Heart attacks are no longer the leading cause of death in the US

Deaths from heart attacks have plummeted in the US over the past 50 years, whereas deaths from chronic heart conditions have skyrocketed, probably due to people living longer.

“We’ve made some really great progress in certain areas of heart disease mortality, but now we’re seeing this shift,” says Sara King at Stanford University in California.

She and her colleagues collected data on heart disease deaths from 1970 to 2022 using the US Centers for Disease Control and Prevention’s WONDER database, which tracks all recorded fatalities in the country.

They found that in 2022, heart disease accounted for 24 per cent of all deaths in the US, down from 41 per cent in 1970. The decline is largely thanks to an almost 90 per cent decrease in heart attack deaths, which were once the deadliest form of heart disease.

“Incredible progress has been made to reduce deaths from heart attacks over the last 50 years,” says King. This includes new therapies such as heart stents, coronary artery bypass surgery and cholesterol-lowering medications. Public health measures, such as bystander CPR training and efforts to lower smoking rates, have also probably helped, says King.

Even so, heart disease remains the country’s top killer, mainly because deaths from other types of heart disease – mostly chronic conditions – have increased 81 per cent over the same period. For instance, fatalities from heart failure, arrhythmia and hypertensive heart disease have risen 146 per cent, 106 per cent and 450 per cent, respectively.

“A lot of these conditions are conditions that come with age,” says King. “To us, it seems like people that are now surviving these heart attacks are living longer and having more time to sort of develop these chronic heart conditions.”

However, the data may exaggerate the shift in heart disease deaths. “There are a lot of different causes that could lead to somebody’s death, and that can lead to misclassification or oversimplification,” says King. For instance, many people die from heart failure after having survived a heart attack. “The underlying cause of that heart failure is still the blockages in those coronary arteries, so it isn’t black and white,” says King.

Still, the majority of heart disease deaths are clearly no longer due to heart attacks. “It is going to be important that we focus on these other rising causes of mortality,” says King. “Finding ways to age healthily will be the next frontier in cardiology.”