Abstract Body (Do not enter title and authors here): Background:
Despite advances in hyperlipidemia therapies, ideal screening and control of lipids remains a challenge. This study aims to evaluate mortality trends associated with ischemic heart disease in hyperlipidemic patients in the United States and to identify the affected population.

Methods:
Data for this study were taken from the CDC WONDER database, which provides comprehensive data on the leading causes of mortality across the United States. Mortality data related to ischemic heart disease in individuals with hyperlipidemia were analyzed. Age-adjusted mortality rates (AAMRs) were measured, and mortality trends were analyzed using JoinPoint regression to determine the annual percent change (APC).

Results:
From 1999 to 2023, a total of 778,109 deaths were associated with ischemic heart disease, with hyperlipidemia as a contributing factor. The AAMRs increased from 6.21 in 1999 to 19.97 in 2023, showing a 3.2-fold increase in mortality. A pronounced rise was observed during the COVID-19 pandemic, with the AAMR reaching 20.82 and an APC of 12.2%(95%CI:9.82 to 13.84). Males showed higher mortality rates compared to females (28.15 vs. 13.52 in 2023) with highest APC 12.66%(95%CI:10.51 to 14.45) in males from 2018-2021 .Among racial and ethnic groups, Non-Hispanic (NH) White individuals showed the highest AAMR of 21.99 and highest APC of 12.40%(95%CI:10.31 to 14.10),followed by NH American Indian or Alaska Native individuals, NH African American individuals, Hispanic individuals, and lastly NH Asian or Pacific Islander individuals. Geographically, the Midwest among census regions had the highest AAMR 21.61, and rural areas had higher mortality rates compared to urban areas with highest AAMR of 24.08 and APC of 14.30%(95%CI:10.01 to 17.13).

Conclusion:
This study reveals an alarming 3.2-fold increase in hyperlipidemia-related ischemic heart disease mortality in the United States from 1999 to 2023. Significant disparities were observed. These findings highlight the urgent need to address clinical inertia in treating hyperlipidemia.