Fewer Americans are dying from heart disease—Black patients still face the highest risks
The overall mortality rate for U.S. patients with cardiovascular disease (CVD) has improved significantly in the last two decades, according to new findings published in JACC.[1] However, despite the continued efforts of cardiologists and other cardiovascular care professionals, disparities remain for certain racial and/or ethnic groups.
This new analysis represents a county-by-county dive into the heart health of Americans from 2000 to 2019. Data came from both the U.S. National Vital Statistics System and the National Center for Health Statistics.
In total, the study’s authors found that CVD mortality rates “varied substantially” from one county to the next. There were often considerable differences in the same state. This highlights the importance of ensuring all patients, no matter where they live, receive high-quality care.
In 2019, the overall age-standardized mortality rate (ASMR) for CVD in the United States was 237.8 deaths per 100,000 adults. The ASMR was the highest for Black patients and the lowest for Asian patients.
Researchers also explored ASMRs for 17 different potential causes of cardiovascular death, including rheumatic heart disease, ischemic heart disease, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, hypertensive heart disease, nonrheumatic calcific aortic valve disease, nonrheumatic degenerative mitral valve disease, myocarditis, alcoholic cardiomyopathy, other cardiomyopathy, pulmonary arterial hypertension, atrial fibrillation (AFib) and flutter, aortic aneurysm, lower extremity peripheral arterial disease, endocarditis and an “other” category that included all remaining cardiovascular and circulatory diseases. From 2000 to 2019, there were notable decreases in the ASMRs for total CVD and 12 of those 17 potential causes. The most substantial relative reductions were seen in aortic aneurysm, ischemic heart disease and other cardiomyopathy. The largest absolute reductions were for ischemic heart disease, ischemic stroke and intracerebral hemorrhage.
On the other hand, the biggest increases in ASMR from 2000 to 2019 was for the “other” category, hypertensive heart disease and AFib/atrial flutter.
Another key takeaway was how many disparities are still present when looking at the ASMRs for those 17 potential causes of cardiovascular death for specific racial/ethnic groups. Mortality was highest for Black patients than any other group for 12 different causes and lowest for Asian patients for 13 different causes.
“For clinical practice, these findings point to the value of integrating local epidemiology into risk assessment, outreach and care delivery,” lead author George A. Mensah, MD, director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute, said in a statement. “Health systems and clinicians need to align prevention strategies with the dominant local causes and the populations experiencing the greatest burden.”
‘A roadmap for action’
In a separate editorial, also published in JACC, American College of Cardiology (ACC) President Roxana Mehran, MD, and two co-authors explained why these data represent an opportunity to improve care going forward.[2]
“Dr. Mensah et al. provided an essential pre-pandemic map of cardiovascular disparities across time, place, race and ethnicity,” Mehran, a veteran cardiologist and director of interventional cardiovascular research and clinical trials at Mount Sinai, said in the same statement. “The next challenge is to turn this map into a roadmap for action. Our commitment to cardiovascular health equity should be measured not by how precisely we describe inequities, but by how effectively we close them.”
Click here to read the full study in JACC, the ACC’s flagship journal. The editorial is available here.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.