377 The impact of high body-mass index on the burden of ischaemic heart disease in the United States: temporal trend analysis of the past 3 decades

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Introduction Ischemic heart disease (IHD) is the leading cause of morbidity and mortality worldwide. High body-mass index (BMI) is one of the known risk factors of IHD and significantly influence outcomes. Accordingly, it is of significance to evaluate the trends in impact of high BMI on the burden of IHD in the United States as it enables effective risk stratification and implantation of interventions. Methods Data including age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were retrieved from the Global Burden of Disease database to evaluate the temporal trends in IHD ASDR and ASMR attributed to high BMI in the US over the period 1990-2021. The Annual Percent Change (APC) and the Average Annual Percent Change (AAPC) were calculated using Joinpoint analysis. Results Over the period 1990-2021, an estimated total of 16,872,006 IHD-related deaths were reported across the US with high BMI attributing to 14.9% of those deaths. A statistically significant decline in IHD ASMR attributed to high BMI was observed in the US with an AAPC of -1.61 (95%CI -1.66 to -1.55, p<0.001). Gender stratification revealed a statistically significant decline in both males and females, with the latter experiencing a higher degree of decline in the ASMR (AAPC -1.90, 95%CI -1.97 to -1.83, p<0.001). Stratification by state revealed a statistically significant decline in all states with the highest decline observed in Massachusetts (AAPC -2.47) followed by Oregon (AAPC -2.18), Minnesota (AAPC -2.13) and New Jersey (AAPC -2.13). In regard to the ASDR, a statistically significant decline was observed in the US (AAPC -1.54, 95%CI -1.60 to -1.48, p<0.001). Stratification by gender revealed a significant decline in both males and females with the latter experiencing a higher rate of decline (AAPC -1.72, 95%CI -1.78 to -1.66, p<0.001). Conclusion The US witnessed a significant decline in the burden of IHD that is attributed to high BMI over the past 3 decades. This decline has been observed across all states and in both, males and females. Further evaluation of this decline is warranted to determine the factors leading to this change in order to reciprocate these findings to other nations and regions.

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