Deaths from coronary artery disease have fallen, but more progress is within reach

Deaths from coronary artery disease in the United States have declined significantly over the past three decades, according to a new study published in JAMA Cardiology. However, researchers warn that nearly nine out of ten deaths related to the condition in 2023 could have been prevented through better management of known risk factors. The findings highlight both the progress made and the challenges that remain in reducing the burden of heart disease. From 1990 to 2023, mortality from ischemic heart disease, caused by blockages in the coronary arteries, fell by more than half. This decline has been driven largely by reductions in deaths from smoking and exposure to particulate air pollution. Smoking-related deaths dropped by 33.3%, and deaths tied to air pollution fell by 74.9%. Despite these gains, the study found that 419,000 of the estimated 473,000 coronary artery disease deaths in 2023 were associated with modifiable risk factors. Gregory Roth, a professor of cardiology at the University of Washington and one of the study's co-authors, emphasized that coronary artery disease is preventable. He noted that many patients are unaware that the leading cause of death in the country can be mitigated through lifestyle changes and medical intervention. “We know how to modify risk factors so that we could potentially remove 80% or 90% of it,” Roth said. The research points to several key risk factors contributing to the ongoing burden of heart disease. High blood pressure, elevated levels of “bad” cholesterol (LDL), and kidney dysfunction all increase the likelihood of fatal heart disease. Behavioral risk factors include poor diet, lack of physical activity, smoking, and excessive alcohol consumption. Environmental risks such as pollution, extreme heat, and exposure to lead also play a role. Despite the overall downward trend in mortality, certain risk factors have worsened over time. Body mass index has risen by 12.5% since 1990, and average blood glucose levels have increased by 10.5%. These trends are linked to the rising prevalence of diabetes and the emergence of the cardiovascular-kidney-metabolic syndrome, a cluster of conditions that includes heart disease, kidney disease, diabetes, and obesity. Sadiya Khan, a professor of cardiovascular epidemiology at Northwestern Medicine, pointed out that while progress has been made, some areas show concerning stagnation. “We’re definitely seeing that ischemic heart disease mortality rates have gone down,” she said. “But we’re losing ground in areas like BMI and diabetes specifically. We can celebrate the success we’ve had without saying the job is done.” Geographic disparities in coronary artery disease mortality were also evident. The states with the highest death rates included Kentucky, Tennessee, West Virginia, Mississippi, and Arkansas. In contrast, Massachusetts, Oregon, Hawaii, Colorado, and Minnesota recorded the lowest rates. Adjusting for age differences, Massachusetts, New Jersey, and Minnesota showed the largest declines in coronary artery disease deaths compared to 1990, with reductions exceeding 63%. Roth stressed the importance of communicating these findings to policymakers. He cited examples such as states that implemented anti-smoking policies, which led to improved outcomes in heart disease. “We want to communicate with individuals about choices they can make, but we really want to communicate this information to people who are in a position to guide health policy,” he said. In 2023, almost half of the heart disease deaths were attributed to metabolic and behavioral risks. High blood pressure accounted for 47.2% of cases, followed by diet (38.6%) and LDL cholesterol (28.5%). As the U.S. population ages and grows larger, the number of heart disease deaths continues to rise, even as progress in reducing risk factors has slowed since 2010. Robert Califf, a cardiologist and former FDA commissioner, highlighted several areas requiring urgent attention, including the cardiovascular-kidney-metabolic syndrome, the influence of social media, and conflicting public policies. He argued that despite abundant resources, the nation is not adequately addressing these issues. “It is ironic that a society with such a surplus of resources is not aggressively addressing this issue when it is overwhelmingly likely that a combination of policy interventions, attention to reliable communication, and coordinated efforts could make a significant impact,” he said.