It’s the classic – bad news always accompanies the good news.Heart disease is the leading cause of death around the world. For decades, the United States has marked triumphant progress in battling heart attacks – formally known as acute myocardial infarctions. However, overall heart disease death rates over the past five decades dropped by 66% in American adults aged 25 and older, according to a new study. What’s even better, deaths from heart attacks dropped by nearly 90%.But as one front recedes, other cardiovascular threats surge forward, changing the battlefield entirely.
What does the study say?
A recent analysis in the Journal of the American Heart Association reports that, from 1970 to 2022, the age-adjusted mortality from heart attacks dropped by a staggering 89% among adults aged 25 and older – driving a 66% overall reduction in heart disease deaths.
In 1970, more than half of heart disease deaths were caused by heart attacks, a form of acute ischemic heart disease. By 2022, the age-adjusted death rate from heart attacks had fallen 89%, with fewer than one-third of heart disease deaths attributed to them.Dr. Sara King, the lead study author and a second-year internal medicine resident at Stanford University School of Medicine in California, said in a statement, “Over the past 50 years, our understanding of heart disease, what causes it and how we treat it has evolved considerably.” King added, “There have been great strides made in helping people survive initial acute cardiac events that were once considered a death sentence.”
Why this dramatic decline in heart attack mortality?
This extraordinary achievement stems from a constellation of coordinated advances:
Prevention and lifestyle interventions: Aggressive anti-smoking campaigns, improved cholesterol and blood pressure control, and heightened public awareness of heart attack symptoms.Faster diagnosis: Empowered by bystander CPR education, streamlined emergency response systems, and advanced biomarker testing (like troponin), early recognition has saved countless lives.Cutting-edge treatments: The rise of percutaneous coronary interventions (stents), mechanical support devices, and potent platelet inhibitors, coupled with refined critical care practices, transformed the management of acute coronary events.The result? What was once a major killer now accounts for less than one-third of all heart disease deaths – down from over 50% in 1970.
The flip side of the coin:
Unfortunately, that positive news has a flip side.Dr. Latha Palaniappan, associate dean for research at Stanford’s School of Medicine and senior author of the study, said in a statement, “Now that people are surviving heart attacks, we are seeing a rise in other forms of heart disease.”The research team found that deaths from other types of heart disease surged 81% over the same 50-year period, with three conditions driving the increase.So, while we’ve quelled the acute heart attack battle, other cardiovascular foes are gaining ground – and fast.
Arrhythmias
Deaths from irregular heartbeats have exploded by 450% since 1970.An arrhythmia is a problem with the rate or rhythm of your heartbeat. Your heart may beat too fast, too slow, or with an irregular pattern. These irregularities are caused by disruptions in the electrical signals that control your heartbeat.Atrial fibrillation alone affects nearly 10.5 million U.S. adults – many undiagnosed – and dramatically raises stroke and heart failure risks.
Heart failure
Mortality rates have increased by 146% since 1970.Heart failure, also known as congestive heart failure, is a condition where the heart can’t pump enough blood to meet the body’s needs. This can happen because the heart muscle is too weak or stiff to pump effectively, or because it can’t fill with enough blood. It’s important to note that heart failure doesn’t mean the heart has stopped working entirely, but it is a serious condition requiring medical attention.Some studies indicate a reversal in earlier declines post-2011, with an annual surge of +3.5%. Currently, 6.7 million Americans have it – with projections hitting 11 million by 2050.Disparities are rising – Black, American Indian, and Alaska Native communities face higher and worsening heart failure mortality.
Hypertensive heart disease
Deaths have more than doubled (+106%) since 1970.Hypertensive heart disease refers to heart problems that arise from long-term high blood pressure (hypertension). It’s a group of conditions, including heart failure and coronary artery disease, that develop when high blood pressure puts extra strain on the heart over time.It’s now accelerating – +4.8% per year after 2011, compared to +1.2% prior, as hypertension contributes to 25% of heart failure cases and is linked to 90% of them in older adults.
Why such a stark rise?
The aforementioned conditions are likely fueled, at least in part, by a growing number of Americans with cardiovascular risk factors, the researchers theorized.
Persistent and growing risk factorsObesity: Prevalence surged from ~15% in the 1970s to nearly 40% by 2022.Hypertension: Affects nearly 50% of American adults, up from ~30% in the late 1970s.Type 2 Diabetes: Now afflicts nearly half of adults, amplifying the risk of heart disease.An aging population: As lifespans lengthen, more people live long enough to encounter chronic heart issues like heart failure and arrhythmias.Lack of care and health equity gaps: With fewer dying from heart attacks, more individuals transition into states of chronic cardiovascular stress – fueling heart failure, rhythm disorders, and hypertensive complications.Besides, the benefits of scientific progress have not been shared equally. Lower-income and marginalized communities often lag behind in access to prevention and care – resulting in higher mortality from chronic cardiovascular conditions. As per Palaniappan, “All of these risk factors contribute to an ongoing burden of heart disease.”As per King, “We’ve won major battles against heart attacks, however, the war against heart disease isn’t over.” She added, “The next frontier in heart health must focus on preventing heart attacks, and also on helping people age with healthier hearts and avoiding chronic heart conditions later in life.”