Report Highlights:
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The number of people dying from cardiovascular diseases (CVD) in the US increased during the first year of the COVID-19 pandemic, from 874,613 CVD-related deaths recorded in 2019 to 928,741 in 2020. The increase in the number of CVD deaths in 2020 represents the largest single-year increase since 2015 and surpassed the previous high of 910,000 recorded in 2003, according to the latest available data from the Heart Disease and Stroke Statistics — 2023 Update of the American Heart Association published in Circulation .
“While the total number of CVD-related deaths increased from 2019 to 2020, what may be even more telling is that our age-adjusted mortality rate increased for the first time in many years and by a fairly substantial 4.6%.” said Statistical Update writing group chair Connie W. Tsao, MD, MPH, FAHA, assistant professor of medicine at Harvard Medical School and attending cardiologist at Beth Israel Deaconess Medical Center in Boston. “The age-adjusted mortality rate takes into account that the total population may have more older adults from one year to the next, in which case higher mortality rates could be expected among older people. So while our total number of deaths has been slowly increasing over the past decade, we have seen a decline each year in our age-adjusted rates, through 2020. I think that’s very indicative of what’s been happening within our country. and the world, in light of people of all ages being affected by the COVID-19 pandemic , especially before vaccines became available to slow the spread.”
The largest increases in the total number of CVD-related deaths were seen among Asian, Black and Hispanic people, the populations hardest hit in the early days of the pandemic, and which focused on growing structural and social disparities.
“We know that COVID-19 took a tremendous toll, and preliminary data from the U.S. Centers for Disease Control and Prevention (CDC) has shown there was a substantial increase in loss of life across all causes since the beginning of the pandemic. That this likely resulted in an increase in cardiovascular deaths overall, although discouraging, is not surprising. In fact, the Association predicted this trend, which is now official,” said American Heart Association Volunteer President Michelle A. Albert, MD, MPH, FAHA, the Walter A. Haas-Lucie Stern Chair of Cardiology, Professor of Medicine at the University of California, San Francisco (UCSF) and Dean of Admissions at the UCSF School of Medicine. “ COVID-19 has direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clots and inflammation . We also know that many people who had new or existing heart disease and stroke symptoms were reluctant to seek medical care, especially in the early days of the pandemic. This resulted in people presenting with more advanced stages of cardiovascular conditions and needing more acute or urgent treatment for what might have been manageable chronic conditions. And, sadly, it seems to have cost many their lives.”
According to Albert, who is also director of the Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center) at UCSF and a recognized leader in health equity and adversity research, the largest increases in the number of Coronary heart disease deaths among adults in Asian, Black, and Hispanic populations appear to correlate with people most frequently infected with COVID-19.
“People in communities of color were among the hardest hit, especially early on, often due to a disproportionate burden of cardiovascular risk factors such as hypertension and obesity. Additionally, there are socioeconomic considerations, as well as the continued impact of structural racism on multiple factors, including limiting the ability to access quality health care,” Albert said. “The American Heart Association responded quickly at the beginning of the pandemic to address the impact of COVID-19 and focus on equitable health for all. The Association launched the first rapid response research grants calling on the research community to rapidly shift transformative science; established a hospital-based COVID-19 cardiovascular disease registry through the Get With The Guidelines ® quality initiative; and also made an unprecedented commitment to aggressively address social determinants while working to support and improve the equitable health of all communities. “We are empowering real change that will save lives.”
Coronary heart disease remains the leading cause of death in the U.S. Stroke remains fifth among all causes of death behind heart disease, cancer, COVID-19, and non-injury/accidents. intentional. COVID-19 appeared on the list of leading causes of death for the first time in 2020, the most recent year for which final statistics are available from the US Centers for Disease Control and Prevention (CDC).
Appropriately, this year’s statistical update includes many references to COVID-19 and its impact on cardiovascular disease. Data points and scientific research findings are inserted into most chapters of the document, including those related to risk factors for heart disease and stroke, such as obesity, diabetes, and high blood pressure, which They also increase people’s risk of COVID. Many of the studies noted identify specific gender, race, and ethnicity disparities.
However, disparities occur not only among age, sex, and racial/ethnic groups, according to a special commentary written by members of the Statistical Update writing committee. While the Statistical Update has included several social determinants of health data in its report, the commentary noted that data is still missing from other underrepresented populations, such as LGBTQ people and people living in rural versus urban areas of the US. The authors of the commentary denounce the lack of scientific research and cumulative data on the impacts of social identity and social determinants.
“We know that to address discrimination and disparities that affect health, we must recognize and better understand the unique experiences of people and populations. “This year’s writing group made a concerted effort to collect information on specific social factors related to health risks and outcomes, including sexual orientation, gender identity, urbanization, and socioeconomic position,” Tsao said. “However, data are lacking because these communities are grossly underrepresented in clinical and epidemiological research. We are hopeful that this gap in the literature will be filled in the coming years, as it will be critical to the American Heart Association’s goal of achieving equity in cardiovascular health for all in the US and around the world. ”.
Global data
Cardiovascular disease remains the leading cause of death globally, killing more than 19 million people worldwide each year, including people of all ages, genders and nationalities. However, risk factors that lead to heart disease and stroke continue to disproportionately affect certain populations in the US and around the world.
Supplementary tables in this year’s statistical update analyze the overall trend of CVD-related deaths globally and regionally, and also provide the number and proportion of deaths caused by various cardiovascular diagnoses. Additionally, supplementary tables compared all-cause deaths and CVD-related deaths attributable to various risk factors, as well as age-standardized disability-adjusted life years (DALYs) across various countries and regions. Of special note:
Globally, ischemic heart disease and stroke represent the two leading causes of CVD-related deaths, accounting for 16.2% and 11.6% of all causes of death, respectively. These rates have increased worldwide over the past decade in all but two regions: North America and Europe/Central Asia.
In 1990, ischemic heart disease accounted for 28.2% of all deaths in North America, falling to 18.7% of all deaths in 2019. Stroke decreased from 7.3% of all deaths in America North in 1990 to 6.4% of all deaths in 2019.
In the Europe and Central Asia region, ischemic heart disease decreased from 27.2% of all causes of death in 1990 to 24.4% in 2019, while stroke accounted for 15.1% of all causes of death in 1990 and decreased to 12.5% in 2019.
The East Asia and Pacific region is the only region where stroke accounts for the largest proportion of CVD-related deaths, with the proportion of deaths increasing from 14.8% in 1990 to 18.3% in 2019. During This same time period, the proportion of deaths caused by ischemic heart disease almost doubled , from 8.1% to 15.6%.
The sub-Saharan Africa region recorded the lowest proportion of CVD-related deaths as a percentage of all causes of death. Stroke was the leading cause of CVD-related death in the sub-Saharan Africa region in 1990, accounting for 3.6% of all causes, followed by ischemic heart disease (3.1%). In 2019, ischemic heart disease and stroke accounted for 5.4% of total deaths.
“As the U.S. prepares to celebrate the 60th annual Heart Month in February 2023, it is critical that we recognize and redouble the progress we have made in saving lives in nearly a century of research, advocacy and education, while also “We identify and remove barriers that still put certain people at disproportionately higher risk of cardiovascular disease,” Albert said. “Tracking such trends is one reason the American Heart Association annually publishes this definitive statistical update, which provides a comprehensive resource of the most current data, relevant scientific findings, and assessment of the impact of cardiovascular disease.” at a national and global level.”
The annual update represents a compilation of the most recent and relevant statistics on heart disease, stroke and risk factors that affect cardiovascular health. Tracks trends related to ideal cardiovascular health, social determinants of health, global cardiovascular health, genetics of cardiovascular health, and healthcare costs. Tsao emphasized the importance of this surveillance as a critical resource for the general public, policymakers, media professionals, physicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
This statistical update was prepared by a volunteer writing group on behalf of the Epidemiology and Prevention Statistics Committee of the Council of the American Heart Association and the Stroke Statistics Subcommittee.
