Total CVD deaths during early period of pandemic highest since 2003
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Heart disease remained among the leading causes of death, even amid the COVID-19 pandemic, which may have exacerbated preexisting CVD morbidity-related racial/ethnic disparities, researchers reported.
In 2020, more than 3.3 million deaths were registered in the U.S., which exceeded the 2019 figure by more than 500,000 deaths, according to the American Heart Association’s annual Heart Disease and Stroke Statistics update.
Data were derived from Tsao CW, et al. Circulation. 2023;doi:10.1161/CIR.0000000000001123.
CVD-related deaths in the U.S. increased from 874,613 in 2019 to 928,741 in 2020, the highest single-year occurrence of CVD deaths since 2003, according to the AHA report.
“While the total number of CVD-related deaths increased from 2019 to 2020, what may be even more telling is that our age-adjusted mortality rate increased for the first time in many years and by a fairly substantial 4.6%,” Connie W. Tsao, MD, MPH, FAHA, assistant professor of medicine at Harvard Medical School, attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston and volunteer chair of the statistical update writing group, said in a press release.
As Healio previously reported, the 2022 statistical update focused on an observed rise in brain disease-related deaths, which shares many of the same risk factors as heart disease.
The 2023 statistical update details decades of population research in CV events and mortality, featuring updated data regarding health behaviors, health factors and other risk factors, CVDs and outcomes in the U.S.
The most recent update highlights the continued impact of the COVID-19 pandemic on public health and provides details on its effects on CVD and CVD-related mortality.
For full details, please see the full statistical update published in Circulation.
CVD-related death amid the pandemic
As of July 1, 2022, the cumulative number of COVID-19-related deaths in the U.S. was more than 1 million, translating to approximately 306 deaths per 100,000 Americans. As a result, the committee reported that life expectancy in the U.S. decreased from 78.8 years in 2019 to 77 years in 2020.
In 2020, 207.1 per 100,000 people died of CVD and stroke, causes that continued to rank ahead of annual deaths from cancer and chronic lower respiratory disease combined.
Researchers estimated that 19.05 million CVD deaths occurred globally in 2020, an 18.71% increase from 2010.
Overall, the crude prevalence of CVD was 607.64 million cases in 2020, a 29.01% increase from 2010; however, the age-standardized rate increased just 0.73% from 2010, according to the statistical update.
CVD-related deaths in the U.S. increased from 874,613 deaths in 2019 to 928,741 in 2020. This increase represents the largest single-year increase since 2015 and is the highest single-year occurrence of CVD deaths since 2003 (910,000 CVD-related deaths), according to the statistical update.
In 2020, CHD was the leading cause of CVD death in the U.S., representing 41.2% of all CVD deaths, followed by stroke (17.3%), other minor CVD causes (16.8%), hypertension (12.9%), HF (9.2%) and diseases of the arteries (2.6%), according to the document.
“COVID-19 has both direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clotting and inflammation,” Michelle A. Albert, MD, MPH, FAHA, the Walter A. Haas-Lucie Stern Endowed Chair in cardiology, professor of medicine at the University of California, San Francisco, and AHA volunteer president, said in the release. “We also know that many people who had new or existing heart disease and stroke symptoms were reluctant to seek medical care, particularly in the early days of the pandemic. This resulted in people presenting with more advanced stages of cardiovascular conditions and needing more acute or urgent treatment for what may have been manageable chronic conditions. And, sadly, appears to have cost many their lives.”
Racial/ethnic disparities in CVD and COVID-19 mortality
The committee reported a decrease in the rate of decline of CVD-related deaths in recent years, which varied by race/ethnicity.
In 1999, the death rate from CVD among Black adults was 337.4 per 100,000 people compared with 156.5 per 100,000 people for Asian or Pacific Islander adults.
In 2020, the rate of CVD-related death in the U.S. was 258.6 per 100,000 men and 125 per 100,000 women.
In 2020, the rate of CVD-related death among Black adults continued to be more than twofold of that of Asian or Pacific Islander adults, with 228.6 per 100,000 Black individuals compared with 90.1 per 100,000 Asian or Pacific Islander individuals.
“We know that to address discrimination and disparities that impact health, we must better recognize and understand the unique experiences of individuals and populations. This year’s writing group made a concerted effort to gather information on specific social factors related to health risk and outcomes, including sexual orientation, gender identity, urbanization and socioeconomic position,” Tsao said in the release. “However, the data are lacking because these communities are grossly underrepresented in clinical and epidemiological research. We are hopeful that this gap in literature will be filled in coming years as it will be critical to the American Heart Association’s goal to achieve cardiovascular health equity for all in the U.S. and globally.”
Reference:
- COVID toll realized: CVD deaths take big jump, especially among certain populations. https://newsroom.heart.org/news/covid-toll-realized-cvd-deaths-take-big-jump-especially-among-certain-populations. Published Jan. 25, 2023. Accessed on Jan. 25, 2023.
Perspective
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Attention to healthy diet, lifestyle and treatment of CV risk factors is critical. Maximizing “ideal CV health” by preventing or treating cardiac risk factors is associated with dramatic reductions in death from any cause as well as death from heart disease and stroke. Disparities in CV prevention and death based on race, ethnicity and socioeconomic background continue to present a major impediment to health in our country. Smoking and high BP remain the No. 1 and No. 2 preventable risk factors leading to premature death (“years of life lost”) in the U.S. This is the case despite consistent declines in the rate of tobacco smoking in the U.S. over decades. Smoking and high BP are both easily identifiable risk factors with rich clinical evidence and clinical guidelines directing doctors, advanced practice providers and patients on how to treat them to improve health. We have no excuse for these remaining contributors to death and disability from heart disease and cancer.
COVID-19 caused a dramatic increase in mortality and a dramatic decrease in life expectancy in the U.S. Much of this mortality is due to general critical illness and respiratory failure, though it also significantly impacted out-of-hospital cardiac arrest. Undoubtedly, many patients with severe CVD died prematurely due to COVID-19 pneumonia. And many likely also died from mild cases of COVID-19 triggering acute cardiac events. The high mortality from COVID-19 compared with other respiratory viruses was driven by lack of population immunity in the early stages of the pandemic and vaccine hesitancy/refusal in the later stages. Although population immunity is now much better, due to cumulative efforts at vaccination and immunity through infection by those who have been infected by SARS-CoV-2 and survived, there is considerable risk for future widespread CV death and disability from pandemics involving new pathogens. Old pathogens could also pose risk if vaccine disinformation and hesitancy continue.
It is a little-known fact that CVDs are the most common cause of maternal or pregnancy-associated death in high-income countries. The U.S. already stands out, in a negative light, for our starkly higher rates of maternal mortality. This is driven, in large part, by disparities in health and health care. If lack of access to abortion for patients with higher-risk CVD continues or worsens in the U.S., this will likely lead to even higher rates of maternal mortality.
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