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Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease logoLink to Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
. 2025 Jun 23;14(13):e038644. doi: 10.1161/JAHA.124.038644

Heart Disease Mortality in the United States, 1970 to 2022

Sara J King 1,*,✉, Tenzin Yeshi Wangdak Yuthok 1,*, Adrian M Bacong 2, Abha Khandelwal 2, Dhruv S Kazi 3,4, Michael E Mussolino 5, Sally S Wong 6, Seth S Martin 7, Eldrin F Lewis 2, Fatima Rodriguez 2, Latha P Palaniappan 2
PMCID: PMC12449979  PMID: 40557798

Abstract

Background

Studying trends in mortality is essential to advance understanding of population health. Further evaluation of long‐term heart disease mortality trends and subtypes in the United States is needed to guide public health and clinical interventions.

Methods

This study used the National Vital Statistics System Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research data for adults aged 25 years and older in the United States from 1970 to 2022. Outcomes included absolute number and age‐adjusted mortality of total heart disease, ischemic heart disease, and other heart disease subtypes.

Results

From 1970 to 2022, overall age‐adjusted heart disease mortality decreased by 66% from 1970 to 2022 (from 761 to 258 per 100 000). In 1970, 91% of all heart disease deaths were ischemic, declining to 53% of all heart disease deaths in 2022. From 1970 to 2022, age‐adjusted mortality decreased by 89% for acute myocardial infarction (from 354 to 40 per 100 000) and 81% for all ischemic heart disease (from 693 to 135 per 100 00). In contrast, from 1970 to 2022 age‐adjusted mortality for other heart disease subtypes increased by 81% (from 68 to 123 per 100 000), with the greatest increases in heart failure (146% increase), hypertensive heart disease (106% increase) and arrhythmias (450% increase).

Conclusions

Heart disease mortality has decreased over the past 5 decades. There is an increasing burden of mortality from other heart conditions including heart failure, hypertensive heart disease, and arrhythmias. Further efforts must be undertaken to address the growing challenge of these other heart conditions.

Keywords: heart disease, ischemic, mortality

Subject Categories: Cardiovascular Disease, Epidemiology, Myocardial Infarction, Heart Failure, Chronic Ischemic Heart Disease

Nonstandard Abbreviations and Acronyms

AAPC

average annual percentage change

Clinical Perspective.

What Is New?

  • In this study of mortality records from 1970 to 2022 in the United States, age‐adjusted mortality for acute myocardial infarction decreased by 89%, and ischemic heart disease decreased by 81%, whereas other heart disease age‐adjusted mortality, including heart failure and arrhythmias, increased by 81%.

What Are the Clinical Implications?

  • Heart disease mortality has evolved over the past 5 decades, reflecting the successes in ischemic heart disease management and the emerging challenges posed by other heart conditions such as heart failure and arrhythmias.

Studying trends in mortality is essential to advance our understanding of population health, to guide public health and clinical interventions, and to improve health outcomes for individuals. In the United States, heart disease has been the leading cause of death for over a century. 1 , 2 Concrete advancements in medical technology, targeted interventions aimed at managing risk factors such as hypertension, hyperlipidemia, and smoking cessation, and significant strides in the management of acute myocardial infarction (AMI) have been posited to have led to a striking decline in ischemic (coronary) heart disease mortality since the 1960s. 3 , 4 , 5 , 6 However, although there have been remarkable improvements in ischemic heart disease mortality, recent studies suggest an increase in mortality rates in the 21st century from other heart diseases such as hypertensive heart disease, heart failure, and arrhythmias. 7 , 8

To further evaluate long‐term trajectories in heart disease mortality, this study examines the mortality trends in ischemic heart disease and other heart disease subtypes, including heart failure, arrhythmias, and hypertensive heart disease, from 1970 to 2022 in the United States. This study contributes to the existing body of research by specifically analyzing AMI mortality as part of ischemic heart disease, identifying periods of significant progress and describing the chronology of public health and clinical advancements. Unlike prior studies, this analysis extends over a broader time span, offering a comprehensive view that not only reflects on historical achievements but may also enable a forward‐looking approach to guide future advancements. Through this analysis, we affirm the extensive efforts and therapeutic innovation that has led to a reduction in ischemic heart disease mortality, while examining and positing explanations for the concurrent rise in mortality from other heart disease subtypes.

METHODS

The data that support the findings of this study are available from the corresponding author upon reasonable request and are publicly available at https://wonder.cdc.gov/.

Data Sources

We accessed mortality data for all United States adults aged 25 years and older from 1970 through 2022 from the National Vital Statistics System through the Centers for Disease Control and Prevention Wide‐ranging Online Data for Epidemiologic Research (WONDER) database, which compiles information from all registered United States death certificates. We used International Classification of Diseases (ICD) codes to ascertain underlying cause of death related to heart disease across multiple revisions of the coding system (Eighth Revision [ICD‐8; 1970–1978], Ninth Revision [ICD‐9; 1979–1998], Tenth Revision [ICD‐10; 1999–2022]). 9 , 10 , 11 Data extraction focused on ischemic (coronary) heart disease (AMI defined as ICD‐10 I21, I22, and ICD‐8, ICD‐9 equivalents, and other ischemic heart disease defined as ICD‐10 I20, I24, I25, and ICD‐8, ICD‐9 equivalents) and other heart disease, which encompassed ICD‐10 subtypes such as heart failure (I50), cardiomyopathy (I42), hypertensive heart disease (I11, I13), valvular heart disease (nonrheumatic) (I34–I38), rheumatic heart disease (I00–I09), arrhythmia (I47–I49, excluding I49.0), cardiac arrest and ventricular arrhythmias (I46.2, I46.8, I46.9, I49.0), pulmonary heart disease (I26–I28) and other cardiac conditions (I30‐I33, I40, I44–I45, I51) with corresponding ICD‐8 and ICD‐9 equivalents (Table S1). 12 , 13 Given that >90% of other ischemic heart disease mortality was ICD‐10 I25 and its ICD‐8, ICD‐9 equivalents, it was renamed chronic ischemic heart disease for this analysis. Population size and life expectancy were extracted from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research population estimates reported within the underlying cause of death data and annual life tables, respectively. 9 , 10 , 11 , 14

Statistical Analysis

Deaths were reported as absolute number and age‐adjusted rates, with annual age‐adjusted mortality rates using the 2000 US Census as the standard population. The Joinpoint Regression Program (Joinpoint V 5.0 available from the National Cancer Institute) was used to calculate interval and overall percentage change over the time period. 7 , 15 , 16 Annual percentage change with 95% CIs were calculated among intervals identified by the joinpoint regression (Table S2). The weighted averages of the annual percentage changes were reported as average annual percentage changes (AAPCs) and 95% CIs as a summary of the reported mortality trend for all heart disease subtypes across the study period (Table S3). The research received an exemption from institutional review board review as it used publicly accessible, deidentified data.

RESULTS

From the years 1970 through 2022, the US population over the age of 25 years increased from 108.9 million to 229.0 million, and life expectancy increased from 70.9 years to 77.5 years. During this time period, the National Vital Statistics System recorded a cumulative total of 119 152 492 deaths, with 37 276 835 (31%) attributable to heart disease over 50 years. In 1970 there were 733 273 heart disease deaths (41% of total deaths), of which 666 257 (91%) were ischemic and 67 016 (9%) were from other heart disease (Figure 1A). In 2022 there were 701 443 heart disease deaths (24% of total deaths), of which 371 360 (53%) were ischemic and 330 083 (47%) were from other heart disease. Of ischemic heart disease deaths in 1970, 356 984 (54%) deaths were attributed to AMI and 309 273 (46%) were attributed to chronic ischemic heart disease (Figure 1A). Of ischemic heart disease deaths in 2022, 108 651 (29%) were attributed to AMI and 267 514 (71%) were attributed to chronic ischemic heart disease (Figure 1A).

Figure 1. Absolute and age‐adjusted mortality for ischemic and other heart disease in the United States, 1970 to 2022.

Figure 1

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Absolute (A) and age‐adjusted (B) mortality for ischemic heart disease (acute myocardial infarction in bright red, chronic ischemic heart disease in dark red) and other heart disease (blue) from 1970 to 2022 in the United States. * See Figure 2 for other heart disease subtypes.

The age‐adjusted mortality for AMI decreased 89%, from 354 per 100 000 in 1970 to 40 per 100 000 in 2022 (Figure 1B). AAPC for AMI was −4.2% (95% CI, −4.3 to −4.1) from 1970 to 2022. The age‐adjusted mortality for chronic ischemic heart disease decreased 71%, from 343 per 100 000 in 1970 to 98 per 100 000 in 2022 (Figure 1B). AAPC for chronic ischemic heart disease was −2.5% (95% CI, −2.6 to −2.4) from 1970 to 2022. Correspondingly, with the decrease in both AMI and chronic ischemic heart disease, the age‐adjusted mortality for ischemic heart disease decreased 81% from 693 per 100 000 in 1970 to 135 per 100 000 in 2022 (Figure 1B). AAPC for ischemic heart disease was −3.1% (95% CI, −3.2 to −3.1) from 1970 to 2022. The age‐adjusted mortality for all heart disease (ischemic and other) deaths decreased 66% from 761 per 100 000 in 1970 to 258 per 100 000 in 2022. AAPC for overall heart disease was −2.0% (95% CI, −2.1 to −2.0) from 1970 to 2022.

In contrast, the age‐adjusted mortality for other heart disease subtypes increased 81%, from 68 per 100 000 in 1970 to 123 per 100 000 in 2022. AAPC for other heart disease subtypes was 1.2% (95% CI, 1.1–1.2) from 1970 to 2022. Among other heart disease subtypes, heart failure, hypertensive heart disease, and arrhythmia had the greatest increases in mortality, with age‐adjusted mortality rising from 13 to 32 per 100 000 (146% increase), 16 to 33 per 100 000 (106% increase), and 2 to 11 per 100 000 (450% increase), respectively from 1970 to 2022 (Figure 2). There were also increases in mortality from pulmonary heart disease, nonrheumatic valvular heart disease, cardiomyopathy, and cardiac arrest from 1970 to 2022. In contrast, rheumatic heart disease age‐adjusted mortality decreased from 13 per 100 000 in 1970 to 2 per 100 000 in 2022 (85% decrease).

Figure 2. Absolute and age‐adjusted mortality for other heart disease subtypes in the United States, 1970 to 2022.

Figure 2

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Absolute (A) and age‐adjusted (B) mortality for other heart disease subtypes from 1970 to 2022 in the United States.

DISCUSSION

Reflecting on the past 50 years, there has been a profound transformation in heart disease mortality. Over this period, we observed a remarkable 89% decline in age‐adjusted mortality from AMI and an 81% decline in age‐adjusted mortality from all ischemic heart disease. In contrast, we found that there has been an 81% increase in age‐adjusted mortality from other heart disease subtypes, most significantly heart failure, hypertensive heart disease, and arrhythmia, which have increased to represent 12%, 13%, and 4%, respectively, of the total heart disease mortality in 2022. Our results expand previous studies that found significant rise of these conditions since the turn of the century, with similar proportions of 13%, 9%, and 6% in 2018. 7 , 8 Correspondingly, we found that from 1970 to 2022, the distribution of deaths within heart disease has shifted; in 1970 ischemic heart disease comprised 91% of all heart disease deaths, but only 53% in 2022, whereas other heart disease subtypes have increased from 9% of all heart disease deaths in 1970 to 47% in 2022.

We also observed a shift in mortality patterns characterized by a transition from AMI to chronic ischemic heart disease. We found that within ischemic heart disease, deaths from AMI significantly declined from 54% in 1970 to 29% in 2022, with a corresponding rise in the percentage of mortality from chronic ischemic heart disease from 46% in 1970 to 71% in 2022.

These changes in heart disease mortality over the past 5 decades likely reflect the successes in medical and public health interventions for ischemic heart disease, and in particular, AMI. However, our analysis reveals the emerging challenges posed by chronic ischemic heart disease and other heart conditions such as heart failure, hypertensive heart disease, and arrhythmias.

Several underlying factors may account for this shift from mortality from ischemic heart disease to other heart conditions. The first is the establishment of effective interventions that significantly reduced mortality from AMI. Beginning in the 1960s, the establishment and promotion of bystander cardiopulmonary resuscitation and later mobile external defibrillators affected preadmission survival, while the invention of coronary artery bypass grafting and the formation of coronary care units improved in‐hospital and long‐term AMI mortality. 17 , 18 , 19 , 20 Cardiac imaging improved into the 1970s with coronary angiography, which was capitalized by the advent of balloon angioplasty in 1977, followed by thrombolytic therapy, the use of aspirin, and coronary stenting in the 1980s to 1990s. 21 , 22 , 23 , 24 , 25 , 26 , 27 Simultaneously, the development of medical therapies such as beta blockers, renal‐angiotensin‐aldosterone system inhibitors, and statins in the 1980s to 1990s all contributed to the decline in AMI mortality from a treatment and secondary prevention perspective. 28 , 29 , 30 At the turn of the 21st century, high‐intensity statin therapy and dual antiplatelet therapy were established, as well as landmark “door‐to‐balloon” trials that displayed substantial mortality benefits from expedited care. 31 , 32 , 33 , 34 , 35 Finally, from 2009 to 2022, high‐sensitivity troponins improved the rapid diagnosis of AMI and advanced antiplatelet agents further improved mortality after revascularization, while lipid‐lowering therapies such as ezetimibe and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors emerged to contribute to secondary prevention. 36 , 37 , 38 , 39

More broadly, the identification and management of clinical risk factors also likely contributed to the reduction in AMI mortality and ischemic heart disease as a whole. These efforts target primary prevention, as well as secondary and tertiary prevention to reduce harmful comorbidities that drive progression of disease among patients with ischemic heart disease. 4 , 5 , 6 One of the first major strides in public health was against cigarette smoking, which was estimated to contribute to as much as 21% of ischemic heart disease mortality. 40 Smoke‐free policies, increased taxation on tobacco products, and public awareness campaigns beginning with the pivotal 1964 surgeon general's report all played roles in the reduction of smoking from approximately 40% in 1970 to 14% in 2019. 41 , 42 , 43 In addition, during this time period from 1977 to 2022, physical activity was encouraged to reduce cardiovascular mortality, cholesterol and blood pressure goals were set and lowered, and clinical guidelines to treat these conditions were expanded. 44 For blood pressure, the Joint National Committee issued 8 sets of hypertension guidelines from 1977 to 2014, with sequential lowering of blood pressure goals to reduce the burden of heart disease and its sequelae. 45 , 46 , 47 , 48 Similarly, from 1988 to 2013, cholesterol goals were lowered according to the National Cholesterol Education Program's guidelines, driving the proportion of adults taking cholesterol‐lowering medications from 3% in 1988 to approximately 45% in 2013, and subsequently decreasing the mean total cholesterol and low‐density lipoprotein levels in the United States. 49 , 50 , 51 , 52

However, despite the progress in therapies and guidelines, there has been rising prevalence of several heart disease risk factors such as obesity, diabetes, hypertension, and physical inactivity in the United States. From the 1970s to 2022, obesity prevalence has risen from 15% to 40%. 53 Diabetes, including prediabetes, has risen to affect an estimated 50% of United States adults in 2020. 54 , 55 Hypertension has increased from a prevalence of approximately 30% in 1978 to nearly 50% in 2022, and although partially attributable to lowered blood pressure goals, continues to see an absolute increase in the 21st century. 48 , 56 , 57 All of these risk factors contribute to an ongoing burden of ischemic heart disease but may also be accelerating pathophysiological processes leading to increased prevalence and subsequent mortality from other heart diseases such as heart failure, hypertensive heart disease, and arrhythmias. 58 , 59 , 60 , 61

Demographic shifts in the United States have additionally contributed significant changes to the landscape of heart disease mortality. Over the decades spanning from 1970 to 2022, there has been a notable increase in life expectancy, from 70.9 years to 77.5 years in the United States. 14 This demographic change, and the successful management of AMI, have led to an increased survivorship burdened with chronic ischemic heart conditions. Consequently, the aging demographic contributes to the rising proportion of chronic ischemic heart disease prevalence and subsequent mortality, even amid the backdrop of overall declining heart disease mortality. 62 , 63 Similarly, the demographic shift toward an aging population allows for longer accumulation and thus mortality from other heart disease conditions such as heart failure, hypertensive heart disease, and arrhythmias, particularly atrial fibrillation. 7 , 8 , 64 , 65 , 66 Notably, although studies cite an increase in heart disease mortality, particularly AMI in the setting of the COVID‐19 pandemic, our study found no reversal of long‐term mortality trends, rather an acute increase in 2020 followed by decline. 67

Finally, improvements in diagnostic capabilities and refinement of definitions over the years have led to improved identification of heart conditions such as heart failure with preserved ejection fraction and pulmonary hypertension, potentially allowing these conditions to more frequently be defined as ultimate underlying causes of mortality. 68 , 69 Regardless of identification, several studies show independent increases in mortality from these conditions in the 21st century, with significant increases in mortality due to heart failure, pulmonary hypertension, and arrhythmia, particularly atrial fibrillation. 70 , 71 , 72

Limitations

Our study has several limitations. The use of multiple iterations of the ICD coding system can allow for potential miscoding and presents challenges in maintaining consistency in comparisons across the years. Particularly prominent is the change from ICD‐8 to ICD‐9 in 1979, when the mortality of several conditions (valvular heart disease, hypertensive heart disease, pulmonary heart disease) dramatically increased. This is thought to be a result of regroupings (“other diseases of the endocardium” into “valvular heart disease,” heart diseases with hypertension into “hypertensive heart disease,” “diseases of pulmonary circulation” defined). 73 Similarly, the decline in 1989, driven by an apparent decline in cardiac arrest, is hypothesized to be due to a major change in death certificates to encourage the inclusion of chronic conditions as the underlying cause of death and requiring the attending physician of record, who had more knowledge of the patient's chronic conditions, to certify the death certificate. 74 However, there is also potential for misclassification, as it has been shown that nonheart disease diagnoses are often assigned coronary heart disease on death certificates in cases with unknown cause. 75 A second limitation of our study is that certain conditions including heart failure, cardiomyopathy, arrhythmias, and in particular ventricular arrhythmias and cardiac arrest, may be overly simplistic, as many of these cases likely have underlying ischemic causes that cannot be precisely differentiated using current or past ICD codes. This limitation suggests that the true burden of ischemic heart disease may be underestimated in our findings. We also used “underlying cause of death” from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research rather than “multiple cause of death,” perhaps underestimating contributions to aggregate mortality from each heart disease subtype.

We recognize that we did not perform a causal analysis, and the observed mortality shifts are not solely or directly linked to the interventions described herein. Instead, this narrative summarizes medical advances and public health progress that have been previously associated with improved cardiovascular mortality in the literature. We also acknowledge there is likely substantial heterogeneity in these reductions in heart disease mortality by age, sex, race, ethnicity, region, and urbanization, which we did not analyze in the present article and should be prioritized in future studies to confirm these overall trends in subpopulations. Finally, given data availability only until 2022, we were unable to assess the full impact of the COVID‐19 pandemic on heart disease mortality trends.

CONCLUSIONS

In summary, the past half‐century has witnessed a dramatic decrease in ischemic heart disease mortality, likely reflecting advancements in prevention and treatment strategies, particularly surrounding AMI. However, although the decline in ischemic heart disease mortality represents a pivotal achievement, the concomitant rise in heart disease mortality from conditions such as heart failure, hypertensive heart disease, and arrhythmias must be addressed. An aging population, improved diagnostic capabilities, and increased ischemic survivorship now burdened with chronic heart conditions may contribute to this rise in mortality, however, further research is needed to elucidate the specific underlying factors. In the future, research and patient care should focus on addressing the growing challenge of these heart conditions, while continuing to maintain and expand our progress in ischemic heart disease.

Sources of Funding

Dr Latha Palaniappan is funded by grant from the National Institutes of Health National Heart, Lung, and Blood Institute (K24 HL150476). Dr Fatima Rodriguez is funded by grants from the National Institutes of Health National Heart, Lung, and Blood Institute (1K01HL144607; R01HL168188), the American Heart Association/Harold Amos Medical Faculty Development program, and the Doris Duke Foundation (2022051). Adrian M. Bacong, PhD reported funding through the American Heart Association (23ARCRM1077167) and the Training Program in the Division of Endocrinology, Gerontology and Metabolism (T32 DK007217‐47).

Disclosures

Dr Seth Martin is on the Advisory Board for Care Access and reports personal consulting fees from Amgen, AstraZeneca, BMS, Chroma, Kaneka, New Amsterdam, Novartis, Novo Nordisk, Premier, Sanofi, and 89bio. Dr Eldrin Lewis reports consulting fees and research grants from Merck, and consulting fees from Astra Zeneca, Intellia, and Dal‐Cor. Dr Fatima Rodriguez reports equity from Carta Healthcare and HealthPals, and consulting fees from HealthPals, Novartis, NovoNordisk, Esperion Therapeutics, Movano Health, Kento Health, Inclusive Health, Edwards, Arrowhead Pharmaceuticals, and HeartFlow outside the submitted work. No other disclosures were noted.

Disclaimer

The views expressed in this articleare those of the authors and do not necessarily represent the views of the American Heart Association; National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.

Supporting information

Tables S1–S3

JAH3-14-e038644-s001.pdf (339KB, pdf)

Acknowledgments

We acknowledge the work of Boglarka Huddleston in assisting with literature search of previous work and landmark accomplishments in the field of heart disease. We also acknowledge Adrienne Mueller for her review of the article.

This article was sent to Manju Jayanna, MD, MS, Assistant Editor, for review by expert referees, editorial decision, and final disposition.

For Sources of Funding and Disclosures, see page 6.

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Supplementary Materials

Tables S1–S3

JAH3-14-e038644-s001.pdf (339KB, pdf)

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