Cardiovascular Disease Still Top Cause of US Mortality Despite Recent Advancements

Despite major advances in cardiovascular health and significant reductions in ischemic heart disease mortality, other subtypes are still holding the top spot in US causes of mortality.1

Heart disease has been the foremost cause of death in the United States for over a century. In the 1970s, heart disease accounted for >700,000 of roughly 2.3 million deaths across all ages and both sexes, with the next most common, malignant neoplasms, coming in at just under 550,000. However, in recent years, substantial improvements in medical technology, specifically targeted interventions for hypertension, hyperlipidemia, and other major risk factors, and advancements in the management and prevention of acute myocardial infarction (AMI) have led to a significant decline in ischemic heart disease mortality.1,2

Despite these substantial strides, recent research has suggested that decreases in ischemic heart disease mortality are actively counterbalanced by increases in mortality from other cardiovascular conditions, including hypertensive heart disease, heart failure, and arrhythmias. Clinicians have attributed these rising mortality rates to a variety of factors, including an aging population with longer life expectancies, increased survivability of first cardiovascular events, and dramatically rising prevalence of major risk factors such as obesity, physical inactivity, diabetes, and hypertension.1

To address this discrepancy and evaluate the trajectory of cardiovascular care moving forward, the HCPLive editorial team sat down with Jesus Almendral, MD, director of the cardiology fellowship program and medical director of the Advanced Heart Failure and LVAD Program at Hackensack Meridian Jersey Shore University Medical Center, and Kanika Mody, MD, medical director of the Surgical Ventricular Assist Device (VAD) Program at Hackensack Meridian Hackensack University Medical Center.

“I think that we’re catching patients earlier with a cardiovascular or ischemic disease – we’ve done a relatively decent job with promoting proper screening of ischemic cardiomyopathy, ischemic disease, and these patients are actually living longer and are now starting to have other issues develop,” Mody told HCPLive. “A lot of other disease processes are also living longer, so now we’re getting a combination of inflammatory processes, like diabetes and hypertension, that are really dominating the landscape of our cardiac patients.”

A recent study from the American Heart Association, published in 2025, more specifically examined these shifting mortality trends. Accessing mortality data for US adults ≥25 years from 1970 to 2022, investigators utilized International Classification of Disease (ICD) codes to determine the underlying cause of death related to heart disease. During the study, deaths were reported as absolute number and age-adjusted rates, with annual age-adjusted mortality rates utilizing the 2000 census as the standard population.1

Between 1970 and 2022, the US population of adults ≥25 years rose from 108.9 million to 229 million, while life expectancy lengthened from 70.9 years to 77.5. The National Vital Statistics System recorded 119,152,492 deaths in total, of which 37,276,835 (31%) were attributable to heart disease. 1970 saw 733,273 heart disease deaths, of which 666,257 were ischemic and 67,016 were attributed to other heart diseases. However, in 2022, investigators found 701,443 heart disease deaths, of which 371,360 were ischemic and 330,083 were from other heart disease.1

Age-adjusted mortality for AMI decreased by 89% over this period, from 354 per 100,000 in 1970 to 40 per 100,000 in 2022. Age-adjusted mortality for chronic ischemic heart disease also fell by 71%, from 343 per 100,000 in 1970 to 98 per 100,000 in 2022. Additionally, the age-adjusted mortality for all heart disease, ischemic and otherwise, decreased by 66%, from 761 per 100,000 in 1970 to 258 per 100,000 in 2022.1

However, age-adjusted mortality for other heart disease subtypes increased by 81%, from 68 per 100,000 to 123 per 100,000, in the same time period. Heart failure, hypertensive heart disease, and arrhythmia saw the most substantial growth in mortality, rising from 13 to 32 per 100,000, 16 to 33 per 100,000, and 2 to 11 per 100,000, respectively. Pulmonary heart disease, nonrheumatic valvular disease, and cardiac arrest also saw substantial increases from 1970 to 2022.1

Ultimately, investigators attributed a significant proportion of these increases to multiple underlying factors. Among these was growth in several heart disease risk factors, including obesity, diabetes, and hypertension. From 1970 to 2022, obesity prevalence rose from 15% to 40%, while diabetes affected roughly half of US adults in 2020. Additionally, hypertension has seen a monumental and continuous surge since the beginning of the 21st century.1

Ultimately, the investigators concluded that, while great progress has been made in curbing ischemic heart disease mortality, further effort is necessary to balance out the increase in other cardiovascular deaths. The growing challenge of these heart conditions is somewhat mitigated by their preventability. To this end, Almendral suggests that clinicians focus on modifiable risk factors, such as obesity and physical activity, to manage the ongoing challenge.

“The estimated length of survival has increased from 70 years to about 77 years, and because of that, people are living longer and are surviving more often with heart disease, with hypertension, diabetes, hyperlipidemia, and so on,” Almendral said. “Trying to control diabetes, trying to control hypertension, asking people to be more active, and making sure that their lipid panels are under control; those are the things that I think will prevent further heart failure down the road, further hypertensive heart disease, and further arrhythmias.”

Editors’ Note: Almendral reports minor honoraria from Abbott and Boston Scientific. Mody reports no relevant disclosures.

References

1. King SJ, Wangdak Yuthok TY, Bacong AM, et al. Heart disease mortality in the United States, 1970 to 2022. Journal of the American Heart Association. 2025;14(13). doi:10.1161/jaha.124.038644

2. The Center for Disease Control: National Center for Health Statistics, National Vital Statistics System. Leading causes of death, 1990–1998. Accessed September 30, 2026. https://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf