Q&A: Why does cardiovascular disease remain the top cause of death in America?

He talked with UVA Today about the new report.

Q. Can you start by describing the findings of the new report?

A. It’s extremely detailed and draws from every published study and major database from the past year. It gives us an overall picture of how heart disease and stroke are changing over time. The latest data are from 2023, and cardiovascular disease remains the No. 1 cause of mortality – by a wide margin – well above cancer and accidents (the second- and third-leading causes of death).

Dr. Christoper Kramer is the chief of UVA Health’s cardiovascular division. He has been at UVA Health for nearly 27 years and is also president of the American College of Cardiology. (UVA Health photo)

Q. How do the figures differ from previous reports?

A. Cardiovascular mortality declined in 2023 compared to 2021 and 2022. Those earlier years saw an increase, most likely due to COVID-19. Viral infections create an inflammatory environment that can raise the risk of heart attacks and strokes. As the effects of COVID-19 diminished, mortality declined back to pre-pandemic levels in 2023.

If we look at the longer trend, heart disease deaths declined steadily from the 1950s through about 2010. After that, they began to rise again, despite declines in smoking and improvements in cholesterol management and heart attack treatment. That increase is largely driven by rising obesity, diabetes and hypertension, which are closely linked. The encouraging news is that mortality began to decline again in 2023, but obesity remains a major challenge.

Q. What do you think is the key message of these findings?

A. Cardiovascular disease is still the leading cause of death for both men and women. There’s a common misconception that certain cancers – like breast cancer – are the leading cause of death for women, but cardiovascular disease overwhelmingly remains No. 1.

The findings reinforce the importance of prevention. Key risk factors include hypertension, diabetes, cigarette smoking and high cholesterol. Family history is also a risk factor, but it’s not modifiable. The others are, and obesity plays a major role in driving many of them.

Q. How does sleep relate to heart health?

A. Sleep is important for overall health, though its direct relationship to cardiovascular disease is still being better understood. Sleep apnea is a major concern and is often linked to obesity. It contributes significantly to hypertension and worsens other cardiovascular risk factors.

Cardiovascular disease kills three in 10 Americans, according to the American Heart Association. (Illustration by Tobias Wilbur, University Communications)

There’s also clear evidence that consistently getting too little sleep – generally under six hours a night – is associated with worse health outcomes. However, the precise mechanisms behind that relationship are still being studied.

Q. Is there anything else you think is important to highlight from the report?

A. The good news is that cardiovascular mortality declined from 2022 to 2023. The bad news is that it has been increasing since 2010. As a country, we need to better address the underlying risk factors – especially obesity, which remains a major driver of cardiovascular disease.