Trends in Heart Failure Incidence in the Community: A Gathering Storm

In populations around the world, a gathering storm of cardiovascular disease occurrence is building on the horizon, the likes of which we have not seen in decades. Between 1970 and 2010, age-adjusted cardiovascular mortality rates declined dramatically in almost all Western nations; in many countries, rates fell by ≥70%. However, in 2016, Sidney et al1 reported that in the United States, a substantial deceleration in the decline of all cardiovascular disease, coronary heart disease, and stroke mortality rates began over the past 5 years, signaling a dramatic shift. Prompted by this report, Lloyd-Jones suggested that perhaps we are now just beginning to “reap what we have sown” in the obesity epidemic over the past several decades. It is not a new concept that the Western world’s obesity epidemic can affect population health. What is less well documented is whether the epidemic obesity is beginning to reverse long-standing declines in disease incidence. A recent report from the Centers of Disease Control and Prevention indicates that between 2014 and 2015, age-adjusted death rates in the United States increased for 8 of 10 leading causes of death, including cardiovascular disease rates. Given that heart disease accounts for >30% of all deaths in the United States, the 0.9% increase in age-adjusted mortality from heart disease is of particular concern.