- A new study found that the vast majority of heart disease deaths were linked to three factors: high blood pressure, poor diet, and high cholesterol.
- Researchers found a 58.7% decrease in preventable heart disease deaths since 1990, though middle-aged adults aged 50-59 showed no improvement, and obesity and high blood sugar are increasingly driving mortality.
- Here, cardiologists break down the results.
Doctors have long known that many cases of heart disease are linked to risk factors that can be addressed through diet, lifestyle, and other means. Now, a new study analyzing over 30 years’ worth of heart health data found that nearly 90% of heart disease deaths that occurred in 2023 were linked to 12 modifiable risk factors, and many with just three common ones: high blood pressure, poor diet, and high cholesterol.
The study, published in JAMA Cardiology, analyzed death records and a broad set of epidemiologic data from across the United States. Researchers estimated mortality from ischemic heart disease—heart damage caused by narrowed heart arteries that reduce oxygen and blood flow to the heart, per the American Heart Association (AHA)—and assessed 12 modifiable risk factors, from diet and alcohol consumption to high LDL cholesterol to air pollution exposure. Using statistical models, the researchers determined how the various risk factors contributed to mortality.
First, the good news: The researchers found that deaths from ischemic heart disease have fallen by 58.7% since 1990, and deaths attributable to tobacco and air pollution exposure also decreased. However, throughout the 33 years the researchers analyzed, the top three mortality risk factors remained the same: high blood pressure, poor diet, and high cholesterol. In 2023, high blood pressure was the biggest contributor at 47%, followed by diet at around 39%, and cholesterol at 28.5%. Researchers also found that obesity and high blood sugar are becoming increasingly important drivers of heart disease mortality, “underscoring the growing impact of metabolic health,” explains Nupur Shah, M.D., cardiologist at Atlantic Health.
Below, cardiologists weigh in on the findings and share what you can do to lower your personal risk of heart disease.
Meet the Experts: Nupur Shah, M.D., cardiologist at Atlantic Health; and Sanjeev Kumar Gulati, M.D., executive deputy director of Baptist Health South Florida Heart & Vascular Care and the system’s chief of cardiovascular medicine.
Why these factors affect heart health
So, it’s clear that blood pressure, cholesterol, and diet affect your risk of developing ischemic heart disease. Here’s why.
High blood pressure: Also known as hypertension, high blood pressure occurs when your heart has to work harder than normal to pump blood through the body, which puts unnecessary stress on blood vessel walls and can cause tiny tears over time. “Hypertension causes the heart to become enlarged and arteries to be stiffer,” which can lead to artery blockages, explains Sanjeev Kumar Gulati, M.D., executive deputy director and chief of cardiovascular medicine at Baptist Health South Florida Heart and Vascular Care. High blood pressure also damages blood vessels over time, accelerates plaque buildup, and increases strain on the heart, adds Dr. Shah.
Poor diet: A diet with excess sodium and ultra-processed foods—and a lack of fresh fruits, vegetables, and whole grains—promotes hypertension, inflammation, and insulin resistance, “which all lead to increased coronary artery disease,” says Dr. Gulati.
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High cholesterol: High low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol, can accelerate the development of atherosclerosis, Dr. Gulati explains. This condition sees plaque build up in the arteries and, over time, progressively restrict blood flow to the heart. “When plaques rupture, they can cause heart attacks or sudden cardiac death,” Dr. Shah notes.
How to lower your heart disease risk
To keep your blood pressure in check, experts recommend regular monitoring—perhaps with an at-home blood pressure monitor—and treating hypertension early. Prescription medication is often used to lower blood pressure, but exercising and cutting your sodium intake can also help, Dr. Gulati notes. Your doctor can help you identify the best strategy for you.
Experts also frequently recommend following a heart-healthy diet. The Mediterranean or DASH diets—both of which emphasize fruits, vegetables, whole grains, legumes, nuts, and healthy fats while limiting sodium and ultra-processed foods—are both good options.
To ensure your cholesterol stays in check, you should also have your levels tested routinely. If needed, your doctor can prescribe cholesterol-lowering medications like statins, says Dr. Shah.
Additionally, maintaining a healthy weight, staying active, avoiding tobacco, and controlling diabetes or pre-diabetes are all important, Dr. Shah notes.
The bottom line
The sooner these modifiable risk factors are addressed, the more effectively you can prevent ischemic heart disease. “We need to focus education on our children and young adults so we can combat these modifiable risk factors,” says Dr. Gulati. “People should begin to work with their cardiologist to make a plan to modify their risk factors early on in life.”
It’s easy to brush these warnings aside when you feel healthy, but as Dr. Shah cautions, that doesn’t always mean you’re in the clear. “Many people feel well until they experience a heart attack,” says Dr. Shah. “That’s why prevention and routine screening are so critical.”
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