Cardiovascular Disease Remains Leading Killer, But COVID's Impact Still Unclear

Megan Brooks
February 01, 2021

Cardiovascular disease (CVD) remains the leading cause of death in the United States and around the world, according to the annual statistical update on heart disease and stroke from the American Heart Association (AHA).

However, that number one rank, which is based on 2018 mortality data, is likely to be affected by the COVID-19 pandemic going forward.

"We are still awaiting final numbers from 2020, but we expect that deaths from COVID-19 will be in the top three to five causes of death in 2020, more likely number three in terms of the overall cause of death in our country," said writing group chair Salim Virani, MD, PhD, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston.

"We anticipate that the direct and indirect effects of COVID-19 on cardiovascular disease will continue to years to come," said Virani.

The AHA's Heart Disease and Stroke Statistics — 2021 Update was published online January 27 in Circulation.

Among the key findings:

  • Between 2015 and 2018, 126.9 million American adults (49.2%) had some form of CVD, including coronary heart disease, heart failure, stroke, or hypertension, with 58.8% of non-Hispanic Black females and 60.1% of non-Hispanic Black males having CVD.
  • In 2018, coronary heart disease was the leading cause (42.1%) of deaths attributable to CVD in the United States, followed by stroke (17.0%), hypertension (11.0%), heart failure (9.6%), arterial disease (2.9%), and other CVD (17.4%).
  • In 2017 alone, CVD claimed the lives of 868,662 Americans. CVD causes the deaths of more Americans each year than all forms of cancer and chronic lower respiratory disease combined.
  • Worldwide, CVD is the leading cause of death, killing roughly 18.6 million people in 2019. This reflects a 17.1% increase over the previous decade. There were more than 523.2 million cases of CVD in 2019, an increase of 26.6% over 2010 cases.

None of the data take into account COVID-19. "We are concerned about what the overall impact of the pandemic long-term is going to be on cardiovascular disease, not just the acute effects," Virani told theheart.org | Medscape Cardiology.

"Not only does COVID-19 cause damage to the heart, but we also know that people have delayed getting care for heart attacks and strokes, which can result in poorer outcomes. That's one indirect impact that COVID-19 has had on cardiovascular disease mortality," he said.

"We are also concerned that diet and physical activity have deteriorated during the pandemic and the toll that the pandemic has taken on mental health and wellness that can also affect how we are taking care of our cardiovascular health," Virani added.

First Chapter on Pregnancy

New in this year's statistical update is a chapter devoted to adverse pregnancy outcomes, which are known to increase the risk for CVD in mothers and babies.

Pregnancy complications, including hypertensive disorders, gestational diabetes, preterm births, and small for gestational age at birth, occur in up to 20% of all pregnancies in the United States.

"These pregnancy complications are all associated with an increased risk of cardiovascular disease in the mother, but also in the offspring," Virani said.

"By highlighting these pregnancy complications, it allows clinicians to focus on women who may have had these conditions during the pregnancy and their offspring with regular follow-up care," he added.

This statistical update was prepared by a volunteer writing group on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Virani reports grant support from the Department of Veterans Affairs, World Heart Federation, American Heart Association, and American Diabetes Association; and honoraria from the American College of Cardiology.

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Reviewed on 2/2/2021
References
SOURCE: Medscape, February 01, 2021. Circulation. Published online January 27, 2021.

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