The number of people dying from cardiovascular disease (CVD) in the U.S. escalating and it is impacting Asian, Black, and Hispanic populations the most.
Cardiovascular disease, overall, includes coronary heart disease, stroke, heart failure, and hypertension/high blood pressure. Coronary heart disease includes clogged arteries or atherosclerosis of the heart, which can cause a heart attack.
During the first year of the COVID-19 pandemic, 874,613 CVD-related deaths were recorded in 2019 to 928,741 in 2020.
The rise in the number of CVD deaths in 2020 represents the largest single-year increase since 2015 and topped the previous high of 910,000 recorded in 2003, according to the latest available data from the Heart Disease and Stroke Statistics — 2023 Update of the American Heart Association, a global force for healthier lives for all, and published today in the Association’s flagship, peer-reviewed journal, Circulation.
According to the American Heart Association (AHA) populations that are most impacted including those who are Asian, Black, and Hispanic are also those who were most impacted in the early days of the pandemic. This brings to light the increasing structural and societal disparities facing these populations.
The rise in cardiovascular disease-related deaths and its connection to age
“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%,” said the volunteer chair of the Statistical Update writing group Connie W. Tsao, M.D., M.P.H., FAHA, an assistant professor of medicine at Harvard Medical School and attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston.
“The age-adjusted mortality rate takes into consideration that the total population may have more older adults from one year to another, in which case you might expect higher rates of death among older people. So even though our total number of deaths have been slowly increasing over the past decade, we have seen a decline each year in our age-adjusted rates – until 2020. I think that is very indicative of what has been going on within our country – and the world – in light of people of all ages being impacted by the COVID-19 pandemic, especially before vaccines were available to slow the spread.”
COVID-19 impacts heart health
“We know that COVID-19 took a tremendous toll, and preliminary data from the U.S. Centers for Disease Control and Prevention (CDC) have shown that there was a substantial increase in the loss of lives from all causes since the start of the pandemic. That this likely translated to an increase in overall cardiovascular deaths, while disheartening, is not surprising. In fact, the Association predicted this trend, which is now official,” said the American Heart Association’s volunteer president, Michelle A. Albert, M.D., M.P.H., FAHA, the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology, a professor of medicine at the University of California at San Francisco (UCSF) and Admissions Dean for UCSF Medical School.
“COVID-19 has both direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clotting and inflammation. 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.”
Albert, who is a renowned leader in health equity and adversity research, states the large increases in the number of coronary heart disease deaths among adults of Asian, Black and Hispanic populations appear to correlate with the people most often infected with COVID-19.
“People from communities of color were among those more highly impacted, especially early on, often due to a disproportionate burden of cardiovascular risk factors such as hypertension and obesity. Additionally, there are socioeconomic considerations, as well as the ongoing impact of structural racism on multiple factors including limiting the ability to access quality health care,” Albert said.
The American Heart Association responded quickly at the beginning of the pandemic to address the impact of COVID-19 and focus on equitable health for all by establishing the first-ever rapid response research grants. In addition, they created a COVID-19 CVD hospital registry through the Get With The Guidelines® quality initiative and continue to pledge to address social determinants and work to support and improve the equitable health of all communities.
“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.
“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.”
Leading causes of death
The release from the AHA notes that coronary heart disease is the number one cause of death in the U.S. Strokes continue to rank fifth among all causes of death behind heart disease, cancer, COVID-19 and unintentional injuries/accidents.
Cardiovascular disease continues to be the number one killer globally, taking the lives of more than 19 million people around the world each year, including people of all ages, genders and nationalities. Yet, the risk factors that lead to heart disease and stroke continue to disproportionately impact certain populations in the U.S. as well as around the world.
In 2020, COVID-19 appeared in the list of leading causes of death according to the U.S. Centers for Disease Control and Prevention (CDC).
Looking ahead to February
“As the U.S. prepares to celebrate the 60th annual Heart Month in February 2023, it’s critical that we recognize and redouble the life-saving progress we’ve made in nearly a century of researching, advocating and educating, while identifying and removing those barriers that still put certain people at disproportionately increased risk for cardiovascular disease,” Albert said. “Tracking such trends is one of the reasons the American Heart Association publishes this definitive statistical update annually, providing a comprehensive resource of the most current data, relevant scientific findings and assessment of the impact of cardiovascular disease nationally and globally.”
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