Abstract Body (Do not enter title and authors here): Background and objectives
Obesity, especially central obesity, is closely linked to both traditional and novel risk factors for Ischemic Heart Diseases (IHD). In view of the ongoing obesity epidemic in the United States, here we aim to assess the trends in obesity-related IHD mortality in the United States from 1999 to 2020, and identify the racial, local, regional, age and gender-wise differences in this trend.

Methods
Data from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database was examined from 1999 to 2020 for IHD and obesity-related mortality in individuals of all ages. Both crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 individuals were determined. Using joinpoint regression analysis, annual percentage changes (APC) in AAMR were calculated.

Results
A total of 226,267 deaths occurred due to obesity related ischemic heart disease from 1999 to 2020 in the United States. There was a uniform rise in AAMR from 1999 to 2020, with an AAPC of 5.03 (95% CI 4.5-5.4). Overall, males had a higher AAMR than females (AAMR men=3.9; women=2.2). The incline in the mortality rates was also more prominent in males (AAPC=5.11; 95% CI 4.1-6.1), especially those aged 55-64 (AAMR=8.5). Age-adjusted mortality was the highest among Black patients (AAMR=?). Significant geographical difference was also observed, with the highest mortality observed in the midwestern states (AAMR: Midwest 3.3; West 3.1; South 2.9; Northeast 2.8). More specifically, Vermont (AAMR=10.4) had the highest AAMR and Alabama (AAMR=1.5) had the lowest. It was also found that non-metropolitan areas (AAMR=4) had higher AAMRs than metropolitan areas (AAMR=2.9).

Conclusion
Obesity-related IHD mortality is on a rise in the United States. Highest mortality rates can be observed among Black people, males, patients in the Midwestern states and rural locale, and ages 55-64.