Heart Disease Remains Number One Killer of Americans

Cardiovascular-related health statistics have returned to their pre-COVID numbers, but heart disease shows no signs of leaving the top spot as the leading cause of death in the United States, according to the latest statistical update from the American Heart Association.

In 2023, the age-adjusted rate of CVD death dipped slightly to 218.3 per 100,000 people, from 224.3 per 100,000 in 2022. Coronary heart disease deaths declined slightly over the same period, as did stroke mortality, but stroke has moved up to the number four position in terms of the leading causes of death for Americans.

“It’s now number four partly because COVID dropped out of the top five,” said Sadiya S. Khan MD (Northwestern Feinberg School of Medicine, Chicago, IL), vice chair of the paper’s writing committee.

“The actual number of stroke deaths, or the age-adjusted mortality rate for stroke was 38.8 [per 100,000] in 2020 and 39.0 in 2023. It didn’t get worse and it’s actually come down since 2004, which is still a really important statistic,” she added. “So, we haven’t seen progress in stroke deaths the way we have in heart disease deaths since the peak of the pandemic, but we haven’t seen worsening either.”

Between 2013 to 2023, there was an 8.3% increase in stroke deaths among people 25 to 34 years of age and an 18.2% increase in those over age 85. At the same time, stroke death rates declined by 5.2% in those 75 to 84 years of age.

The 2026 statistical update, from Khan and colleagues led by writing committee chair Latha P. Palaniappan, MD (Stanford University, Palo Alto, CA), was published online ahead of print in Circulation. It joins the recently debuted report on cardiovascular data from the journal JACC.

Numbers for Context in Practice

The AHA document, which is published each year, provides important perspective from a population health and a clinical policy standpoint, said Khan. In particular, she highlighted the quality-of-care chapter. This is another area that seems to have recovered from the COVID era, although that recovery has been incomplete and inequitable in some instances. It provides overviews on healthcare effectiveness data in CVD, diabetes, tobacco, nutrition, and lifestyle, while also offering insight into specific quality-of-care measures like PCI within 90 minutes, smoking cessation counseling, cardiac rehabilitation referral, and prescribing of drugs at discharge.

“If you look at aspirin on discharge after a heart attack, it’s over 99% and that’s great, but then you look at heart failure with reduced ejection fraction and the odds of getting quadruple therapy medications [was] 67% in 2024,” Khan said. “We have made a lot of progress in the last 10 to 20 years, but here’s where we need to now focus our efforts.”

There was a slight decrease in the percentage of adults in the US with obesity or severe obesity when comparing the period of 2017-2020 with 2021-2023, but the condition still affects half the population. Among those ages 2 to 19, rates of obesity and severe obesity have increased from 25.4% to 28.1% during that same period. If these trends continue, the prevalence of overweight and obesity in children and adolescents is projected to reach 45.1% and 57.3%, respectively, by 2050.

While hopes are high that the new GLP-1 medications may make a dent in the obesity crisis in the US, Khan said two things will inform how quickly those benefits play out.

“One is access to the medication, and we know that was interrupted during COVID, even for patients with diabetes,” she noted. “The second is going to be affordability. If they’re not affordable, what we’ve seen is that many people will take them for a short period of time and not be able to continue on them.”

A recent review and meta-analysis highlighted the potential end result of that scenario by showing that after stopping semaglutide (Wegovy; Novo Nordisk) or tirzepatide (Zepbound; Eli Lilly), the average weight regained in the first year was 9.9 kg. That analysis also projected that stopping any weight-loss medication would lead to a return to baseline weight within 1.7 years, an average gain of 0.8 kg per month.

Hypertension has increased slightly since the last statistical update, from 46.7% of US adults to 47.3%. Similarly, the number of adults with diagnosed diabetes increased from 29.3 million to 29.5 million.

[The AHA statistics] can be a tool for encouraging and supporting people to engage in health behavior changes. Sadiya S. Khan

To TCTMD, Khan pointed to the newest section of the statistical update: a chapter devoted to cardiovascular-kidney-metabolic (CKM) syndrome.

“This was an exciting opportunity to expand the document,” she noted. “We know that these conditions occur together, but we need to be able to quantify how common it is, how it’s changing, and what are the opportunities to make improvements.”

According to the writing committee, nearly 90% of adults in the US have some form CKM syndrome, with more than 80% of those who age 20 to 44 having early CKM risk. Prevalence rates of advanced CKM (stages 3 and 4) are known to be highest in individuals from underrepresented racial and ethnic groups, including American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and multiple races or ethnicities, followed by those who are non-Hispanic Black, Hispanic, non-Hispanic white, and Asian.

Khan said while the document can seem large and overwhelming, she uses some of the information from it in her practice to inform conversations with patients about risk factor control and future expectations for health.

“The numbers can help contextualize when we talk about Life’s Essential 8, for example,” she added. “Or if blood pressure is out of control, it’s helpful to say, ‘Well, we know this is really common and in fact half of Americans have blood pressure that’s under or poorly controlled or out of control.’ And then we can talk about what are some things we can do for you. I think it also can be a tool for encouraging and supporting people to engage in health behavior changes, and [in] interventions that can help them improve their health as well.”