Abstract Body (Do not enter title and authors here): Introduction: Ischemic heart disease (IHD) remains a significant cause of morbidity and mortality in the United States, with dietary risk factors playing a critical role. This study provides the first comprehensive estimate of the IHD burden attributable to various dietary risk factors over the last three decades, including the initial two years of the COVID-19 pandemic.

Methods: Using the Global Burden of Disease Study 2021 tool, we estimated the deaths and disability due to IHD associated with twelve dietary risk factors across different age groups, genders, and years spanning from 1990 to 2021 in the US.

Results: Over the period from 1990 to 2021, there was a 25% decrease in both the total percentage change (TPC) in deaths and years of life lost (YLLs), while years lived with disability (YLDs) saw a 35% increase (95% uncertainty intervals: 19%-86%). The highest mortality was associated with diets low in whole grains, resulting in 54,046 deaths, followed by diets low in Omega 3 fatty acids (36,886 deaths), and diets high in processed meat (27,280 deaths). Additional significant dietary factors included low fibre (26,681 deaths), low legumes (25,601 deaths), high sodium (21,484 deaths), high red meat (20,411 deaths), low fruits (18,551 deaths), low vegetables (13,000 deaths), low nuts and seeds (8,222 deaths), low omega 6 fatty acids (5,089 deaths), and high sugar-sweetened beverages (360 deaths). The age group with the highest number of deaths was 85-89 years old, accounting for 22,514 deaths. Males experienced a disproportionately higher disease burden compared to females over these three decades.

Conclusion: Deaths due to IHD attributable to dietary risk factors accounted for 36.86% of all CVD-related deaths in the US in 2021. To reduce the burden of ischemic heart disease linked to dietary risks, targeted interventions such as eHealth education, mHealth apps for personalized diet tracking, and partnerships with influencers to promote evidence-based health messages are essential. These strategies can enhance public awareness and encourage healthier dietary choices, potentially improving public health outcomes significantly.