New Study Finds Obesity-Related Cardiovascular Deaths Tripled Since 1999

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An analysis of CDC data from 1999 to 2020 offers clinicians a snapshot of overall, and race-specific, trends in obesity-related cardiovascular disease deaths since the turn of the century.

A new study is shedding light on how significant the rise in obesity prevalence has been on population-level cardiovascular health, with results indicating the rate of obesity-related cardiovascular deaths tripling from 1999 to 2020.

An analysis of age-adjusted mortality rates (AAMRs) of more than 280,000 obesity-related cardiovascular deaths from the US Centers for Disease Control and Prevention’s Multiple Cause of Death (MCOD) database, results of the study and shed light on difference in AAMRs across racial and ethnic group, with results also suggesting Black individuals had the greatest AAMR and the rate of AAMRs increased by 415% among American Indian or Alaska Native individuals during the study period.1

“The number of people with obesity is rising in every country across the world. Our study is the first to demonstrate that this increasing burden of obesity is translating into rising heart disease deaths,” said lead investigator Zahra Raisi-Estabragh, MD, a cardiologist and clinical lecturer at the William Harvey Research Institute in London. “This rising trend of obesity is affecting some populations more than others, particularly Black women.”

The year 2023 marks 10 years since the American Medical Association recognized obesity as a disease. Ballooning prevalence of obesity in the past 10 years coupled with recent pharmacologic advances in chronic weight management have placed the disease in the spotlight of the medical community and public consciousness.3

In this context, exploring the historic and contemporary impact of the obesity epidemic has become a focal point for many research efforts. In the current study, Raise-Estabragh and a team of colleagues sought to estimate trends and disparities in obesity-related cardiovascular mortality within the US from 1999 to 2020 using the MCOD database.

From the MCOD database, investigators obtain the single underlying cause of death and up to 20 contributing causes of death recorded using ICD-10 codes for all US residents with a physical-completed death certificate. For inclusion in the study, patients needed to be older than 15 years of age, with cardiovascular disease recorded as the primary cause of death and obesity recorded as a contributing cause of death.1

During the study period, a total of 281,135 primary cardiovascular disease deaths with obesity recorded as a contributing factor. Baseline analysis of this cohort revealed 43.6% were women, 78.1% were White, 19.8% were Black, 1.1% were Asian or Pacific Islander, and 1.0% were American Indian or Alaska Native individuals.1

Investigators pointed out a reduction in crude rate of all cardiovascular deaths decreased by 17.6% , with this effect consistent across all races. Investigators also pointed out the degree of reduction became more significant when calculating age-adjusted rate, with the greatest reduction in age-adjusted cardiovascular mortality observed among American Indian or Alaska Native individuals (−42.9%) and the smallest reduction observed among Black individuals (−31.9%).1

Upon analysis, results suggested the AAMRs for obesity-related cardiovascular disease deaths increased from 2.2 per 100,000 in 1999 to 6.6 per 100,000 in 2020, with investigators suggesting the rate of increase in age-adjusted mortality appeared to increase in the latter years of the study. Further analysis revealed notable differences between racial and ethnic groups.1

Age-Adjusted mortality rate in 2020:1

  • Black: 11.6 per 100,000
  • American Indian or Alaska Native: 6.7 per 100,000
  • White: 6.2 per 100,000
  • Asian or Pacific Island: 1.6 per 100,000

“The trend of higher obesity-related cardiovascular death rates for Black women than men was striking and different from all other racial groups considered in our study,” said senior investigator Mamas A. Mamas, MD, Dphil, professor of Cardiovascular Medicine at Keele University.2


  1. Raisi-Estabragh Z, Kobo O, Mieres JH, et al. Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020 [published online ahead of print, 2023 Sep 6]. J Am Heart Assoc. 2023;e028409. doi:10.1161/JAHA.122.028409
  2. Obesity-related cardiovascular disease deaths tripled between 1999 and 2020. American Heart Association. September 6, 2023. Accessed September 6, 2023.
  3. Campbell P, Iapoce C. 10 years of obesity: A Decade of Advancement and challenges. HCP Live. June 23, 2023. Accessed September 6, 2023.