Deaths from Cardiovascular Disease on Rise Since 2011

Sadiya Khan, MD, MSc

A recent review from investigators at Northwestern University is confirming the fears of many cardiologists throughout the country.

The results of the review revealed progress in the fight against cardiometabolic disease, as rates of death in the United States are no longer in decline and have been rising since 2011.

"Our findings make it clear that we are losing ground in the battle against cardiovascular disease,” said Sadiya Khan, MD, MSc, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. "We need to shift our focus as a nation toward prevention to achieve our goal of living longer, healthier and free of cardiovascular disease."

In an effort to evaluate recent national trends in cardiometabolic mortality, investigators reviewed rates of cardiovascular disease (CVD) and other key cardiometabolic disease mortality rates by sex and by race from 1999 to 2017. Using ICD-10 codes, investigators determined mortality rates through analysis of death certificates from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) from January 1, 1999 to December 31, 2017.

Mortality rates for causes of death included heart disease, diabetes, stroke, or essential hypertension and hypertensive renal disease were adjusted using the 2000 US standard population. Additionally, age-adjusted morality rates (AAMR) were examined overall and by sex-race groups.

Upon analysis, investigators noted 752,192 (AAMR per 100,000 = 266.5) deaths from heart disease in 1999. During that same year, investigators observed 167,366 (61.6) deaths from stroke, 68,399 (25.0) from diabetes, and 16,968 (6.2) from hypertension. In 2017, total deaths from heart disease were 647,457 (165.0) 146,383 (37.6) from stroke, 83,564 (21.5) from diabetes, and 35,316 (9.0) from hypertension.

Investigators point out that AAMRs reached an inflection point in 2010 for deaths due to heart disease, stroke, and diabetes. Rates of AAMR decline for heart disease pre-2010 was β = −8.3 (95% CI, −8.8 to −7.8; P<.001) compared to β = −1.8 (95% CI, −2.5 to −1.0; P = .001) post-2010. From 1999 to 2010 AAMR declines for stroke were β=−2.3 (95% CI, −2.5 to −2.1; P < .001) and for diabetes were β=−0.4 (95% CI, −0.6 to −0.3; P<.001).

AAMRs for diabetes and stroke did not change significantly between 2010 and 2017. An inflection point was noted in terms of hypertension AAMR in 2003 and rates increased less rapidly after that point (1999-2003: β=0.3 (95% CI, 0.3 to 0.4); P=.001 and 2003-2017: β=0.1 (95% CI, 0.04 to 0.1); P< .001).

Investigators noted that black individuals had consistently higher AAMRs compared to white individuals. The highest AAMR ratios were in black compared with white women due to diabetes and in black compared with white men due to hypertension. Black men has the highest AAMRs across all underlying causes of death. &#8232;&#8232;

This study, “Trends in Cardiometabolic Mortality in the United States, 1999-2017” was published online as a research letter in JAMA.