AHA: More Than Half of U.S. Adults Don't Know Heart Disease is Leading Cause of Death, Despite 100-Year Reign

More than half of people in the U.S. (51%) do not know that heart disease is the leading cause of death in the country, according to a recent Harris Poll survey conducted on behalf of the American Heart Association in November 2023. Yet, heart disease has now been the #1 killer for more than a century, according to the 2024 Heart Disease and Stroke Statistics: A Report of U.S. and Global Data From the American Heart Association. The annual update published today in Circulation, the peer-reviewed, flagship journal of the American Heart Association, the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke, celebrating 100 years of lifesaving work in 2024.

"Heart disease has now been the leading cause of death in this country for 100 years straight, since 1921, according to the Centers for Disease Control and Prevention," said Joseph C. Wu, M.D., Ph.D., FAHA, volunteer president of the American Heart Association, director of the Stanford Cardiovascular Institute and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. "Heart disease along with stroke, which is the fifth leading cause of death, claims more lives in the U.S. than all forms of cancer and chronic lower respiratory disease combined, based on the most recent data available. So, the results of this survey, finding that most people do not know the significant impact of heart disease, is discouraging and even a bit frightening."

In the survey, only 49% of people named heart disease as the leading cause of death; 16% said they didn't know the leading cause and 18% listed cancer as the top cause of death of people in the U.S.

Wu cautioned that this lack of knowledge and awareness is potentially deadly, as this year's statistical update reports that nearly half of all people in the U.S. (48.6%) have some type of cardiovascular disease (CVD), including coronary heart disease, heart failure, stroke and, most notably, high blood pressure.

According to the 2024 statistical update, 46.7% of U.S. adults have high blood pressure. Yet, 38% those with high blood pressure are unaware that they have it. In the past 10 years, the age-adjusted death rate from high blood pressure increased 65.6% and the actual number of deaths rose 91.2%.

"High blood pressure is a leading risk factor for heart disease and stroke, and yet with proper treatment and management it can be controlled and your risk for cardiovascular disease can be greatly reduced. The first step toward reducing any risk factor for cardiovascular disease is awareness." Wu said. "When the American Heart Association was founded 100 years ago, heart disease was considered a death sentence. Little was known about what caused it and even less about how to care for people living with and dying from it. The knowledge we continue to gain through research and data such as that reported in this statistical update is helping make significant inroads. Although too many people still die each year, many are living longer, more productive lives while managing their cardiovascular disease and risk factors.”

Wu noted there are several highlights in the fight against cardiovascular disease published in a special foreword of this year's statistical update:

• Since 1950, death rates from CVD have declined 60%; the rates have fluctuated over the years and have recently trended upward. Wu notes this trend aligns with increases in the prevalence of risk factors that cause heart disease and stroke, such as high blood pressure and obesity.
   
• The number of people in the United States dying of a heart attack each year has dropped from 1 in 2 in the 1950s to now 1 in 8.5. Wu notes this is likely due in part to improved diagnosis and treatment options.
   
• Stroke was first ranked as the third leading cause of death in 1938; however, stroke mortality has been on the decline since the early 20th century and now ranks as the fifth leading cause of death in the United States. Aggressive evidence-based public health programs and clinical interventions have played a key role in reducing the number of stroke deaths, Wu said.
   
• Cigarette smoking has fallen dramatically from >40% of U.S. adults smoking in the mid-1960s to about 11% today. According to Wu, the American Heart Association has led the charge in this decline, supporting increased public awareness about the dangers of nicotine and tobacco use and policy initiatives that have placed legal restrictions on smoking in public spaces and placed higher taxes on cigarette products.

"Identifying trends like this is a key reason why we compile the American Heart Association's statistical update, which has been released annually since 1927. Although the research and statistics included in each year's report illustrate the most recent data available, the historical data pulled from the collective work over the years is especially invaluable," said volunteer chair of the statistical update writing committee Seth S. Martin, M.D., M.H.S., FAHA, a professor of medicine and cardiologist at John's Hopkins School of Medicine in Baltimore, Maryland. "As it has evolved over the years, the report has become a preeminent resource in identifying the overall impact of cardiovascular disease, including who is most affected, where it is most prevalent and what factors may increase the risk of it. This type of information is crucial to the development of awareness initiatives and policy strategies and provides a road map for cardiovascular research priorities."

Martin noted that last year's statistical update identified a concerning increase in cardiovascular related deaths -- the largest single-year increase since 2015 -- which may have been a reflection of the first year of the COVID-19 pandemic. The data trends on cardiovascular deaths reported in this year's update also show an increase, however it appears lower in magnitude:

• The overall number of cardiovascular related deaths was 931,578, an increase of less than 3,000 from the 928,741 deaths reported last year. Last year, the number of deaths increased more than 54,000 over the previous year.
   
• Cardiovascular deaths include deaths from coronary heart disease (40.3%), stroke (17.5%), other minor CVD causes combined (17.1%), high blood pressure (13.4%), heart failure (9.1%) and diseases of the arteries (2.6%).
   
• The age-adjusted death rate from cardiovascular disease increased to 233.3 per 100,000, up 4.0% from 224.4 per 100,000 reported last year, whereas the rate had increased 4.6% in the previous year. Last year's increase was the first increase in age-adjusted death rates seen in many years.

"While the long-term impact of the pandemic is yet to be seen, we're cautiously optimistic that the trends from this year's update indicate a slowdown in the striking effects we initially saw," Martin said. "There is still much work to be done in the overall fight against cardiovascular disease. Recognizing that most people do not realize heart disease is the leading cause of death in the U.S., it's imperative that we share the data from our statistics update even more broadly to increase this awareness."

Here are some other key facts from the 2024 report:

• There are 2,552 deaths from total cardiovascular disease (CVD) each day, based on 2021 data.
   
• On average, someone dies of CVD every 34 seconds in the U.S.
   
• There are about 1,905 deaths from heart disease, each day in the U.S., including heart attacks.
   
• Approximately every 40 seconds, someone in the U.S. will have a heart attack.
   
• Each year in the U.S., there are about 605,000 new heart attacks and 200,000 recurrent attacks. Of these, it is estimated that 170,000 are silent, without significant symptoms.
   
• The average age at first heart attack is 65.6 years for males and 72.0 years for females.
   
• There are about 446 deaths from stroke each day, based on 2021 data.
   
• On average, someone dies of a stroke every 3 minutes and 14 seconds in the U.S.
   
• Each year, 795,000 people experience a new or recurrent stroke.
   
• Approximately 610,000 of these are first attacks and 185,000 are recurrent attacks.
   
• On average, someone dies of a stroke every 3 minutes 14 seconds.
   
• Stroke accounts for about 1 of every 21 deaths in the United States.
   
• In 2021, sudden cardiac arrest attributed to 20,114 deaths in the U.S.
   
• On average, there are about 55 deaths from sudden cardiac arrest in the U.S. each day.
   
• According to 2022 U.S. data, most adult Out of Hospital Cardiac Arrests (OHCA) occur at a home or a residence (72.1%).
   
• Public settings (17.3%) and nursing homes (10.6%) were the second and third most common locations of adult OHCA.
   
• According to 2022 U.S. data for adult OHCA only, survival to hospital discharge was 9.3% for all EMS-treated non-traumatic OHCA cardiac arrests. Bystander witnessed adult arrests had a 14.0% survival to hospital discharge and 9-1-1 responder witnessed arrests had a 17.0% survival to hospital discharge.

"This year, our annual statistical report has a new name, as we've added 'Global' to the title to reflect the continued addition of more data noting the impact of cardiovascular disease around the world," said volunteer vice-chair of the report writing committee Latha P. Palaniappan, M.D., M.S., FAHA, a professor of cardiovascular medicine at Stanford University in Palo Alto, California. "Cardiovascular disease is the leading cause of death not only in the U.S., but worldwide. The information gathered in our statistical update helps identify the global burden of CVD and guides the American Heart Association's lifesaving work around the world."

Here are a few key global statistics from the new report:

• In 2019, 27% of the world's deaths were caused by CVD, making it the predominant cause of death globally.
   
• CVD accounted for approximately 19.91 million global deaths in 2021.
   
• Worldwide, tobacco contributed to an estimated 7.43 million deaths in 2021.
   
• Worldwide, high body mass index was attributed to 3.69 million deaths in 2021, an increase of 46.7% compared with 2010.
   
• In 2021, an estimated 1.70 million deaths were attributed to diabetes globally.

"I cannot stress enough how important it is for people to fully recognize just how much cardiovascular diseases, including heart disease and stroke, impact each of us as individuals and communities. If you don't have heart disease yourself, chances are you know someone who does, perhaps a family member or other loved one," Wu said. "Arm yourself with knowledge that can help you reduce your risk of becoming a future statistic. In 2024, with Bold Hearts™ -- the American Heart Association's Centennial celebration -- the organization celebrates 100 years of progress as a global force transforming the way the world understands, treats and prevents cardiovascular and cerebrovascular diseases. This year, more than ever, our future is about improving yours."

This statistical update was prepared by a volunteer writing group on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee.

Reference

1. Seth S. Martin, Aaron W. Aday, Zaid I. Almarzooq, Cheryl A.M. Anderson, Pankaj Arora, Christy L. Avery, Carissa M. Baker-Smith, Bethany Barone Gibbs, Andrea Z. Beaton, Amelia K. Boehme, Yvonne Commodore-Mensah, Maria E. Currie, Mitchell S.V. Elkind, Kelly R. Evenson, Giuliano Generoso, Debra G. Heard, Swapnil Hiremath, Michelle C. Johansen, Rizwan Kalani, Dhruv S. Kazi, Darae Ko, Junxiu Liu, Jared W. Magnani, Erin D. Michos, Michael E. Mussolino, Sankar D. Navaneethan, Nisha I. Parikh, Sarah M. Perman, Remy Poudel, Mary Rezk-Hanna, Gregory A. Roth, Nilay S. Shah, Marie-Pierre St-Onge, Evan L. Thacker, Connie W. Tsao, Sarah M. Urbut, Harriette G.C. Van Spall, Jenifer H. Voeks, Nae-Yuh Wang, Nathan D. Wong, Sally S. Wong, Kristine Yaffe, Latha P. Palaniappan. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation, 2024; DOI: 10.1161/CIR.0000000000001209

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