Whether cardiovascular mortality has stopped falling, and why

For fifty years the fall in deaths from heart disease and stroke was the engine of rising life expectancy in high-income countries. Around 2011 it slowed in the United Kingdom, the United States and several others, and since then cardiovascular mortality has been flat or falling only slowly at ages under 75, with some evidence of rises in younger adults in the United States. The candidate causes are known and their shares are not: the gains from statins, blood pressure treatment and smoking cessation may be largely banked; obesity and diabetes have risen in the cohorts now reaching the ages where they matter; and the pandemic disrupted diagnosis and treatment for two years. Studies decompose the slowdown differently depending on which they measure. The GLP-1 trials add a new term — a drug class that reduces cardiovascular events in people with obesity — whose population effect has not yet appeared in any national series. The stall is established; its explanation is building, and the evidence points in more than one direction.

Status

building

Direction

mixed

Would change our view

A cross-country decomposition apportioning the slowdown between treatment plateau, risk-factor rise and access to care; or two years of post-pandemic national data showing cardiovascular improvement resuming.

Trackers

Gaps

Cause-specific mortality at ages 45 to 75 by deprivation outside the UK; consistent risk-factor prevalence series across countries; Japan and Korea, where the trajectory differs.