mortality rates, AAPC were -2.7 and -2.9 respectively. While for males and females globally these values were -0.96 and -1.32 respectively for DALYs and -1.07 and -1.49 respectively for mortality rates.

Conclusions:
The data shows a steeper decline in DALYs and AAMR in the US compared to global trends. This decline is particularly evident for high systolic blood pressure, high LDL cholesterol, and smoking and is consistent across both males and females, indicating significant improvements in public health outcomes in the United States relative to global averages.