Heart disease #1 cause of death rank likely to be impacted by COVID-19 for years to come

DALLAS, Jan. 27, 2021 — Heart disease remains the leading cause of death worldwide, according to the American Heart Association’s Heart Disease and Stroke Statistics — 2021 Update, published today in the Association’s flagship journal Circulation, and experts warn that the broad influence of the COVID-19 pandemic will likely continue to extend that ranking for years to come.

Globally, nearly 18.6 million people died of cardiovascular disease in 2019, the latest year for which worldwide statistics are calculated. That reflects a 17.1% increase over the past decade. There were more than 523.2 million cases of cardiovascular disease in 2019, an increase of 26.6% compared with 2010.

Experts predict the global burden of cardiovascular disease will grow exponentially over the next few years as the long-term effects of the current COVID-19 pandemic evolve.

“COVID-19 has taken a huge toll on human life worldwide and is on track to become one of the top three to five causes of death in 2020. But its influence will directly and indirectly impact rates of cardiovascular disease prevalence and deaths for years to come,” said Salim S. Virani, M.D., Ph.D., FAHA, chair of the writing committee for the 2021 Statistical Update and an associate professor in cardiology and cardiovascular research sections at Baylor College of Medicine in Houston, Texas. “Research is showing that the unique coronavirus can cause damage to the heart. Importantly, we also know people have delayed getting care for heart attacks and strokes, which can result in poorer outcomes.”

But Virani said an even more critical issue will be the cardiovascular health risks that are exacerbated by the poor lifestyle behaviors that have been prevalent throughout the pandemic.

“The extraordinary circumstances of dealing with COVID-19 have changed the way we live, including adopting unhealthy behaviors that are known to increase the risk of heart disease and stroke,” Virani said. “Unhealthy eating habits, increased consumption of alcohol, lack of physical activity and the mental toll of quarantine isolation and even fear of contracting the virus all can adversely impact a person’s risk for cardiovascular health. We’ll need to watch and address these trends as the full ramifications will likely be felt for many years to come.”

Based on the 2021 Statistical Update, which furnished U.S. mortality data from 2018, cardiovascular disease remains the leading cause of death in the U.S. In the year 2020, approximately 360,000 lives were lost to COVID-19 in the U.S.; the release of data regarding all causes of death in the coming years will enable rank comparison of disease-specific causes of mortality that include COVID-19.

Tracking such trends is one of the reasons the American Heart Association publishes the 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. The annual update represents a compilation of the newest, most relevant statistics on heart disease, stroke and risk factors impacting cardiovascular health.

The U.S. data is gathered in conjunction with the National Institutes of Health and other government agencies, while the global trends are provided by the Global Burden of Disease Study from the Institute for Health Metrics and Evaluation at the University of Washington.

New in this year’s report is a chapter devoted to adverse pregnancy outcomes, which are known to increase the risk of cardiovascular disease in mothers and their babies. Pregnancy complications including hypertensive disorders, gestational diabetes, preterm births and small for gestational age at birth deliveries occur in 10% to 20% of all pregnancies in the U.S. Cardiovascular deaths are the most common cause (26.5%) of maternal death in the U.S.

“We must address this issue to save the lives of mothers and to improve the health of their children at birth, but also over their lifetime,” Virani said. “There can be long-term effects on offspring of women who suffer pregnancy-related complications. But we can also help impact the health of future generations because as we help women learn to reduce their cardiovascular risk, they’re likely to adopt healthier lifestyles. In turn, they can influence the health behaviors of their families.”

The annual report continues to track trends related to ideal cardiovascular health, social determinants of health, global cardiovascular health, cardiovascular health genetics and health care costs. Virani emphasized the importance of this surveillance as a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates and others seeking the best available data on these factors and conditions.

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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.

Co-authors are Alvaro Alonso, M.D., Ph.D.; Hugo J. Aparicio, M.D., M.P.H.; Emelia J. Benjamin, M.D., Sc.M.; Marcio S. Bittencourt, M.D., Ph.D., M.P.H.; Clifton W. Callaway, M.D., Ph.D.; April P. Carson, Ph.D., M.S.P.H.; Alanna M. Chamberlain, Ph.D., M.P.H.; Susan Cheng, M.D., M.M.Sc., M.P.H.; Francesca N. Delling, M.D., M.P.H.; Mitchell S.V. Elkind, M.D., M.S.; Kelly R. Evenson, Ph.D., M.S.; Jane F. Ferguson, Ph.D.; Deepak K. Gupta, M.D., M.S.CI.; Sadiya S. Khan, M.D., M.Sc.; Brett M. Kissela, M.D., M.S.; Kristen L. Knutson, Ph.D.; Chong D. Lee, Ed.D., M.Ed.; Tené T. Lewis, Ph.D.; Junxiu Liu, Ph.D.; Matthew Shane Loop, Ph.D.; Pamela L. Lutsey, Ph.D., M.P.H; Jun Ma, M.D., Ph.D.; Jason Mackey, M.D.; Seth S. Martin, M.D., M.H.S.; David B. Matchar, M.D.; Michael E. Mussolino, Ph.D.; Sankar D. Navaneethan, M.D., M.S., M.P.H.; Amanda Marma Perak, M.D., M.S.; Gregory A. Roth, M.D.; M.P.H.; Zainab Samad, M.D.; Gary M. Satou,; M.D.; Emily B. Schroeder, M.D., Ph.D.; Svati H. Shah, M.D., M.H.S.; Christina M. Shay, Ph.D.; Andrew Stokes, Ph.D.; Lisa B. VanWagner, M.D., M.Sc.; Nae-Yuh Wang, Ph.D., M.S.; Connie W. Tsao, M.D., M.P.H. Author disclosures are in the manuscript.

Additional Resources:

After 4 a.m. CT/5 a.m. ET Wednesday, Jan. 27, 2021, view the manuscript online.

View 2021 fact sheets on specific populations at heart.org/statistics

COVID-19 resources
For additional inquiries on COVID-19 and CVD, please visit the AHA COVID-19 Registry for more information
How to have a heart-healthy pregnancy before you even conceive
Early in pregnancy may be a prime time to promote heart health

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