Total heart disease deaths rise in US

Heart disease deaths are on the rise in the U.S., according to research published in the Journal of the American Medical Association Aug. 27—and they have been for almost a decade.

In their study, senior author Sadiya S. Khan, MD, MSc, and colleagues found that while the overall rate of heart disease deaths fell by around 36% between 2000 and 2014, the rate of decline started slowing after 2010. Deaths from stroke and diabetes declined between 1999 and 2010 but leveled off after that; deaths from high blood pressure increased between 1999 and 2017.

“It appears unlikely that strategic goals from the American Heart Association (20% reduction by 2020) will be achieved,” Khan, a cardiologist at Northwestern Medicine, et al. wrote in JAMA. “To clarify the most recent national trends, we investigated CVD and other key cardiometabolic disease mortality rates overall, by sex and by race from 1999 to 2017.”

The other key cardiometabolic diseases the team considered were stroke, diabetes and hypertension, and they studied their prevalence in the CDC’s Wide-Ranging Online Database for Epidemiological Research (WONDER) registry—a rolling database that logs death data in the U.S.

Khan and co-authors calculated age-adjusted mortality rates (AAMRs) for each CV condition, ultimately finding that advancements in the diagnosis and treatment of CVD led to significant declines in heart disease-related deaths until 2011, at which point AAMRs due to heart disease, stroke and diabetes flattened. Death rates due to hypertension, on the other hand, began to rise.

The authors reported that, in 1999, total deaths by cause were:

  • 725,192 from heart disease (AAMR 266.5 per 100,000 population)
  • 167,366 from stroke (AAMR 61.6)
  • 68,399 from diabetes (AAMR 25.0)
  • 16,968 from hypertension (AAMR 6.2)

By 2017, total deaths by cause were:

  • 647,457 (AAMR 165.0 per 100,000 population)
  • 146,383 from stroke (AAMR 37.6)
  • 83,564 from diabetes (AAMR 21.5)
  • 35,316 from hypertension (AAMR 9.0)

Between 1999 and 2017, Khan et al. said 12.3% of cardiometabolic deaths occurred in black people and 85.1% occurred in white people. Just over half—51.3%—took place in women.

The authors said the greatest culprit behind increasing CV death rates might be obesity, since it’s been such a substantial contributor to diabetes and related deaths in recent years. They said that while it’s important for individuals to manage their own CVD risk factors, it’s also up to policymakers to ensure Americans have access to healthy food, safe places to exercise and affordable healthcare.

“Clinical and public health efforts focusing on primordial and primary prevention throughout the life course, with an emphasis on identifying and addressing the causes of racial disparities, are needed to reverse the slowing of cardiometabolic mortality rate declines,” Khan and colleagues wrote.