Key result
Atherosclerotic heart disease mortality declined ~2.7% annually from 1999–2020 before a sharp late rebound.
Why the study?
Understanding long-term atherosclerotic heart disease mortality trends can guide public health strategies and address demographic disparities.
Observational (n=7,638,608)
Atherosclerotic heart disease mortality in the U.S. steadily declined for two decades but showed an alarming reversal with a sharp increase from 2018 to 2020, disproportionately affecting males, non-Hispanic Whites, and nonmetropolitan populations.
Recent reversal in atherosclerotic heart disease mortality trends merits monitoring; leaves open causal drivers and need for confirmatory studies.
Background: Atherosclerotic heart disease (ASHD) remains a leading cause of mortality worldwide, especially among older adults. Understanding the long-term mortality trends in ASHD can guide public health strategies and address demographic disparities. Methods: Mortality data for individuals aged 35 years and older were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 100,000 persons were calculated and stratified by year, gender, race, urbanization, and place of death. The trends were assessed using the annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CI) calculated through Joinpoint regression analysis. Results: From 1999 to 2020, 7,638,608 ASHD-related deaths were recorded. The overall AAMR declined from 291.08 in 1999 to 170.07 in 2020, with an AAPC of -2.70 % (95 % CI: 2.96 to -2.54). However, an abrupt rise was observed from 2018 to 2020 (APC: 4.55; 95 % CI: 0.77 to 6.75). Males reported higher AAMR than females (Males: 271.9 vs. Females: 151.9). Non-Hispanic (NH) White individuals had the highest AAMR (209.38), followed by NH Black (202.47), NH American Indian (176.12), Hispanic (158.1), and NH Asian (113.7) populations. Nonmetropolitan areas reported the highest AAMR (214.77), while medium metropolitan areas reported the lowest (195.41). The majority of deaths occurred in medical facilities (42.81 %), followed by decedent's homes (25.67 %), and nursing homes (24.79 %). Conclusion: Despite a long-term decline in ASHD-related mortality, the recent increase from 2018 to 2020 requires further study. Gender and racial disparities persist, highlighting the need for targeted public health efforts to reduce these inequities.
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Akhtar et al. (2025) conducted an observational in Atherosclerotic Heart Disease (ASHD) (n=7,638,608). Time period (1999-2020) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 persons (AAPC -2.70%, 95% CI -2.96 to -2.54, p=<0.05). The overall age-adjusted mortality rate for atherosclerotic heart disease declined with an average annual percent change of -2.70% from 1999 to 2020, though it sharply increased from 2018 to 2020.
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