A comprehensive analysis of five decades of US mortality data reveals a dramatic shift in heart disease death patterns, with acute myocardial infarction deaths plummeting while chronic heart conditions surge, according to research published in the Journal of the American Heart Association.
The study, led by Dr. Sara King from Stanford University School of Medicine, analyzed data from the National Vital Statistics System covering adults aged 25 and older from 1970 to 2022. The findings show that while heart disease accounted for 41% of all US deaths in 1970, this proportion fell to 24% by 2022, representing significant progress in acute cardiac care.
Dramatic Decline in Heart Attack Deaths
Age-adjusted mortality for acute myocardial infarction decreased by 89%, from 354 per 100,000 in 1970 to 40 per 100,000 in 2022. The average annual percentage change for AMI was -4.2% (95% CI, -4.3 to -4.1) throughout the study period. Similarly, chronic ischemic heart disease mortality fell by 71%, from 343 per 100,000 to 98 per 100,000, with an average annual percentage change of -2.5% (95% CI, -2.6 to -2.4).
"People are now surviving these acute events, so they have the opportunity to develop these other heart conditions," explained Dr. King, the study's lead author.
Surge in Chronic Heart Disease Deaths
However, the data revealed a concerning countertrend: age-adjusted mortality for other heart disease subtypes increased by 81%, from 68 per 100,000 to 123 per 100,000, with an average annual percentage change of 1.2% (95% CI, 1.1 to 1.2).
The most dramatic increases occurred in specific chronic conditions:
- Heart failure mortality rose 146%, from 13 to 32 per 100,000
- Hypertensive heart disease deaths increased 106%, from 16 to 33 per 100,000
- Arrhythmia-related deaths surged 450%, from 2 to 11 per 100,000
Rising Risk Factor Burden
The shift toward chronic heart disease mortality coincides with worsening cardiovascular risk factors across the US population. According to the American Heart Association's 2025 Heart Disease and Stroke Statistics report, nearly 47% of US adults have high blood pressure, more than 72% have unhealthy weight, and 42% have obesity. Additionally, 57% of adults have type 2 diabetes or prediabetes.
"If recent trends continue, hypertension and obesity will each affect more than 180 million U.S. adults by 2050, whereas the prevalence of diabetes will climb to more than 80 million," noted Dr. Dhruv Kazi from Beth Israel Deaconess Medical Center in an accompanying editorial.
Health Disparities Persist
The data revealed significant disparities in cardiovascular risk factors across demographic groups:
- Black women had the highest obesity rate at 58%, compared to 15% among Asian women
- Hispanic men showed the highest diabetes rate at 15%, versus 8% among white women
- Black women had the highest hypertension rate at 58%, compared to 35% among Hispanic women
Dr. Latha Palaniappan from Stanford University emphasized that excess weight "lowers life expectancy by as much as 2.4 years compared to a healthy weight," with the impact being "twice as high for women, and higher for Black adults than for white adults."
Economic Implications
The evolving heart disease landscape carries substantial economic consequences. The US spent $418 billion on cardiovascular disease-related healthcare in 2020-2021, representing 11% of total national health spending. Projections suggest cardiovascular disease costs will triple by 2050, constituting nearly 5% of the national gross domestic product.
Treatment Advances and Future Challenges
The researchers attributed the decline in acute heart disease deaths to several medical advances, including interventional procedures to reduce AMI mortality, improvements in cardiac imaging, and the development of beta blockers and renin-angiotensin-aldosterone system inhibitors.
Despite these successes, the rising burden of chronic heart disease presents new challenges. "We have so many tools in our toolbox now, but still, there's a lot more that can be developed and improved," Dr. King noted. "I hope the numbers just keep getting better."
The study encompassed data from 119,152,492 deaths during the study period, with 37,276,835 (31%) attributed to heart disease. The US population over 25 years increased from 108.9 million to 229 million during this timeframe, while life expectancy rose from 70.9 years to 77.5 years.
Heart disease remains the leading cause of death in the United States, with someone dying from heart disease every 34 seconds, amounting to nearly 2,500 deaths daily. The condition kills more people than all cancers and accidental deaths combined.
