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Fewer People Are Dying Of Heart Attacks — But These 3 Deadly Conditions Are On The Rise

Even good news can break your heart.

A new study found that the number of Americans dying from heart attacks has dropped nearly 90% over the last 50 years — but your ticker still isn't in the clear.

Researchers are warning that three other heart conditions are on the rise, now making up a larger share of cardiovascular disease deaths than ever before.

Heart disease is the No. 1 killer of men and women in the US. Dragonstock – stock.Adobe.Com

Age-adjusted heart disease death rates among adults 25 and older from 1970 to 2022 were analyzed for the study, published Wednesday in the Journal of the American Heart Association.

Researchers found that heart disease deaths overall dropped by 66% during this five-decade period, largely driven by a sharp decline in heart attacks.

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.

Advancements in prevention and treatment have dramatically reduced heart disease deaths in recent years. PintoArt – stock.Adobe.Com

"This evolution over the past 50 years reflects incredible successes in the way heart attacks and other types of ischemic heart disease are managed," Dr. Sara King, a second-year internal medicine resident at Stanford University School of Medicine and the study's first author, said in a statement.

"There have been great strides made in helping people survive initial acute cardiac events that were once considered a death sentence," she added. 

Among these advances: more bystander CPR, greater awareness of early heart attack signs, improved imaging tools and treatments and public health measures like no-smoking laws.

But don't celebrate just yet.

"Now that people are surviving heart attacks, we are seeing a rise in other forms of heart disease," said Dr. Latha Palaniappan, associate dean for research at Stanford's School of Medicine and senior author of the study. 

Roughly 1 in 5 deaths in the US is attributed to heart disease. Tiero – stock.Adobe.Com

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.

Deaths from arrhythmias — when the heart beats too fast, too slow or irregularly — increased the most, with the age-adjusted death rate soaring 450%.

Heart failure deaths, caused by the heart's inability to pump enough blood, climbed 146%.

And deaths from hypertensive heart disease, linked to long-term high blood pressure, rose 106%.

These conditions are likely fueled, at least in part, by a growing number of Americans with cardiovascular risk factors, the researchers theorized.

For example, obesity rates in the US jumped from 15% in the 1970s to 40% by 2022.

Type 2 diabetes now affects almost half of all adults, while the percentage of people with high blood pressure increased from 30% in 1978 to nearly 50% in 2022.

The rise in obesity in the US started in the late 1970s and early 1980s. Motortion – stock.Adobe.Com

"All of these risk factors contribute to an ongoing burden of heart disease," Palaniappan said.  

The researchers also pointed to the country's aging population and longer life expectancy as potential factors, with more Americans living to ages when heart disease becomes more common.

"We've won major battles against heart attacks, however, the war against heart disease isn't over," King said. 

"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," she added. 

The American Heart Association has outlined steps to significantly lower the risk of cardiovascular disease, called "Life's Essential 8."

They include eating a healthier diet, managing weight, quitting smoking, getting more physical activity, improving sleep and maintaining healthy cholesterol, blood pressure and blood sugar levels.


Heart Disease Landscape Changes: Fewer Heart Attacks, But More Deaths From Failure And Arrhythmias

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Heart Disease Deaths Decline Over Last 50 Years, But Not Across The Board

The number of deaths attributable to heart disease, particularly acute myocardial infarction and ischemic heart disease, has declined significantly in the United States over the past 50 years or so, new research shows.

Despite the good news, there are worrisome developments, including the rise in deaths from other types of heart disease.

"Ischemic heart disease is still a huge problem and it's something that we continue to face, but we really saw about an 80% increase in mortality from things like heart failure; hypertensive heart disease, which really is a type of heart failure; and arrythmias," lead investigator Sara King, MD (Stanford University School of Medicine, CA), told TCTMD. "We also saw increases [in mortality from] from pulmonary hypertension or pulmonary heart disease and increases in mortality from valvular heart disease."

While the study was not designed to address why the causes of death have changed, King said the data likely reflect a shift toward more chronic heart disease in the US population.

"With our aging population, people are now surviving these acute ischemic events," she said. "They're living longer, so there's more time for them to have these disease processes and to die from them. I don't think we've made quite the progress with these other heart conditions as we have with myocardial infarction."

The new study, published Wednesday in the Journal of the American Heart Association, spans from 1970 to 2022 and includes data from the National Vital Statistics System available through the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) resource. During this time, the US population 25 years and older increased from 108.9 million to 229 million and life expectancy increased from 70.9 to 77.5 years.

Over the 52-year period, 31% of all deaths were attributable to heart disease. In 1970, heart disease accounted for 41% of total deaths, of which the vast majority (91%) were from ischemic heart disease. Among those who died from ischemic heart disease, 54% had an acute MI and 46% had chronic disease.

In 2022, just 24% of all deaths were due to heart disease. Here, 53% of deaths were attributable to ischemic heart disease and 47% from other forms of heart disease. Of the ischemic heart disease deaths in 2022, 29% were related to acute MI and 71% to chronic disease.

Cardiovascular disease remains the number one cause of death in the US, but age-adjusted mortality for all types of heart disease declined by 66% from 1970 to 2022. For acute MI, age-adjusted mortality decreased by 89%, dropping from 354 to 40 deaths per 100,000 people. Similarly, age-adjusted mortality from chronic ischemic heart disease declined by 71%, falling from 343 to 98 deaths per 100,000 people. Mortality from all types of ischemic heart disease declined by 81% from 693 to 135 deaths per 100,000 people.

Conversely, age-adjusted deaths for other types of heart disease—rheumatic heart disease, cardiomyopathy, heart failure, arrhythmias, valvular heart disease, hypertensive heart disease, pulmonary heart disease, and cardiac arrest/ventricular arrhythmias—increased 81% from 1970 to 2022 (68 to 123 deaths per 100,000). Deaths from heart failure, hypertensive heart disease, and arrhythmias increased the most during the study period, up 146%, 106%, and 450%, respectively. Only deaths from rheumatic heart disease declined over time (85% decrease).

With our aging population, people are now surviving these acute ischemic events. Sara King

The study period spans an era that includes multiple advances to reduce the risk of dying from ischemic heart disease, including the introduction of CABG surgery, cardiac imaging, balloon angioplasty, thrombolytic therapy, and aspirin, say investigators. There also was the establishment of PCI and an emphasis on rapid door-to-balloon times as well as the routine use of secondary prevention drugs such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, and statins. High-sensitivity troponin testing led to more rapid diagnoses, and the use of more advanced antiplatelet agents after revascularization aided the decline in ischemic heart disease deaths, they say.

There have also been public health efforts to reduce cholesterol and blood pressure, among other interventions. "One big thing is the decline in tobacco use," said King. "I think that was a huge public health accomplishment." In 1970, roughly 40% of adults smoked, as compared with 14% in 2019.

There are different challenges today, with a rising prevalence of obesity, diabetes, and hypertension, as well as declining physical activity levels, say researchers. Still, King is optimistic that medical advances will continue to make similar inroads against these other cardiovascular diseases. "I think we've made really big leaps with heart failure and our four pillars of drug therapy," she said. "I am hopeful we'll just kind of keep making breakthroughs."

King acknowledged limitations to their analysis, noting that it relied on ICD coding for the cause of death and that there is the potential for misclassification. Also, deaths from heart failure, cardiomyopathy, and arrythmias (particularly ventricular arrhythmias) might also have ischemic causes that aren't captured with ICD coding, say the researchers.

"I think overall, though, the trends are quite clear," said King.





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