Addressing Post-Pandemic Cardiovascular Mortality Rate Increases, With Brandon Yan, MD

A recent JACC data report has investigated cardiovascular disease (CVD) mortality trends in the US from 1999 to 2023, highlighting an abrupt increase in the wake of the COVID-19 pandemic.1

From 1999 to 2023, age-adjusted mortality rates (AAMR) for CVD decreased from 350.8 to 218.3 deaths per 100,000, falling by 33.5%. These rates reached their lowest point in 2019, at 214.6 per 100,000. However, since the pandemic, mortality rates switched back, rising to 233.3 per 100,000 in 2021.1,2

The editorial team at HCPLive spoke with Brandon Yan, MD, resident physician at the University of California and lead report author, to discuss the stark shift in mortality trends and what can be done to curtail them.

“Years of decline have plateaued overall, and it’s a very concerning plateau indeed, and we are still only beginning to learn why we’re not seeing continued progress,” Yan told HCPLive. “Ischemic heart disease, heart failure, cerebrovascular disease, and hypertensive diseases are large components of what we’re seeing here.”

During the analysis, Yan and colleagues analyzed death certificate data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) database from the US Centers for Disease Control and Prevention, spotlighting the period from 1999 to 2023. CVD mortality was categorized into the following subtypes:

• Hypertensive diseases
• Ischemic heart diseases
• Pulmonary heart and circulatory diseases
• Non-rheumatic valvular diseases
• Conduction disorders and cardiac dysrhythmias
• Heart failure
• Cerebrovascular diseases
• Aortic aneurysm and dissection
• Other cardiovascular diseases

AAMRs were calculated using the 2000 US population as a standard, and CVD mortality was examined in 2 forms: underlying CVD cause or contributing CVD cause.1

Yan and colleagues found that ischemic heart diseases saw a decline in mortality from 194.6 per 100,000 in 1999 to 88 in 2019, a decrease of 54.8%, but increased again to 92.8 in 2021 before declining again to 82.2 in 2023. Hypertensive diseases saw mortality double from 15.8 to 31.9 in 2023 and are now the fastest-growing underlying cause of cardiovascular death. Since 2022, hypertensive diseases have been the leading contributing cardiovascular cause of death.1

Heart failure mortality initially declined from 20.3 in 1999 to 16.9 in 2011, but rose back to 21.6 in 2023, which was its highest recorded level. Cerebrovascular disease mortality fell from 61.6 in 1999 to 36.2 in 2013 but rose again to 37 in 2019 and to 39 in 2023. Finally, Yan and colleagues reported that aortic aneurysm and dissection mortality saw a 59% decrease during the study period alone.1

Ultimately, Yan and colleagues noted that, while the immediate impact of the pandemic may have subsided, underlying trends that existed prior are still exerting influence. Ischemic heart disease mortality has begun to decrease again, responding to advancements in access to acute care and continuous efforts to manage risk factors. Through these methods, ischemic heart disease mortality has largely returned to its past levels despite sharp increases during the pandemic.1

However, hypertensive disease mortality represents the opposite, having reached record heights and still rising. Yan and colleagues attribute this in part to lingering issues born of interrupted care during the pandemic, but also cite the struggle of addressing and maintaining chronic diseases.1

The team called for public health interventions, spotlighting the importance of examining the long-term effects of the pandemic on chronic disease management. They also encouraged the strengthening of chronic disease surveillance and establishing easier and more equitable access to preventive care.1

“I think we need a full-court press,” Yan said. “I would love for there to be a focus and investment in the prevention of heart disease from that population level. And I think a personalized approach is going to be very important as well. We’re seeing much more research on personalizing people’s risk factors for developing heart disease, atherosclerosis, and cardiovascular disease events. I think that’s going to be an important part of the equation as well.”

Editor's Note: Yan reports no relevant disclosures.

References

1. Yan BW, Arun AS, Curtis LH, et al. JACC Data Report. Journal of the American College of Cardiology. 2025;85(25):2495-2498. doi:10.1016/j.jacc.2025.05.018

2. Wen J, Hu J, Zou G. Trends and differences in cardiovascular disease and alzheimer’s disease-related mortality among older adults in the United States, 1999 to 2023: A CDC wonder database analysis. American Heart Journal Plus: Cardiology Research and Practice. 2025;59:100618. doi:10.1016/j.ahjo.2025.100618