WASHINGTON, Jan 22: Deaths from heart disease and stroke in the United States declined in 2023 after a five-year upward trend likely influenced by the COVID-19 pandemic, but the two conditions remain the nation’s leading killers, according to the 2026 Heart Disease and Stroke Statistics report from the American Heart Association (AHA).

Heart disease, responsible for 22% of all U.S. deaths, has been the top cause of death for more than a century, while stroke, now the fourth leading cause of death, accounted for 5.3% of fatalities. Together, they made up more than a quarter of all U.S. deaths in 2023, the latest year for which data are available.

The annual report, published Wednesday in Circulation, the AHA’s peer-reviewed flagship journal, shows 915,973 deaths from cardiovascular disease (CVD) in 2023—including heart disease, stroke, hypertension, and heart failure—down from 941,652 in 2022. The age-adjusted CVD death rate declined to 218.3 per 100,000 people, compared with 224.3 per 100,000 in 2022. On average, a person died of CVD every 34 seconds.

Coronary heart disease, the most common form of CVD, caused 349,470 deaths in 2023, down from 371,506 the previous year, averaging two deaths every three minutes. Stroke caused 162,639 deaths, down from 165,393 in 2022, or one death every 3 minutes and 14 seconds.

“It’s encouraging to see that total deaths from heart disease and stroke declined. The past five years appear to have been an anomaly given the huge impact the pandemic had on all health during that time,” said Dr. Stacey E. Rosen, AHA volunteer president and senior vice president of women’s health at Northwell Health in New York City. “The fact remains that heart disease and stroke continue to take the lives of too many of our loved ones each and every day. Together, they still kill more people than cancer and accidents combined.”

While overall stroke deaths fell, younger and older populations face a rising risk. Between 2013 and 2023, the crude stroke death rate increased 8.3% among people aged 25–34 and 18.2% among those over 85.

“Fewer people are dying overall, and death rates are improving as life expectancy rebounds after the COVID-19 pandemic,” said Dr. Latha P. Palaniappan, chair of the AHA statistics update writing committee and professor of cardiovascular medicine at Stanford University. “However, about half of all U.S. adults continue to have some form of cardiovascular disease. Persistent increases in high blood pressure, diabetes, and obesity continue to drive risk.”

Comparing 2017–2020 with 2021–2023, the report found 125.9 million U.S. adults (47.3%) now have high blood pressure, nearly 29.5 million have diagnosed diabetes, and about 50% are obese or severely obese. Among youth aged 2–19, obesity and severe obesity rose from 25.4% to 28.1%.

For the first time, the report includes cardiovascular-kidney-metabolic (CKM) syndrome, which links heart disease, kidney disease, diabetes, and obesity. Nearly 90% of adults and more than 80% of young and middle-aged adults show some CKM risk.

“These numbers should ring alarm bells, particularly among young adults,” said Dr. Sadiya S. Khan, vice-chair of the report’s writing group and associate professor at Northwestern University’s Feinberg School of Medicine. “Overall projections show increases in these health conditions over the next few decades. But advances in diagnostics and treatments provide hope. Prevention remains our most powerful tool.”

The report emphasizes the AHA’s Life’s Essential 8™ framework, which includes four health behaviors—healthy diet, physical activity, sleep, and tobacco cessation—and four health factors—weight, cholesterol, blood sugar, and blood pressure. Research shows ideal adherence reduces cardiovascular event risk by 74% and could prevent up to 40% of all-cause and CVD deaths.

Despite this, adherence remains low. Only 25.3% of adults meet physical activity guidelines, and just 19.5% of youths aged 6–17 are active 60 minutes daily. Diet scores are the lowest of the eight measures. E-cigarettes are the most-used tobacco product among U.S. youths, with 18.1% of high school students reporting use, 26.3% daily. Less than half of adults treated for Type 2 diabetes have the condition under control.

“We know that up to 80% of heart disease and stroke is preventable with lifestyle changes, and many chronic conditions are manageable,” Rosen said. “Improving cardiovascular health is possible, but it will take a concerted effort. These statistics are lives on the line, not just numbers.”

Since 1927, the AHA has produced the annual statistics update to track cardiovascular trends, identify at-risk populations, and inform public health policies. Nancy Brown, AHA CEO, said the report helps guide research, awareness campaigns, and policy efforts to combat the global burden of cardiovascular disease.