Heart Disease Deaths Decline Over Last 50 Years, but Not Across the Board

The number of deaths attributable to heart disease, particularly acute myocardial infarction and ischemic heart disease, has declined significantly in the United States over the past 50 years or so, new research shows.

Despite the good news, there are worrisome developments, including the rise in deaths from other types of heart disease.

“Ischemic heart disease is still a huge problem and it’s something that we continue to face, but we really saw about an 80% increase in mortality from things like heart failure; hypertensive heart disease, which really is a type of heart failure; and arrythmias,” lead investigator Sara King, MD (Stanford University School of Medicine, CA), told TCTMD. “We also saw increases [in mortality from] from pulmonary hypertension or pulmonary heart disease and increases in mortality from valvular heart disease.”

While the study was not designed to address why the causes of death have changed, King said the data likely reflect a shift toward more chronic heart disease in the US population.

“With our aging population, people are now surviving these acute ischemic events,” she said. “They’re living longer, so there’s more time for them to have these disease processes and to die from them. I don’t think we’ve made quite the progress with these other heart conditions as we have with myocardial infarction.”

The new study, published Wednesday in the Journal of the American Heart Association, spans from 1970 to 2022 and includes data from the National Vital Statistics System available through the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) resource. During this time, the US population 25 years and older increased from 108.9 million to 229 million and life expectancy increased from 70.9 to 77.5 years.

Over the 52-year period, 31% of all deaths were attributable to heart disease. In 1970, heart disease accounted for 41% of total deaths, of which the vast majority (91%) were from ischemic heart disease. Among those who died from ischemic heart disease, 54% had an acute MI and 46% had chronic disease.

In 2022, just 24% of all deaths were due to heart disease. Here, 53% of deaths were attributable to ischemic heart disease and 47% from other forms of heart disease. Of the ischemic heart disease deaths in 2022, 29% were related to acute MI and 71% to chronic disease.

Cardiovascular disease remains the number one cause of death in the US, but age-adjusted mortality for all types of heart disease declined by 66% from 1970 to 2022. For acute MI, age-adjusted mortality decreased by 89%, dropping from 354 to 40 deaths per 100,000 people. Similarly, age-adjusted mortality from chronic ischemic heart disease declined by 71%, falling from 343 to 98 deaths per 100,000 people. Mortality from all types of ischemic heart disease declined by 81% from 693 to 135 deaths per 100,000 people.

Conversely, age-adjusted deaths for other types of heart disease—rheumatic heart disease, cardiomyopathy, heart failure, arrhythmias, valvular heart disease, hypertensive heart disease, pulmonary heart disease, and cardiac arrest/ventricular arrhythmias—increased 81% from 1970 to 2022 (68 to 123 deaths per 100,000). Deaths from heart failure, hypertensive heart disease, and arrhythmias increased the most during the study period, up 146%, 106%, and 450%, respectively. Only deaths from rheumatic heart disease declined over time (85% decrease).

With our aging population, people are now surviving these acute ischemic events. Sara King

The study period spans an era that includes multiple advances to reduce the risk of dying from ischemic heart disease, including the introduction of CABG surgery, cardiac imaging, balloon angioplasty, thrombolytic therapy, and aspirin, say investigators. There also was the establishment of PCI and an emphasis on rapid door-to-balloon times as well as the routine use of secondary prevention drugs such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, and statins. High-sensitivity troponin testing led to more rapid diagnoses, and the use of more advanced antiplatelet agents after revascularization aided the decline in ischemic heart disease deaths, they say.

There have also been public health efforts to reduce cholesterol and blood pressure, among other interventions. “One big thing is the decline in tobacco use,” said King. “I think that was a huge public health accomplishment.” In 1970, roughly 40% of adults smoked, as compared with 14% in 2019.

There are different challenges today, with a rising prevalence of obesity, diabetes, and hypertension, as well as declining physical activity levels, say researchers. Still, King is optimistic that medical advances will continue to make similar inroads against these other cardiovascular diseases. “I think we’ve made really big leaps with heart failure and our four pillars of drug therapy,” she said. “I am hopeful we’ll just kind of keep making breakthroughs.”

King acknowledged limitations to their analysis, noting that it relied on ICD coding for the cause of death and that there is the potential for misclassification. Also, deaths from heart failure, cardiomyopathy, and arrythmias (particularly ventricular arrhythmias) might also have ischemic causes that aren’t captured with ICD coding, say the researchers.

“I think overall, though, the trends are quite clear,” said King.