As fewer Americans die from heart attacks, more succumb to chronic heart disease
From 1970 to 2022, deaths from heart attacks dropped by almost 90%, but more Americans now die from other types of heart disease, Stanford Medicine-led research has found.
In 1970, someone over the age of 65 hospitalized for a heart attack in the United States had about a 60% chance of leaving the hospital alive. Today, the survival rate is over 90%, with even better outcomes for younger patients.
Those numbers have contributed to a remarkable decrease in the likelihood of dying from any type of heart disease over the last 50 years, according to a new study of heart disease mortality led by Stanford Medicine researchers. In 1970, 41% of all deaths were attributed to ailments of the heart; in 2022, that statistic had dropped to 24% of all deaths.
Most strikingly, the proportion of deaths from acute myocardial infarctions — commonly known as heart attacks — fell nearly 90% during that period.
The decrease is a testament to the leaps and bounds made in our ability to manage and prevent heart attacks, from bystander CPR to artery-opening stents and cholesterol-lowering statins, as well as public health measures that have drastically cut tobacco smoking.
But the researchers also found that more Americans now die from other types of heart disease, including heart failure, hypertensive heart disease and arrhythmias. More deaths from chronic heart conditions are, in part, the trade-off from more patients living beyond events like heart attacks.
“People now are surviving these acute events, so they have the opportunity to develop these other heart conditions,” said Sara King, MD, a medical resident and lead author of the new study published June 25 in the Journal of the American Heart Association.
The senior author of the study is Latha Palaniappan, MD, a professor of cardiovascular medicine and associate dean for research.
The shifting trends in heart disease mortality revealed by the new study are largely a success story, but they also point to areas that need improvement.
“Ischemic heart disease is caused by plaque building up in the arteries,” King said. “It’s a common pathophysiology that we have learned can be prevented and treated.”
In 1970, nearly all heart disease deaths — 91% — could be attributed to ischemic causes. About half of those were heart attacks.
Every decade since has seen life-saving innovations in the treatment of ischemic heart conditions, and of heart attacks in particular.
In the ’70s, bystander CPR and portable defibrillators became more widespread and allowed more people to make it to the hospital alive. Coronary care units, cardiac imaging, the invention of bypass surgery and balloon angioplasty improved the odds of survival. In the 1980s and 1990s, coronary stenting kept arteries open, and medications like aspirin and other anti-platelet therapies averted and treated many heart attacks. In the 21st century, high-intensity statin therapy and new cholesterol and diabetes treatments improved prevention and further lowered mortality.
Moreover, the increasing recognition of heart attacks as a medical emergency that requires rapid intervention — ideally within 90 minutes of arriving at a hospital — has spared many lives.
And beginning with the 1964 surgeon general’s report on smoking and health, the public health campaign against cigarette smoking has reduced a major risk factor for cardiovascular disease. In 1970, 40% of Americans smoked, compared with 14% in 2019.
Though the new study did not link specific developments to lower mortality, the big picture is one of advancements.
Website: cognitivescientist.org
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