In the Journals

Heart disease deaths declining, but not as fast as before

Sadiya S. Khan
Nilay S. Shah

Researchers have determined that the decline of age-adjusted mortality due to heart disease is slowing, which may mean that the American Heart Association’s strategic goal of a 20% reduction by 2020 is becoming more unlikely.

According to a study published in JAMA, while age-adjusted mortality rates (AAMR) due to heart disease, stroke and diabetes have been on the decline, as seen in AAMR data from 1999 to 2017, mortality associated with hypertension has increased in most sex and race groups, with the exception of black women, for whom it remained unchanged.

In 1999, the total number of deaths  by heart disease was 725,192 (AAMR per 100,000 = 266.5), while there were 167,366 deaths from stroke (AAMR per 100,000 people = 61.6), 68,399 deaths from diabetes (AAMR per 100,000 people = 25) from diabetes and 16,968 deaths from hypertension (AAMR per 100,000 people = 6.2). By 2017, according to the researchers, these statistics had declined, for the most part; 647,457 (AAMR per 100,000 people = 165) individuals died from heart disease, 146,383 (AAMR per 100,000 people = 37.6) from stroke, 83,564 (AAMR per 100,000 people = 21.5) from diabetes and 35,316 (AAMR per 100,000 people = 9) from hypertension.

Prevention focus needed

“The fact that we are seeing a slowing of the decline in cardiometabolic mortality rates despite the medical advancements of the last 2 decades suggests that worsening trends in obesity and diabetes may be the culprit,” Sadiya S. Khan, MD, MSc, assistant professor of cardiology and epidemiology at the Feinberg School of Medicine at Northwestern Medicine, told Healio. “It is important to note that we also demonstrated key differences in death rates due to race/sex, with highest mortality rates in black Americans. Important factors that drive all of these disparities include differences in health insurance and access to care, which requires federal- and state-level changes including expansion of the affordable care act to impact upon CV health equitably. Innovative strategies such as mobile technology may also help improve use of evidence-based preventive medications.”

Racial disparities

Black individuals had consistently higher AAMRs compared with while individuals during the study period and accounted for 12.3% of all fatal cardiometabolic events, Shah and colleagues wrote, noting that by 2017 black women had higher rates of mortality due to diabetes compared with white women (AAMR ratio = 2.09) and black men had higher rates of mortality due to hypertension compared with white men (AAMR ratio = 2.18).

In other findings, researchers found an inflection point in 2010 that indicated a slowing in the decline of heart disease-related deaths. Leading up to 2010, the rate of AAMR decline for heart disease had been progressing faster (β = −8.3; 95% CI, −8.8 to −7.8), however between 2010 and 2017, researchers noticed a slowing of the rate of decline in deaths per year (β = −1.8; 95% CI, −2.5 to −1).

Researchers analyzed data from the CDC’s Wide-Ranging Online Data for Epidemiologic Research from 1999 to 2017. They assessed trends in mortality rates wherein the underlaying cause of death was reported as heart disease, stroke, diabetes or essential hypertension and hypertensive renal disease. The AAMRs were evaluated based on sex as well as black or white race.

Future research

“One of the limitations of this study was that it was challenging to look at cardiometabolic mortality rate in a more diverse group of Americans,” Nilay S. Shah, MD, MPH, cardiology fellow in the department of preventive medicine at Northwestern University Feinberg School of Medicine, told Healio. “Current death certificate data do not reliably or consistently identify other race/ethnic groups, like Asian Americans, Hispanic Americans, or Native Americans. We would like to be able to look at cardiometabolic mortality rates in these groups and aim to do so as data in these groups becomes available.”

“For policy makers, we need to public health prevention strategies to support Americans in eating a healthy diet, having safe places to exercise in the neighborhood, access to health care and medications,” Khan said. – by Scott Buzby

Disclosures: Khan and Shah report no relevant financial disclosures.

Sadiya S. Khan
Nilay S. Shah

Researchers have determined that the decline of age-adjusted mortality due to heart disease is slowing, which may mean that the American Heart Association’s strategic goal of a 20% reduction by 2020 is becoming more unlikely.

According to a study published in JAMA, while age-adjusted mortality rates (AAMR) due to heart disease, stroke and diabetes have been on the decline, as seen in AAMR data from 1999 to 2017, mortality associated with hypertension has increased in most sex and race groups, with the exception of black women, for whom it remained unchanged.

In 1999, the total number of deaths  by heart disease was 725,192 (AAMR per 100,000 = 266.5), while there were 167,366 deaths from stroke (AAMR per 100,000 people = 61.6), 68,399 deaths from diabetes (AAMR per 100,000 people = 25) from diabetes and 16,968 deaths from hypertension (AAMR per 100,000 people = 6.2). By 2017, according to the researchers, these statistics had declined, for the most part; 647,457 (AAMR per 100,000 people = 165) individuals died from heart disease, 146,383 (AAMR per 100,000 people = 37.6) from stroke, 83,564 (AAMR per 100,000 people = 21.5) from diabetes and 35,316 (AAMR per 100,000 people = 9) from hypertension.

Prevention focus needed

“The fact that we are seeing a slowing of the decline in cardiometabolic mortality rates despite the medical advancements of the last 2 decades suggests that worsening trends in obesity and diabetes may be the culprit,” Sadiya S. Khan, MD, MSc, assistant professor of cardiology and epidemiology at the Feinberg School of Medicine at Northwestern Medicine, told Healio. “It is important to note that we also demonstrated key differences in death rates due to race/sex, with highest mortality rates in black Americans. Important factors that drive all of these disparities include differences in health insurance and access to care, which requires federal- and state-level changes including expansion of the affordable care act to impact upon CV health equitably. Innovative strategies such as mobile technology may also help improve use of evidence-based preventive medications.”

Racial disparities

Black individuals had consistently higher AAMRs compared with while individuals during the study period and accounted for 12.3% of all fatal cardiometabolic events, Shah and colleagues wrote, noting that by 2017 black women had higher rates of mortality due to diabetes compared with white women (AAMR ratio = 2.09) and black men had higher rates of mortality due to hypertension compared with white men (AAMR ratio = 2.18).

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In other findings, researchers found an inflection point in 2010 that indicated a slowing in the decline of heart disease-related deaths. Leading up to 2010, the rate of AAMR decline for heart disease had been progressing faster (β = −8.3; 95% CI, −8.8 to −7.8), however between 2010 and 2017, researchers noticed a slowing of the rate of decline in deaths per year (β = −1.8; 95% CI, −2.5 to −1).

Researchers analyzed data from the CDC’s Wide-Ranging Online Data for Epidemiologic Research from 1999 to 2017. They assessed trends in mortality rates wherein the underlaying cause of death was reported as heart disease, stroke, diabetes or essential hypertension and hypertensive renal disease. The AAMRs were evaluated based on sex as well as black or white race.

Future research

“One of the limitations of this study was that it was challenging to look at cardiometabolic mortality rate in a more diverse group of Americans,” Nilay S. Shah, MD, MPH, cardiology fellow in the department of preventive medicine at Northwestern University Feinberg School of Medicine, told Healio. “Current death certificate data do not reliably or consistently identify other race/ethnic groups, like Asian Americans, Hispanic Americans, or Native Americans. We would like to be able to look at cardiometabolic mortality rates in these groups and aim to do so as data in these groups becomes available.”

“For policy makers, we need to public health prevention strategies to support Americans in eating a healthy diet, having safe places to exercise in the neighborhood, access to health care and medications,” Khan said. – by Scott Buzby

Disclosures: Khan and Shah report no relevant financial disclosures.