The Biggest Heart Disease Risks You Can Actually Control

What is ischemic heart disease?

Ischemic heart disease is the medical term for what most people just call heart disease. It happens when the arteries carrying blood to your heart get narrow or clogged, usually from a buildup of fatty deposits. When your heart doesn’t get enough blood, it can cause chest pain, a heart attack, or worse. It remains the number one cause of death in the United States.

What did this new study find?

Researchers reviewed every US death record from 1990 through 2023 as part of a large national research effort called the Global Burden of Disease Study. In 2023 alone, about 473,000 Americans died of ischemic heart disease.

The bigger finding was this: nearly 9 out of 10 of those deaths — 88.7% — were linked to risk factors people can actually do something about, like blood pressure, diet, cholesterol, and blood sugar. That’s not bad luck. Those are things a doctor can measure and help you manage.

There was also a warning sign in the numbers. Death rates from heart disease fell steadily and sharply from 1990 to 2010. Since 2010, that progress has slowed a lot — the death rate has kept dropping, but at a much slower pace than before.

Which risk factors mattered most?

The study ranked how much each risk factor contributed to 2023 heart disease deaths. Four stood out. High blood pressure was the single biggest factor, linked to about 47% of these deaths. An unhealthy diet came next, linked to about 39%. High LDL cholesterol, the “bad” cholesterol, was tied to about 29%. High blood sugar, the kind seen with diabetes, was linked to 18%, and carrying extra body weight was linked to 17%.

These numbers overlap rather than add up, since many people deal with more than one of these at the same time.

Is progress being made, or is it stalling?

It’s mixed. Deaths linked to high blood pressure and high cholesterol have edged down a bit since 1990, mainly because more people are being treated for them with medication, not because fewer people actually have high blood pressure or high cholesterol in the first place. Both conditions are still extremely common.

Two risk factors are moving in the wrong direction. Heart disease deaths linked to high body weight have grown by more than half since 1990. Deaths linked to high blood sugar have grown by nearly 40%. Both trends track with rising rates of obesity and diabetes across the country.

On the positive side, deaths linked to smoking and to air pollution have both dropped sharply since 1990, which shows large-scale improvement is possible when actual exposure to a risk goes down.

Could this apply to you?

If you have high blood pressure, high cholesterol, extra body weight, or diabetes (or prediabetes), you’re carrying some of the exact risk factors this study found driving the most heart disease deaths in the country. None of these announce themselves with obvious symptoms early on. High blood pressure and high cholesterol in particular can go unnoticed for years before they cause damage. The only way to know where you actually stand is to get checked.

Source: Benziger CP, Stark B, Johnson CO, Roth GA, and the GBD 2023 US IHD Collaborators. “Modifiable Risk Factors and Attributable Ischemic Heart Disease Mortality in US States, 1990-2023: A Systematic Analysis for the Global Burden of Disease Study 2023.” JAMA Cardiology, published online July 15, 2026.