A new study published this week in the Journal of the American Heart Association found deaths from heart attacks have significantly declined in the United States over the past five decades. At the same time, more people are dying from chronic heart conditions.
“Incredible progress has been made to reduce deaths from heart attacks over the last 50 years, including new medicines, procedural interventions, and public health measures,” Sara King, MD, the study’s lead author and a second-year internal medicine resident in the Stanford Department of Medicine, told Health.
“However, now, with an aging population, there are more deaths from conditions such as heart failure, arrhythmias, and hypertensive heart disease,” she said.
To understand trends in deaths from heart disease—a condition encompassing a broad range of heart problems—King and her colleagues sifted through a national dataset compiled from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research. The dataset included all heart disease-related deaths of adults aged 25 and older between 1970 and 2022.
Despite heart disease still emerging as the top killer in the U.S., responsible for 24% of all deaths in 2022, overall deaths from heart disease decreased by 66%.
Deaths from ischemic heart disease, which is caused by a blockage or restriction of blood flow from narrowed arteries and is the most common type of heart disease, dropped from 91% to 53%. Mortality from heart attacks—sometimes the first sign of ischemic heart disease—decreased by 89%, making up just below a third of all heart disease deaths in 2022.
But researchers also found a considerable increase in other heart conditions, which now make up nearly half of all heart disease deaths. The three that spiked the most were:
- Hypertensive heart disease (106% rise, making up 13% of all heart-related deaths in 2022): The condition occurs when chronic high blood pressure damages the heart, raising the risk of problems like heart attack, stroke, or heart disease.
- Heart failure (146% rise, making up 12% of all heart-related deaths in 2022): This is when the heart stops pumping sufficient blood over time. There is no cure, but the condition can be managed with medication, diet, and other lifestyle choices.
- Arrhythmias (450% rise, making up 4% of all heart-related deaths in 2022): This is when the heart beats too fast, too slow, or irregularly. Over time, an arrhythmia can cause a stroke, blood clots, or heart failure.
Though King said the trends are “quite clear,” she noted that revisions to the coding system led to some inaccurate labeling.
Other study limitations included failing to consider how comorbid heart conditions or demographic factors such as race might have shaped the results, pointed out John P. Higgins, MD, a cardiologist and professor at McGovern Medical School at UTHealth Houston. Because problems like arrhythmias or cardiac arrest can stem from ischemic heart disease, researchers may have underestimated deaths from that condition, he added.
Still, Higgins told Health the study “offers valuable insights into epidemiological transitions in cardiovascular disease.”
Jason Hoff, MD, a structural interventional cardiologist at Loma Linda University Medical Center, agreed. “This is a well-designed, large-scale epidemiological study using over 50 years of national mortality data, which gives it impressive scope and relevance,” he told Health.
Hoff and Higgins attributed the decline in some types of heart disease deaths to diagnostic advancements and improvements in care, from the development of statins and other medications to procedures like revascularization, which helps to restore blood flow to parts of the heart.
But many people who have a non-fatal heart attack go on to develop other heart conditions, such as heart failure or arrhythmias, Hoff noted. “Combine that with an aging population, rising rates of obesity, diabetes, and high blood pressure, and you’ve got the perfect storm for chronic cardiac disease,” he said.
The new “wave of chronic cardiovascular disease mortality” primarily affects older adults and those with multiple comorbidities, Higgins added. “We’ve won major battles against acute heart disease, but the war is far from over,” he said. “Chronic heart conditions are the next frontier in cardiovascular health.”
Hoff suggested five ways to keep your ticker healthy and “reduce your risk for both ischemic and non-ischemic heart conditions.”
- Know your numbers: Track the metrics that have a significant effect on the heart, such as blood pressure, cholesterol, blood sugar, and weight. “Early detection is critical,” Hoff said.
- Move your body: Aim for at least 150 minutes of moderate-intensity aerobic exercise each week. “Even walking helps lower blood pressure and improves heart function,” Hoff said.
- Eat a diet full of nutritious, whole foods: “A diet rich in vegetables, fruits, whole grains, lean protein, and healthy fats, like olive oil or nuts, supports vascular and metabolic health,” Hoff said. His advice aligns with guidelines from the American Heart Association, which rated the DASH, Mediterranean, pescatarian, and vegetarian diets as the most heart-healthy eating plans.
- Don’t smoke—or get help with quitting if you do: “Smoking is still a leading driver of heart disease,” Hoff said.
- Manage stress and sleep: “Chronic stress and poor sleep both increase cardiovascular risk,” he said. “Practices like mindfulness, adequate rest, and strong social connections are underappreciated tools for heart health.”
