Obesity-related deaths among U.S. adults with clogged heart arteries increased by 180% between 1999 and 2020, according to data released in advance of the American Heart Association scientific meeting in Chicago.

In men, ischemic heart disease deaths associated with obesity rose from 2.1 per 100,000 people in 1999 to 7.2 per 100,000 in 2020, an increase of 243%, researchers found.

In women, the rate increased by 131%, from 1.6 deaths per 100,000 people in 1999 to 3.7 per 100,000 in 2020.

The increases were particularly marked among middle-aged men, Black adults, residents of Midwestern states and non-metropolitan areas, researchers found.

“We did expect an increase in deaths related to obesity since the prevalence of obesity has been rising steadily for years. However, we did not anticipate this magnitude of increase in mortality, especially among middle-aged men,” study leader Aleenah Mohsin, MD of Brown University said in a statement.

Overall, the analysis of 21 years of data from a U.S. Centers for Disease Control and Prevention database identified 226,267 obesity-related ischemic heart disease deaths during that period.

“The relative change in ischemic heart disease deaths related to obesity that was observed in this study between 1999 and 2020 was greater than the overall increase in obesity prevalence that we’ve seen in the United States, from about 30% to about 40% over this same time frame,” AHA spokesperson Sadiya Khan, MD, of Northwestern School of Medicine in Chicago, said in a statement.

Kahn, who was not involved in the study, suggested that greater awareness of obesity as a risk factor and more treatment for the condition may have made it more likely to be included on death certificates, which were the basis of the new data.

“The important thing is that we know we need to do more to identify, manage and treat obesity-related risk,” she said.