Heart disease kills differently now than five decades ago

Heart disease remains the leading cause of death in the United States, but the specific types causing death have shifted.

From 1970 to 2022, deaths from heart attacks dropped by 89 percent – a major shift. In the same time period, deaths from other heart problems like heart failure, arrhythmias, and high blood pressure-related conditions rose by 81 percent.

Dr. Sara King is a second-year resident in the Department of Medicine at the Stanford School of Medicine in California.

“This distribution shift in the types of heart disease people were dying from the most was very interesting to us,” said Dr. King. “This evolution over the past 50 years reflects incredible successes in the way heart attacks and other types of ischemic heart disease are managed.”

Treatment reduced heart attack deaths

In 1970, most people who died from heart disease had a heart attack. By 2022, only 29% of ischemic heart disease deaths were from heart attacks, while the rest were from chronic ischemic disease.

Emergency response and hospital care has improved in the United States. CPR, defibrillators, and coronary care units have helped. Imaging tools like angiography arrived in the 1970s, and angioplasty followed in 1977. Stents and thrombolytics came in the 1980s and 1990s.

Medications like statins, beta blockers, and blood thinners have become common. After 2009, doctors got access to PCSK9 inhibitors and better tests to detect heart attacks.

Habits and policies supported heart health

Smoking rates dropped. In 1970, 40% of adults smoked. In 2019, that fell to 14 percent. People moved more. Cholesterol and blood pressure guidelines improved, and more patients took medication.

Dr. Keith Churchwell, the 2024-2025 American Heart Association volunteer president, is an associate clinical professor at the Yale School of Medicine and an adjunct associate professor at the Vanderbilt School of Medicine.

“Through the nearly $6 billion dollars the Association has invested in scientific research since 1948, we have enhanced the knowledge of how we diagnose and treat heart disease in almost all forms,” noted Dr. Churchwell.

Risk factors are rising again

Obesity rose from 15% to 40% between 1970 and 2022. Diabetes, including prediabetes, now affects half of all adults. Almost 50% of adults live with hypertension.

People also live longer. In 1970, life expectancy was 70.9 years. In 2022, it reached 77.5. Older adults face higher risks for heart failure, atrial fibrillation, and other lasting heart problems.

The total heart disease death rate dropped by 66 percent, but the type of heart disease causing death shifted. Ischemic deaths fell, while deaths from other heart conditions rose. Today, chronic problems cause more cases.

“We’ve won major battles against heart attacks, however, the war against heart disease isn’t over,” said Dr. King.

Healthy habits prevent heart disease

“Now that people are surviving heart attacks, we are seeing a rise in other forms of heart disease like heart failure,” noted Dr. Latha Palaniappan, associate dean for research at Stanford University School of Medicine.

“The focus now must be on helping people age with strong, healthy hearts by preventing events, and prevention can start as early as childhood.”

The American Heart Association highlights eight important goals to protect heart and brain health. A healthy diet comes first. Choosing fruits, vegetables, whole grains, and lean proteins can lower bad cholesterol and support heart function.

It’s not just about food, though. Regular physical activity keeps the heart strong, improves circulation, and helps manage body weight. This could mean a structured workout or simply walking more each day.

Further steps to protect heart health

Smoking damages blood vessels, raises blood pressure, and increases the risk of both stroke and heart attack. Once someone stops smoking, the body starts to heal. The risk of cardiovascular complications begins to drop.

Sleep matters, too. People who get enough quality rest give their hearts time to recover and maintain a steady rhythm.

Managing key health markers is just as critical. Keeping a healthy weight takes pressure off the heart and reduces the risk of chronic disease. Controlling cholesterol keeps arteries clear and lowers the chance of a blockage.

Blood sugar control helps avoid complications tied to diabetes, which often worsens heart problems. And stable blood pressure can prevent stroke, heart failure, and kidney damage.

When combined, these eight steps offer more than protection. They lay the groundwork for a healthier, longer life with fewer heart-related problems.

The study is published in the Journal of the American Heart Association.

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