Heart Attacks No Longer a Leading Cause of Death in the U.S. Here's What Is Instead
Heart attacks have become more survivable in the past 50 years, and are no longer the leading cause of heart disease-related deaths, a new study reports.
As heart attack deaths fall, fatalities from other heart conditions are rising due to various factors, including higher rates of other forms of cardiovascular disease.
In recent decades, deaths from heart disease have still been responsible for more U.S. fatalities than any other cause.
Heart attacks are no longer the number one cause of heart-related deaths in the United States, according to a new report.
Fatalities from heart attacks — acute myocardial infarctions — decreased by 89% from 1970 to 2022, the report, published on June 25 in the Journal of the American Heart Association, shows.
Heart attacks are severe ischemic heart disease events in which blood flow to and from the heart is restricted. Ischemic heart disease was responsible for 91% of all heart disease-related deaths in 1970, declining to 53% by 2022.
Heart disease overall has decreased by 66% since 1970, yet it remains the leading cause of death among Americans.
With more people avoiding death from myocardial infarctions (MI), fatalities from other heart disease subtypes now represent 81% of heart-related deaths. These include:
heart failure, for which fatalities have increased by 81%
hypertension-related heart disease deaths, which have risen by 106%
arrhythmia-related fatalities, which have increased by 450%
Heart attack deaths drop in recent decades
Jayne Morgan, MD, cardiologist and vice president of medical affairs for Hello Heart, told Healthline that the report does not indicate that fewer heart attacks are occurring. Morgan wasn't involved in the new report.
'I did not note a decline in myocardial infarctions themselves, but rather a decline in heart attacks being the primary cause of death,' she said. 'As Americans, we are not that great at prevention. Our strength has been in the science and application of medicine.'
'The inference is that more and more heart attacks are survivable now as compared to 55 years ago,' Morgan said.
This is because emergency physicians have become better at saving people experiencing heart attacks with the help of contemporary medications, lifesaving procedures, and devices.
Deaths from non-fatal heart attacks
Morgan explained that the non-fatal heart attack 'was the catalyst for the chain of events leading to eventual long-term chronic heart disease conditions such as heart failure and arrhythmias.'
'Patients who otherwise would have passed from their heart attack are now surviving, and then living longer dealing with the consequences,' Cheng-Han Chen, MD, board certified interventional cardiologist, told Healthline. Chen wasn't involved in the new report.
Chen described heart-muscle damage that non-fatal heart attacks often leave in their wake. The extent of that damage depends on the severity and duration of the attack. Weakness in the heart muscle can result in heart failure.
It's important to understand that heart failure does not mean that a heart has completely failed. Rather, it means that it is no longer functioning as well as it once did.
'Heart failure is a spectrum in which the heart just doesn't work perfectly,' said Chen. 'It could be very mild, or it could be very severe and everything in-between.'
'You can actually live with mild heart failure for the remainder of your life,' said Chen, 'and it doesn't really affect you that much, and you can control it with medication.'
Another obvious result of non-fatal heart attacks is that people who survive them tend to live longer.
Heart failure, hypertension-related heart disease, and arrhythmia are all associated with aging. Living longer only increases the odds of eventually developing these conditions.
Lifestyle factors impact heart health
The typical American lifestyle puts many people at a high risk for heart failure, hypertension, and arrhythmia, Morgan noted.
It is characterized, she said, by ' obesity, hypertension, sedentary lifestyles, processed and palatable fast food, decreased physical movement, smoking, cholesterol, diabetes, as well as societal stressors leading to chronic inflammation.'
She noted that socioeconomic issues complicate lifestyle risk factors and make addressing them especially difficult for many.
'This includes pregnancy complications such as hypertension of pregnancy, preeclampsia, gestational diabetes, etc.,' Morgan added. 'These all increase a woman's lifetime risk of heart disease, and are still the primary drivers of maternal mortality outcomes.'
The general decline in heart fatalities, however, indicates that some progress is being made against some of these risk factors.
Sharp increase in arrhythmia-related deaths
The report found the most dramatic increase in arrhythmia-related deaths. Arrhythmias are disorders in which the rate at which the heart beats is abnormal. There are four main types of arrhythmia:
bradycardia — slow heart rate
tachycardia — fast heart rate
ventricular arrhythmia — begins in the ventricles
supraventricular arrhythmia — begins above the ventricles (i.e., atrial fibrillation or irregular heartbeat)
Arrhythmias are common and are often harmless. However, should an arrhythmia interfere with the heart's ability to maintain blood flow, damage may occur to the heart, brain, lungs, and other vital organs. As the report describes, arrhythmias can be fatal.
It is important to get annual checkups that include a heart-health examination.
In addition, if you can feel your heart is beating without having your hand on your chest, it is a good idea to consult your doctor to be checked for arrhythmia.
This is especially essential for heart-attack survivors. 'Reducing the risk of arrhythmias after a myocardial infarction is crucial, as these irregular heart rhythms — especially ventricular arrhythmias — can be life threatening,' Morgan said.
She cited several interventions that can help the survivor of a non-fatal heart attack avoid death from arrhythmia, including a four-drug combo known as the 'foundational four' for managing HFrEF (Heart Failure with Reduced Ejection Fraction).
Morgan said statins, cardiac rehab, implantable defibrillators, sleep apnea management, and lifestyle changes may also be valuable in such cases.
AHA's tips for staying heart-healthy
The American Heart Association (AHA) provides an eight-step framework for maintaining heart health:
eat healthy
be more active
quit tobacco
get healthy sleep
manage your weight
control your cholesterol
regulate your blood sugar
manage your blood pressure
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