Cardiovascular disease remains the leading killer in the United States, but a comprehensive new report suggests the country is losing ground in the fight against it.
Published in the Journal of the American College of Cardiology (JACC), the inaugural statistical report paints a sobering picture: Progress on managing blood pressure and cholesterol has stagnated, while rates of obesity and diabetes are climbing.
The data shows that while medical technology has advanced, the fundamental drivers of heart disease are becoming more prevalent, not less.
Here are the five cardiovascular diseases that account for the most deaths and disability — and five risk factors fueling them.
Coronary heart disease
Coronary heart disease is the most common form of heart disease and the primary driver of cardiovascular death. It occurs when plaque builds up in the arteries, restricting blood flow to the heart.
According to the JACC report, coronary heart disease now affects over 20.5 million U.S. adults. The prevalence of the disease has risen since 2019. Perhaps most concerning is the treatment gap: Only 1 in 2 adults with the condition receives optimal medical treatment, leaving millions vulnerable to preventable complications.
Heart attack
A heart attack, technically known as an acute myocardial infarction, happens when the blood flow to a part of the heart is blocked, such as by a blood clot.
The new data highlights a shift in who is getting hit hardest. While hospitalizations for heart attacks have generally declined over the last two decades, they are now rising among younger adults. This uptick suggests that cardiovascular damage is starting earlier in life than previously seen, driven likely by the worsening metabolic health of younger generations.
Heart failure
Heart failure does not mean the heart has stopped; it means the heart is too weak to pump blood effectively. It is a chronic, progressive condition often caused by other problems like high blood pressure or previous heart attacks.
Approximately 6.7 million Americans are living with heart failure. After years of decline from 1999 to 2011, death rates have reversed course and are climbing again.
Peripheral artery disease
Peripheral artery disease involves the narrowing of arteries in the legs, stomach, arms and head — most commonly in the legs — causing circulation issues that can be painful.
The disease affects roughly 1 in 14 adults, though experts believe it is widely underdiagnosed. It is estimated that over 12 million people have the condition.
The consequences of poor management of peripheral artery disease are severe: Nearly 1 in 10 patients with the most advanced form of the disease (called chronic limb-threatening ischemia) eventually undergo a major amputation.
Stroke
A stroke occurs when blood supply to the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. It is a leading cause of long-term disability and death.
Stroke is currently the fifth-leading cause of death in the U.S., accounting for nearly 1 in 20 deaths in 2023. Prevalence has ticked up slightly to 2.9% in recent years. While quality of care has improved, the sheer volume of cases is growing as the population ages and risk factors remain uncontrolled.
5 risk factors to know
The JACC report makes it clear that these conditions are not random. They are driven by specific risk factors that are largely preventable or manageable:
- Hypertension: High blood pressure affects nearly 1 in 2 adults. Despite clear guidelines, control rates have stagnated for 15 years, and deaths related to hypertension have nearly doubled in the last two decades.
- Diabetes: Prevalence is rising sharply, particularly among younger adults. Only half of adults with diabetes achieve proper blood sugar control, which directly accelerates heart damage.
- Obesity: This has reached epidemic levels, now affecting more than 40% of adults. It worsens every other risk factor on this list.
- LDL cholesterol: Managing “bad” cholesterol is critical, yet fewer than 1 in 4 high-risk adults are hitting their target levels.
- Smoking: While cigarette use has declined overall, it remains high in lower-income populations. Additionally, the rise of e-cigarettes among younger people poses a new, evolving threat to cardiovascular health.
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