The prevalence of heart failure (HF) in the U.S. is increasing hand-in-hand with rising rates of diabetes and obesity, according to a recent analysis, and HF-related CVD death rates have followed suit—most notably in younger adults.
In a letter published ahead of print in the Journal of the American College of Cardiology, Peter Glynn, MD, and colleagues at the Northwestern University Feinberg School of Medicine said that while CVD mortality in the country trended downward for four decades after a focused push for better heart health, in 2011 that decline began to slow, reflecting the wide reach and impact of the obesity crisis.
“The dramatic declines in CVD mortality achieved between the 1970s and 2010 reflected success of policy measures focused on control of blood pressure and cholesterol, as well as increased rates of smoking cessation and use of cardioprotective medications,” Glynn and colleagues wrote. “However, the prevalence of obesity and diabetes has increased dramatically, decline in overall CVD death rates has stalled and HF-related CVD mortality rates are rising.”
Glynn and his team pulled cause of death files from the CDC’s Wide-Ranging Online Data for Epidemiological Research (WONDER) system, which logs the underlying and contributing causes of death for all death certificates filed in the U.S. The researchers identified HF-related CVD deaths as those in which the underlying cause of mortality was CVD and the contributing cause was HF.
Overall, Glynn and colleagues found the age-adjusted rates for HF-related CVD death declined significantly between 1999 and 2012, falling from 78.7 deaths per 100,000 population to 53.7 deaths per 100,000. By 2017, though, the rate had once again peaked, rising to 59.3 deaths per 100,000 people.
The authors said they observed similar patterns in death rates between black and white patients, marked by an inflection point in 2012 when mortality rates started to increase again. Black men saw a 1.16-fold versus 1.43-fold higher age-adjusted HF-related CVD death rate compared with white men in 1999 versus 2017, and black women had a 1.35-fold versus 1.54-fold higher age-adjusted death rate compared with white women during the same years.
Racial disparities were most clear-cut in younger populations (adults aged 35 to 64) compared to older adults (65 to 84 years old). Age-adjusted HF-related CVD death rates were 2.60-fold and 2.97-fold higher in young black versus white men and women, respectively, in 2017.
“Our results highlight a significantly higher burden of HF-related CVD mortality among young and middle-aged blacks, resulting in premature deaths and significant years of life lost before age 65 years,” Glynn and co-authors wrote. “Prior reports from the CARDIA study identified a 20-times higher incidence of HF among black men and women compared with whites before the age of 50 years, with HF diagnosis associated with higher rates of antecedent factors.”
The team said their study is limited in that it relies on the CDC’s death certificate data, which could be flawed, but their data still “highlight the changing dynamics of CVD burden in the United States.”
“Given the substantial mortality burden of HF, population-wide policy measures are urgently needed to eliminate racial disparities and target individuals earlier in life for HF prevention,” they said.