Heart attacks are no longer the leading cause of death from heart disease. (Carlos_Pascual/Shutterstock)

In a nutshell

Heart attack deaths have dropped by 89% since 1970, thanks to major medical advances, public health efforts, and better emergency care.

Other heart conditions like heart failure, arrhythmias, and high blood pressure-related disease have sharply increased, now accounting for nearly half of all heart disease deaths.

As Americans live longer, surviving heart attacks often leads to chronic heart problems, highlighting the growing need to manage long-term cardiovascular health, not just prevent heart attacks.

STANFORD, Calif. — Deaths from heart attacks have plummeted by an astounding 89% since 1970, even after accounting for the aging population. However, Americans are now dying from completely different heart problems at alarming rates. A new study from Stanford University reveals that the nature of heart disease mortality has transformed over the past five decades, with conditions like heart failure, irregular heartbeats, and high blood pressure-related heart disease now killing far more people than ever before.

Back in 1970, when your grandparents were young adults, 91% of all heart disease deaths came from what doctors call “ischemic” heart disease. This includes heart attacks and related conditions caused by blocked arteries. Fast-forward to 2022, and that number has dropped to just 53%. Meanwhile, deaths from other heart conditions have skyrocketed by 81% overall.

The data, published in the Journal of the American Heart Association, analyzed over 37 million heart disease deaths spanning more than half a century. Researchers discovered that acute heart attack deaths fell from 354 per 100,000 people in 1970 to just 40 per 100,000 in 2022.

Why Heart Attack Deaths Plummeted

Starting in the 1960s, a cascade of medical breakthroughs began saving heart attack victims. Emergency responders learned CPR, hospitals created specialized cardiac care units, and doctors developed techniques to open blocked arteries. The 1970s brought coronary angiography (mapping the heart’s blood vessels), followed by balloon angioplasty in 1977, which could physically open blocked arteries.

More people survive their first cardiac events thanks to modern medicine. (© pixelheadphoto – stock.adobe.com)

The 1980s and 1990s saw the introduction of clot-busting drugs, aspirin therapy, coronary stents, and powerful cholesterol-lowering medications called statins. Each advancement chipped away at heart attack mortality rates. By the 2000s, doctors had established the critical “door-to-balloon” protocols that ensure heart attack patients get life-saving treatment within 90 minutes of arriving at the hospital.

Meanwhile, public health campaigns were transforming American behavior. Smoking rates plummeted from about 40% in 1970 to 14% in 2019, thanks to everything from the landmark 1964 Surgeon General’s report linking cigarettes to heart disease to smoke-free policies and tobacco taxes. Doctors also got more aggressive about treating high blood pressure and cholesterol, with treatment guidelines becoming increasingly strict over the decades.

The Unintended Consequences of Success

Deaths from heart failure increased by 146%, deaths from high blood pressure-related heart disease jumped 106%, and deaths from dangerous heart rhythm problems exploded by a staggering 450%.

Life expectancy increased from 70.9 years in 1970 to 77.5 years in 2022. As more Americans survived their initial cardiac events and lived longer overall, they accumulated more time for other heart problems to develop.

Heart disease comes with a lifelong journey. (Credit: New Africa/Shutterstock)

In 1970, if you had a massive heart attack, you probably died. Today, thanks to many advances in medicine, you’ll likely survive that heart attack. But you might spend the next 20 years dealing with a weakened heart that eventually develops heart failure or dangerous rhythm problems.

Modern Health Challenges Add Fuel to the Fire

Rising rates of obesity, diabetes, and high blood pressure haven’t helped. Obesity rates have nearly tripled since the 1970s, jumping from 15% to 40% of the adult population. Diabetes now affects an estimated 50% of American adults, when you include pre-diabetes. These conditions are also major drivers of heart failure and other cardiovascular problems.

Researchers also point to improved diagnostic capabilities as a factor. Doctors today are much better at identifying conditions like heart failure with preserved ejection fraction (where the heart squeezes normally but doesn’t fill properly) and pulmonary hypertension (high blood pressure in the lungs).

Every life saved from a heart attack is a victory, but many of those survivors will eventually face years of living with weakened hearts, requiring ongoing medical care, and ultimately dying from complications like heart failure or dangerous heart rhythms. Today, the keys to maintaining heart health throughout a longer lifespan include managing conditions like diabetes and high blood pressure that contribute to various forms of heart disease, and recognizing that surviving a cardiac event is just the beginning of a longer journey with heart health.

Paper Summary Methodology

Researchers analyzed mortality data from the National Vital Statistics System covering all U.S. adults aged 25 and older from 1970 through 2022. They examined over 37 million heart disease deaths, representing 31% of all deaths during this period. The team used International Classification of Diseases codes to categorize different types of heart disease across multiple coding system revisions. They calculated both absolute numbers of deaths and age-adjusted mortality rates (standardized to account for population aging) and used statistical software to identify trends and percentage changes over time.

Results

Overall heart disease mortality decreased by 66% from 1970 to 2022. Acute heart attack deaths plummeted 89%, while all ischemic heart disease deaths fell 81%. However, deaths from other heart conditions increased 81% overall, with heart failure up 146%, hypertensive heart disease up 106%, and arrhythmias up 450%. The proportion of heart disease deaths caused by ischemic conditions dropped from 91% in 1970 to 53% in 2022. Within ischemic heart disease, acute heart attacks declined from 54% of deaths in 1970 to 29% in 2022, while chronic ischemic heart disease increased from 46% to 71%.

Limitations

The study relied on death certificates, which can contain coding errors and inconsistencies, particularly when disease classification systems changed over the decades. Some conditions like heart failure and arrhythmias may have underlying ischemic causes that current coding systems cannot precisely identify, potentially underestimating the true burden of ischemic heart disease. The researchers used “underlying cause of death” rather than “multiple cause of death,” which may underestimate how much each condition contributes to mortality. The study also didn’t analyze differences by age, sex, race, ethnicity, or geographic region.

Funding and Disclosures

Several authors reported funding from the National Institutes of Health, including the National Heart, Lung, and Blood Institute, the American Heart Association, and the Doris Duke Foundation. Some authors disclosed consulting relationships with various pharmaceutical companies, though no conflicts of interest were noted that would affect the study’s conclusions.

Publication Information

The study “Heart Disease Mortality in the United States, 1970 to 2022” was published in the Journal of the American Heart Association in 2025, authored by Sara J. King and colleagues from Stanford University School of Medicine and other institutions. The research was published as an open-access article under Creative Commons licensing.