Heart Disease is Still the Leading Cause of Death

To say that America has a heart disease problem is to put it mildly. For more than a century, heart disease has reigned as the leading cause of death in the U.S. It kills one out of every three men and a quarter of women or roughly 690,000 Americans every year. 

These are grim statistics, but they bely a positive fact. Until recently, heart disease deaths were trending down at a rate that would have made it the second leading cause of death, which is cancer. Cancer killed approximately 599,000 Americans in 2020, the last year for which estimates are available.

Heart disease has already fallen to number two in several countries including Canada, Sweden, Chile and Argentina. 

Why Are Heart Disease Deaths Declining?

Heart disease emerged as the top epidemic of the twentieth century as public health and healthcare professionals got a grip on infant mortality, improved food availability and found treatments for communicable infections such as pneumonia, influenza and tuberculosis. Unfortunately, Americans began smoking more, exercising less and eating an abundance of calorically dense processed, unhealthy foods at the same time public health officials were making progress against other deadly diseases.  

Data suggests the heart disease epidemic peaked in the mid-1960s. Thanks to advancements including healthcare technology, medications, and smoking cessation efforts, cardiovascular disease has been declining – albeit very slowly – over the last few decades. In fact, there was a significant drop in heart related deaths between 2000 and 2011, according to a study published in JAMA.

Progress Stalled

But progress began waning after 2011. A recent study from the CDC provides insights as to why.

CDC researchers combed through data spanning 2011 to 2018 from the Behavioral Risk Factor Surveillance System telephone survey to find people who self-reported as having coronary heart disease (CHD) -- 3,572,977 participants were identified. (CHD is one of the three leading causes of heart disease deaths; stroke and high blood pressure are the others.) After analyzing data from this survey, researchers didn’t find a significant change in the number of people with CHD, which is good news. But the pace at which CHD is dropping has slowed. 

Gains made in reducing smoking and managing cholesterol have been offset by a rise in heart disease deaths related to obesity and type 2 diabetes.

“This study has some limitations,” says Bernard Kaminetsky, MD, medical director, MDVIP. “However, intuitively, I think the researchers have found the last two linchpins of coronary heart disease in the U.S. More than 80 percent of people with coronary heart disease are either obese or overweight and more than 32 percent of people with coronary heart disease also have type 2 diabetes.” 

Heart Disease and Obesity

Let’s look at American obesity rates. Between 1999 and 2000, the U.S. obesity rate was 30.5 percent and severe obesity was 4.7 percent. This rose to 42.4 percent for obesity and 9.2 percent for severe obesity between 2017 and 2018. Obesity is notorious for raising cholesterol levels, raising blood pressure and your risk for type 2 diabetes – all major risk factors for CHD because the damage blood vessels.

Heart Disease and Diabetes

Between 1999 and 2000, 7.7 percent of Americans had diabetes (type 1 or 2). These rates hit 10.5 percent in 2018. Another 38 percent of U.S. adults have prediabetes, a condition where elevated glucose levels, if untreated, can lead to full blown type 2 diabetes. Diabetes can cause the lining of blood vessels to thicken, restricting blood flow. It can also raise levels of bad cholesterol while suppressing good cholesterol. 

Unfortunately, many Americans with type 2 diabetes aren’t managing their risk factors for CHD, according to an analysis published in Circulation. The analysis found that less than one in five adults with type 2 diabetes, not diagnosed with CHD, have healthy blood sugar, blood pressure and cholesterol levels and don’t smoke. Type 2 diabetes is typically managed through medication and lifestyle such as eating healthy, exercising, losing weight, giving up smoking and limiting alcohol.

“Losing weight and managing type 2 diabetes is often easier said than done,” Dr. Kaminetsky says. “This is why it’s important to establish a strong relationship with a primary care doctor who knows you, understands your life and is able to work closely with you to accomplish your health goals.”

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