Heart disease remains the main killer in the United States, but the face of heart death has changed dramatically over the past fifty years.
The overall heart disease mortality rate has dropped by 66% since 1970, but heart attack deaths have dropped by nearly 90%, an amazing medical success story. But now Americans are increasingly dying from different types of heart disease, especially heart failure, arrhythmia and hypertensive heart disease.
This shift reflects the victory and challenges in modern cardiology. Advanced treatments that once meant some deaths in a heart attack now allow people to survive and live longer, but often suffer from chronic heart disease, which ultimately proves deadly.
From heart attack to heart failure
The transformation is shocking. In 1970, heart attacks accounted for 54% of all heart disease deaths. By 2022, that percentage has dropped to just 29%. Meanwhile, death to other heart disease has soared by 81%, from 9% of heart disease deaths in 1970 to 47% in 2022.
“This shift in distribution of the type of heart disease that people are most important to us is very interesting for us,” said Dr. Sara King, first author of the study and a sophomore resident of Internal Medicine at Stanford University School of Medicine. “This evolution has reflected the success of heart attacks and other types of ischemic heart disease over the past 50 years.”
The study, published in the Journal of the American Heart Association, analyzes data from the Centers for Disease Control and Prevention, covering adults aged 25 and older between 1970 and 2022.
New heart landscape
There are several specific trends in data from the data:
- Arrhythmia: Mortality rate increased by 450%, although still only accounts for 4% of heart disease deaths in 2022
- Heart failure: Age-adjusted mortality rate rose by 146% as more people survive initial cardiac events
- Hypertensive heart disease: Deaths increased by 106% due to long-term hypertension
- Overall impact: Heart disease drops from 41% of total deaths in 1970 to 24% in 2022
Medical progress drives change
The sharp drop in heart attack deaths stems from decades of medical innovation. Coronary artery bypass surgery appeared in the 1960s, followed by the coronary artery care department, which completely changed the treatment in the hospital. The 1970s brought coronary angiography and life-saving drugs, including beta blockers and early statins.
Balloon angioplasty arrived in 1977 and coronary stents continued in the 1980s and 1990s. The 21st century has introduced high-intensity statin therapy, dual antiplatelet therapy, and a “door-to-door” solution to accelerate emergency treatment. Recently, hypersensitivity troponin can be a rapid diagnosis of heart attacks, while advanced antiplatelet drugs and new cholesterol drugs such as PCSK9 inhibitors such as PCSK9 inhibitors have further improved the results.
Public health measures are equally important. Smoke-free policies, physical exercise promotion, and latest guidelines for blood pressure and cholesterol management have all contributed to a decrease in heart attack death.
Rising risk factors bring new challenges
Despite medical advances, several related trends have contributed to the growth of chronic heart disease. The prevalence of obesity soared from 15% in the 1970s to 40% in 2022. Now, nearly half of American adults have affected type 2 diabetes and diabetes. Hypertension increased from about 30% in 1978 to nearly 50% in 2022.
These challenges are compounded by an aging population. Life expectancy has increased from 70.9 years in 1970 to 77.5 years in 2022, which means more people live long enough to develop chronic heart disease.
“All of these risk factors can lead to an ongoing burden of heart disease, especially related to heart failure, hypertensive heart disease and arrhythmia,” explained Dr. Latha Palaniappan, associate dean of research at Stanford University School of Medicine. “The death to heart disease has dropped by 90% since 1970, but heart disease has not gone away.”
Next boundary
These findings point to a fundamental shift in the focus of cardiovascular medicine. The field must now emphasize preventing chronic diseases and helping people with a healthy heart rather than focusing primarily on emergency treatments for acute events.
Dr. King highlighted this evolution: “We have won a big battle with a heart attack, but the war against heart disease is not over yet. We now need to address heart failure and other chronic diseases that affect people’s impacts with age.”
The American Heart Association’s Basic 8 Framework for Life – Diet, Exercise, Tobacco Smoking Quit, Sleep, Weight Management, and Control of Cholesterol, Blood Sugar and Blood Pressure – provides a roadmap for this prevention-centric approach.
As medical advances continue to extend life, challenges will ensure additional years of living in a strong, healthy heart rather than a chronic heart condition that gradually reduces the quality of life.
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