Abstract Body (Do not enter title and authors here): Introduction: Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies.

Method: Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019.

Results: Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019.

Conclusion: IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.