CVD-Related Deaths Surged During First Year of COVID-19 Pandemic

Connie W. Tsao, MD, MPH

Mortality rates from cardiovascular disease (CVD) in the United States surged during the first year of the COVID-19 pandemic, with particularly high numbers for Asian, Black, and Hispanic populations.

The American Heart Association (AHA) 2023 Statistical Update reported more people died from cardiovascular-related causes in 2020, the first year of the COVID-19 pandemic, than in any year since 2003.

The data show CVD-related deaths swelled from 874,612 in 2019 to 928,741 in 2020, the largest single-year increase since 2015. This surpassed the previous high death rate of 910,000 recorded in 2003.

“The age-adjusted mortality rate takes into consideration that the total population may have more older adults from one year to another, in which case you might expect higher rates of death among older people,” said writing committee volunteer chair Connie W. Tsao, MD, MPH, Assistant Professor of Medicine, Harvard Medical School in a statement. “So even though our total number of deaths have been slowly increasing over the past decade, we have seen a decline each year in our age-adjusted rates – until 2020.”

Overall, CVD consists of coronary heart disease, stroke, heart failure and hypertension/high blood pressure. Coronary heart disease remains the number one cause of death in the United States, while stroke continued to rank fifth among all causes of death. In 2020, COVID-19 appeared in the list of leading causes of death for the first time.

The update clarified the mechanisms by which COVID-19 impacts cardiovascular health. This included its relationships to risk factors for heart disease and stroke, such as diabetes and high blood pressure putting individuals at greater risk for more severe COVID-19 illness.

The current report indicated the greatest increases in CVD deaths seen in Asian, Black, and Hispanic communities represented ongoing structural and societal disparities, as these populations were most impacted in the early days of the COVID-19 pandemic. Committee authors cited the disproportionate burden of cardiovascular risk factors in these populations, including hypertension and obesity.

“COVID-19 has both direct and indirect impacts on cardiovascular health,” added Michelle A. Albert, MD, MPH, volunteer president of the American Heart Association and the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology at the University of California at San Francisco (UCSF) in a statement. “As we learned, the virus is associated with new clotting and inflammation. We also know that many people who had new or existing heart disease and stroke symptoms were reluctant to seek medical care, particularly in the early days of the pandemic. This resulted in people presenting with more advanced stages of cardiovascular conditions and needing more acute or urgent treatment for what may have been manageable chronic conditions. And, sadly, appears to have cost many their lives.”

Study authors further cited disparities related to gender, race, and ethnicity that occurred in the research. However, a special commentary by members of the update’s writing committee noted a lack of data from other underrepresented populations, including LGBTQ people and those living in rural versus urban areas of the United States.

In doing so, they aimed to “better recognize and understand the unique experiences of individuals and populations” and gather information on specific social factors related to health risk and outcomes.

“However, the data are still lacking because these communities are grossly underrepresented in clinical and epidemiological research,” Tsao said. “We are hopeful that this gap in literature will be filled in coming years as it will be critical to the American Heart Association’s goal to achieve cardiovascular health equity for all in the US and globally.”

Global and regional trends in death were addressed in the statistical update, related to different cardiovascular diagnoses and risk factors. CVD continued to be the top killer globally and took the lives of more than 19 million people around the world each year.

The trends show that globally, coronary heart disease and stroke are the top two causes of death linked to CVD. Study authors noted the rates were shown to rise around the world in the past decade in all but two regions, North America, and Europe/Central Asia.

Data on North America show heart disease death rates have been falling in recent decades, from 28.2% of all deaths in 1990 to 18.7% in 2019. Stroke deaths fell from 7.3% of all deaths in 1990 to 6.4% in 2019. In Europe and Asia, heart disease death rates fell from 27.2% of all deaths in 1990 to 24.4% in 2019, with stroke death rates falling from 15.1% to 12.5% in the same period.

Study authors emphasized the importance of the report as a critical resource for policymakers, clinicians, researchers, health advocates, and others seeking the best available data on these conditions and their risk factors.

"As the U.S. prepares to celebrate the 60th annual Heart Month in February, it's critical that we recognize and redouble the lifesaving progress we've made in nearly a century of researching, advocating, and educating, while continuing to identify and understand those barriers that still put certain people at increased risk for cardiovascular disease," Albert said.

The report, “Heart Disease and Stroke Statistics—2023 Update: A Report from the American Heart Association,” was published in Circulation.