Heart Disease Deaths Decline, But Remain Leading Cause Of Death In U.s.

Heart disease remains the leading cause of death in the United States, while stroke has climbed to the fourth main cause. Busà Photography/Getty Images

• Deaths from heart disease and stroke are declining, but still kill more Americans than any other cause.
• New data show progress since the pandemic, yet significant rates of obesity, diabetes, and kidney disease remain major public health obstacles.
• The findings underscore the importance of better prevention, risk awareness, and health equity.

Deaths from heart disease and stroke have declined since the COVID-19 pandemic, but they still kill more people in the United States than any other cause.

Heart disease remains the leading cause of death in the United States, while stroke has climbed to the fourth main cause, according to the latest statistics from the American Heart Association (AHA).

The report, which includes data up through 2023, marks the reversal of a five-year upward trend. 

Experts have attributed much of the increase in deaths from heart disease and stroke to effects from the COVID-19 pandemic.

Overall, deaths from cardiovascular disease (CVD) — which includes heart disease, hypertension, stroke, and heart failure — declined to 915,973 in 2023, down from 941,652 in 2022, a decrease of about 26,000 deaths or 2.7%.

“The revisions indicate to us that we are making some progress,” said Keith C. Ferdinand, MD, Gerald S. Berenson Chair in Preventive Cardiology at Tulane University School of Medicine, who was not involved in the study. But, he said, there is plenty more work to do.

Contributing factors for heart disease, stroke

The United States may finally be turning a corner, but it must tackle a number of serious contributing factors, including obesity, high cholesterol (hyperlipidemia), and type 2 diabetes, that continue to rise.

The report also highlights kidney function as an indicator of cardiovascular health.

Kidney disease, alongside these other conditions, is collectively part of a cluster of interconnected diseases known as cardiovascular-kidney-metabolic (CKM) syndrome. 

To address these challenges, the new report places greater emphasis on health equity — working with populations that have historically been underserved or have borne a disproportionate share of disease burden in the United States.

“Heart disease [is] still the number one cause of death in the United States. So if we want to curb the overall increased death rates, then we need to pay more attention to health equity and try to help the people who are struggling to control their risk factors,” Ferdinand told Healthline.

Recent decline in heart disease, stroke deaths

Heart disease remains the leading cause of death for Americans, and has been for more than 100 years.

Coronary heart disease is the most common form of heart disease. It occurs when plaque builds up in the arteries that supply blood to the heart and can lead to a heart attack.

In 2023, there were 22,000 fewer deaths linked to coronary heart disease, about 6% less than the year before. But the number of deaths was still overwhelming: 350,000 Americans died from it that year, or about 2 people every 3 minutes.

The number of deaths from stroke also fell subtly during that same time period. However, the report notes that for certain age groups, deaths from stroke actually increased. 

Among young adults ages 25 to 34, stroke deaths rose by more than 8% between 2013 and 2023. That rise is even more striking given that stroke death rates in this age group were flat in the preceding between 2012 and 2022.

“This persistent increase that we see in younger people is a sign that we perhaps need to get the message out that in order to curtail the burden of strokes in middle age and older populations, we want young people to identify their risk prior to reaching those ages,” said Ferdinand.

Adults ages 85 and older experienced the steepest rise in stroke deaths, increasing by more than 18%. 

The findings underscore the need for a targeted approach to prevention, especially for specific populations such as young adults who may not be aware of their risk.

Obesity, hypertension, other risk factors remain high

Despite the modest decrease in deaths from stroke and heart disease, other complications and comorbidities remain stubbornly high in the United States.

Nearly half (47.3%) of U.S. adults have some form of hypertension, according to the latest statistics.

Between 2022 and 2023, the prevalence of hypertension remained roughly the same. It remains the single most important modifiable risk factor for cardiovascular disease.

Type 2 diabetes also remains a major risk factor. Today, nearly 30 million U.S. adults have type 2 diabetes, many of whom are untreated, a major red flag that can trigger a cascade of downstream cardiovascular risk.

“Almost 10 million adults are not aware of a diabetes diagnosis. Only a minority of them have their risk factors controlled, with less than a quarter of adults having their blood pressure controlled,” said Sadiya S. Khan, MD, AHA volunteer vice-chair of the statistical update writing group, and professor of cardiology at Northwestern’s Feinberg School of Medicine. Khan wasn’t involved in the report.

The obesity epidemic is also one of the most pressing public health concerns. Similar to hypertension, about half of adults have some form of obesity. But the condition is even more concerning in children.

Obesity among children ages 2 to 19 rose from 25.4% to 28.1%. Childhood obesity signals that cardiovascular risk is beginning earlier in life and may compound as children age, increasing the likelihood of heart attack and stroke at younger ages.

“There are multiple steps that can be taken in order to address obesity in children, which would then perhaps curtail what we see with obesity and severe obesity climbing in adulthood. But it’s not easy. There is no silver bullet,” Ferdinand said.

The report also acknowledges kidney disease and CKM as indicators of cardiovascular health, and also as potential contributing factors.

“We now know that the kidney is the canary in the coal mine,” Ferdinand said.

CKM, which links a number of conditions — including heart disease, kidney disease, diabetes, and obesity — is present in the majority of U.S. adults.

About 90% of adults have some form of CKM, which is graded on a severity scale from stage 1 to stage 4 based on the presence of different risk factors. More than 80% of young and middle-aged adults also show some early forms of CKM.

Tips to promote cardiovascular health

The AHA recommends its Life’s Essential 8 system as the foundation for improving cardiovascular health and decreasing risk of heart attack and stroke.

The framework recommends how to make effective changes to modifiable risk factors, including:

• stopping smoking
• being more active
• getting healthy sleep
• managing weight
• controlling cholesterol
• managing blood sugar
• managing blood pressure
• eating better

Making healthy changes is linked to a demonstrable decrease in CVD risk.

The report found that across numerous studies, individuals with good cardiovascular health, as measured by Life’s Essential 8, had 74% lower risk of heart attack and stroke, as well as improved brain health and lower risk of dementia.

In fact, the report estimates that up to 40% of U.S. deaths could be prevented with optimal scores.

“The goal is to start with small, actionable steps,” Khan said, “Social factors are powerful drivers of health across the life course. We need to shift our approach from being reactive to proactive and think about ways to reshape policies and environments to promote lifelong health.”

For individuals who have already had a heart attack or stroke, Life’s Essential 8 is even more important. Both Khan and Ferdinand also emphasize “knowing your numbers,” meaning understanding what your blood pressure, cholesterol, and A1C mean for your health.

Ferdinand recommended an initial target goal of lowering blood pressure to less than 130, ideally 120, over 80. Ideally LDL cholesterol levels should be less than 100, or ideally less than 70.

For those with diabetes, A1C levels should be less than seven, Ferdinand noted.