Although age-adjusted mortality rates for cardiovascular disease, heart disease and stroke in the U.S. have decreased since 2000, the rate of decline has slowed since 2011, according to an analysis of data from the Centers for Disease Control and Prevention (CDC).

Lead researcher Stephen Sidney, MD, MPH, of Kaiser Permanente Northern California in Oakland, and colleagues published their results online in JAMA Cardiology on June 29.

“Given the high absolute burden and associated costs of [heart disease] and stroke, continued vigilance and innovation are essential in our efforts to address the ongoing challenge of [cardiovascular disease] prevention,” the researchers wrote. “However, the recent deceleration in the rate of decline in [heart disease] mortality is alarming and warrants expanded innovative efforts to improve population-level [cardiovascular disease] prevention.”

The researchers noted that since 1910, heart disease has been the leading cause of death in the U.S. except for the flu pandemic from 1918 to 1920. In 2014, heart disease accounted for 23.4 percent of all deaths in the U.S., according to data released on June 30 from the National Center for Health Statistics.

The researchers mentioned a few explanations for the recent decline in cardiovascular disease death rates, including the expanded use of evidence-based therapies and changes in risk factors and lifestyle modifications.

In this study, they evaluated CDC data on the cause of death from death certificates filed in the U.S. from 2000 to 2014.

During that time period, age-adjusted mortality decreased 35.6 percent for all cardiovascular diseases, 35.2 percent for heart disease and 40.1 percent for stroke. However, the decline has slowed in recent years.

From 2000 to 2011, the mean annual age-adjusted rates of decline were 3.79 percent for cardiovascular disease, 3.69 percent for heart disease and 4.53 percent for stroke. From 2011 to 2014, the rates of decline were 0.65 percent, 0.76 percent and 0.37 percent, respectively.

In addition, the crude mortality rates increased from 2011 to 2014 for cardiovascular disease (253.3 per 100,000 person-years vs. 251.4), heart disease (192.7 vs. 191.5) and stroke (41.7 vs. 41.4).

From 2000 to 2014, the annual rates of decline of cardiovascular disease, heart disease and stroke were higher for women than men. The mortality rates for cardiovascular disease and heart disease were highest among non-Hispanic blacks in all of the years studied.

The researchers also mentioned that cancer mortality declined 19.2 percent between 2000 and 2014, but the difference between heart disease and cancer mortality has not changed since 2011.

“If the rates of decline from 2000 to 2011 had persisted, [heart disease] mortality in the United States would have been below that of cancer mortality in 2013, but the pattern of [heart disease] and cancer being the first and second leading causes of death, respectively, has endured,” they wrote.

Further, they said that cardiovascular health would improve by 6 percent between 2010 and 2020 if current trends persist, which is short of the American Heart Association (AHA) goal of 20 percent improvement during that time. Although they expect the prevalence of smoking and high cholesterol levels to decline, they estimate that the rates of diabetes and obesity will significantly increase.

To achieve the AHA goal, cardiovascular disease and stroke mortality rates would need to decline by more than two percent per year, which the researchers noted was a much higher decrease than in recent years.