Despite gains in treatment, cardiovascular disease remains the leading cause of death in the United States, accounting for nearly three in 10 fatalities — 916,000 — in 2023, according to a report published Wednesday by the American Heart Association.
It outnumbers deaths from the second and third leading causes — cancer and accidental injuries — combined.
The statistics are a sobering reminder that there is “a lot of work to do” when it comes to prevention and treatment of heart disease and stroke, said Dr. Donald Lloyd-Jones, a professor of cardiology at Boston University and former president of the association, who was not involved in the new report.
Heart disease, which includes heart attack and heart failure, has been the leading killer of Americans for more than a century. Things started improving in the 1970s; less cigarette smoking, new medications for high blood pressure and high cholesterol, and interventions like stents and bypass surgery contributed to a major decline in deaths over decades.
But progress slowed around 2010, as mortality from types of heart disease other than heart attack increased and risk factors like obesity and Type 2 diabetes increased. Then, the Covid-19 pandemic disrupted access to care and increased the short- and long-term risks of heart attack, said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University and vice-chair of the committee that wrote the new report. Deaths from cardiovascular disease surged to 932,000 in 2021 and to 942,000 in 2022.
The new report examined numbers from 2023, the latest year for which data were available. Deaths from cardiovascular diseases totaled 916,000, including about 680,000 deaths from heart disease and 180,000 from stroke, Together, these two causes account for more than a quarter of all U.S. deaths.
Getting back to prepandemic levels is a win, Dr. Khan said. But the rates of conditions that drive cardiovascular diseases are on the rise. And while cigarette smoking is down to about 11 percent of U.S. adults, e-cigarette use is increasing in adults, the report said.
Most notably, Dr. Lloyd-Jones said, the obesity epidemic “has worked its way through the population for the last 40 years,” increasing the risk factors for heart disease.
Close to half of all adults in the United States have high blood pressure, which is often driven by obesity. High blood pressure can lead to heart failure and contributes to the accumulation of plaque and hardening of the arteries, which can result in heart attack or stroke. But less than a quarter of people with high blood pressure have it well controlled through diet, exercise or medication, according to the report.
And about 14 percent of adults have diabetes, a majority of which is Type 2. An additional 37 percent have prediabetes, a condition in which blood sugar levels are slightly elevated but have not yet developed into diabetes.
An estimated 10 million people who have diabetes don’t know it, according to a national nutrition survey, and less than half of people with diabetes have their blood sugar well controlled. Chronically high blood sugar levels damage large and small arteries and contribute to heart attack, stroke, dementia and kidney disease.
Doctors’ understanding of cardiovascular disease — and therapies to treat it, including new drugs for obesity, diabetes, cholesterol and heart failure — has improved, Dr. Khan said. But more can be done to screen eligible patients for conditions like diabetes and kidney disease, and to educate people about ways to prevent cardiovascular disease, she said.
The new report also examined whether patients were receiving the best care. For example, the report found that few people with a certain kind of heart failure participate in cardiac rehabilitation, though it has been shown to improve quality of life.
Such data, Dr. Khan said, can help clarify the answer to an important question about the future of cardiovascular disease: “Are we at the inflection point where we’re going to continue to make progress or not?”
Nina Agrawal is a Times health reporter.
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