After more than a decade of steady improvements, the decline in mortality rates from heart disease and stroke has slowed nationally and nearly leveled out since 2011, according to a new analysis from Kaiser Permanente published in JAMA Cardiology.
“Continued innovation is essential in our efforts to address the ongoing challenge of cardiovascular disease prevention,” said lead author Stephen Sidney, MD, MPH, director of research clinics at the Kaiser Permanente Northern California Division of Research.
Kaiser Permanente researchers analyzed publicly available data from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) data system, for 2000 to 2014. They determined national trends in age-adjusted mortality for cardiovascular disease, heart disease, stroke, and cancer.
Between 2000 and 2011, researchers found the national heart-related mortality rate declined at an average of 3.7 percent per year, while stroke mortality declined at 4.5 percent per year. During this time, total cardiovascular mortality, including from heart disease and stroke, declined an average of 3.8 percent annually. Since 2011, however, the decline in these rates has slowed to less than 1 percent per year.
Heart disease has been the leading cause of death in the United States since 1921, according to the CDC. Since then, population-level declines in mortality from heart disease have been attributed to advances in medical treatment and prevention; the increased use of statins and aspirin; the focus on lifestyle-related risk factors such as smoking and physical activity; and public health campaigns targeting high blood pressure.
Senior author Jamal S. Rana, MD, PhD, Kaiser Permanente cardiologist and adjunct investigator with the Division of Research, said that increases in obesity and diabetes, both well-established risk factors in the development of heart disease, may be to blame. “Despite significant improvements in heart health over the past century, the increase in these chronic health conditions in epidemic proportions may be driving the recent slowdown,” Rana said.
The American Heart Association (AHA) has established a strategic goal of reducing deaths from both cardiovascular disease and stroke by 20 percent between 2010 and 2020. “Total mortality from cardiovascular disease and stroke would need to decrease by more than 2 percent annually, much higher than the recent rate of decline,” Dr. Sidney said. “If this deceleration trend continues, these public health goals may not be reached.”
By comparison, the researchers found that mortality from cancer has declined at a steady rate of 1.5 percent annually from 2000 to 2014. “From 2000 to 2011, cancer was on track to bypass heart disease as the leading cause of death in the United States. Based on the current findings, this may not happen,” Dr. Rana said. “Given this startling trend, the cardiovascular health care community needs to reaffirm its commitment to developing innovative ways to improve heart disease prevention at the population level.”
The Kaiser Permanente researchers will next analyze how the health care system’s heart disease and mortality rates compare with the national trends in recent years.
In addition to Sidney and Rana, co-authors of the study were Charles P. Quesenberry, Jr., PhD, Michael Sorel, MPH, Mai N. Nguyen-Huynh, MD, Lawrence H. Kushi, ScD, Alan S. Go, MD, Kaiser Permanente Northern California Division of Research; and Marc G. Jaffe, MD, Kaiser Permanente South San Francisco Medical Center.
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