Data from the US population-level Multiple Cause of Death database were analyzed, including 281,135 deaths in 1999-2020 for which obesity was listed as a contributing factor.
Overall, the crude rate of all cardiovascular deaths dropped by 17.6% across all races.
However, age-adjusted obesity-related cardiovascular mortality tripled from 2.2/100,000 to 6.6/100,000 from 1999 to 2020, consistent across all racial groups.
Blacks had the highest age-adjusted obesity-related cardiovascular mortality (rising from 4.2/100,000 in 1999 to 11.6/100,000 in 2000).
Ischemic heart disease was the most common cardiovascular cause of death across all races, and hypertensive disease was second.
Age-adjusted obesity-related cardiovascular mortality was higher among Blacks (6.7/100,000) than any other racial group, followed by American Indians or Alaskan Natives (3.8/100,000), and lowest among Asian or Pacific Islanders (0.9/100,000).
The risk of obesity-related cardiovascular disease death rose most rapidly among American Indians and Alaskan Natives.
Among Blacks, age-adjusted mortality was slightly higher among women than men (6.7/100,000 vs 6.6/100,000), whereas the reverse was true for all other races (0.6-3.0/100,000 vs 1.2-6.0/100,000).
Blacks living in urban settings experienced higher rates of age-adjusted cardiovascular mortality than those living in rural areas (6.8/100,000 vs 5.9/100,000), whereas the opposite was true for all other racial groups (0.9-3.5/100,000 vs 2.2-5.4/100,000).
There is need for dedicated health strategies aimed at individual communities to better understand and tackle the social determinants of obesity and to design interventions that may alleviate the population burden of both obesity and cardiovascular disease.