Mortality from Chronic Heart Disease Increases as Heart Attack Mortality Falls

Although the last 50 years have seen a decrease in heart disease deaths, chronic disease mortality has concurrently risen in a trade-off from more patients surviving events such as heart attacks.

According to a recent study, heart disease accounted for 41% of all deaths in the US in 1970; by 2022, it accounted for 24% of all deaths. The proportion of deaths caused by acute myocardial infarctions (AMI) dropped by almost 90% during this period. However, chronic heart diseases, such as heart failure, hypertensive heart disease, and arrhythmias, are rising substantially in the American population.1

“People are now surviving these acute events, so they have the opportunity to develop these other heart conditions,” said Sara King, MD, a medical resident of Stanford University of Medicine and lead author of the study.1

Investigators collected data from the National Vital Statistics System Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database, examining adults ≥ 25 years of age in the US from 1970 to 2022. Investigated outcomes included absolute number and age-adjusted mortality of total heart disease, ischemic heart disease, and other subtypes.2

During the indicated time, the US population > 25 years of age increased from 108.9 million to 229 million. Life expectancy likewise increased from 70.9 years to 77.5 years. The National Vital Statistics System recorded a total of 119,152,492 deaths, with 37,276,835 (31%) attributed to heart disease. In 1970, 733,273 heart disease deaths were recorded, of which 666,257 (91%) were ischemic and 67,016 (9%) were from other diseases. In 2022, investigators found 701,443 heart disease deaths, of which 371,360 (53%) were ischemic and 330,083 (47%) were from other heart diseases.2

Age-adjusted mortality for AMI also decreased by 89%, from 354 per 100,000 in 1970 to 40 per 100,000 in 2022. Average annual percentage change (AAPC) for AMI was -4.2% (95% CI, -4.3 to -4.1) from 1970 to 2022. Age-adjusted mortality for chronic ischemic heart disease fell by 71%, from 343 per 100,000 to 98 per 100,000. AAPC for chronic ischemic heart disease was -2.5% (95% CI, -2.6 to -2.4).2

Notably, investigators also saw age-adjusted mortality for other heart disease subtypes increase by 81%, from 68 per 100,000 to 123 per 100,000. AAPC for other heart disease subtypes was 1.2% (95% CI, 1.1 to 1.2). Heart failure, hypertensive heart disease, and arrhythmia had the greatest mortality increases, with age-adjusted mortality rising from 13 to 32 per 100,000 (146% increase), 16 to 33 per 100,000 (106% increase), and 2 to 11 per 100,000 (450% increase).2

Additionally, the rise in non-ischemic heart disease deaths reflects a rise in risk factors including obesity, diabetes, hypertension, and physical inactivity, according to King and colleagues. Roughly 50% of adults have diabetes or pre-diabetes, and 40% have obesity.1

While investigators noted the reduction in heart disease mortality over the last 50 years may be indicative of success in medical and public health interventions, they also indicated the emerging challenges presented by chronic ischemic heart disease and similar conditions. They suggest several possible explanations for the shift; interventional methods to reduce mortality from AMI, improvement in cardiac imaging, and the development of beta blockers, renal-angiotensin-aldosterone system inhibitors, and others.2

“We have so many tools in our toolbox now, but still, there’s a lot more that can be developed and improved,” King said. “I hope the numbers just keep getting better.”1

References

1. Standford Medicine. As fewer Americans die from heart attacks, more succumb to chronic heart disease. Eurekalert! June 25, 2025. Accessed July 2, 2025. https://www.eurekalert.org/news-releases/1088540

2. 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