Cardiovascular disease

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. Behind the death rates, the conditions that lead to them are moving in different directions: heart attacks are fewer, while heart failure and atrial fibrillation are more common, partly because more people survive to the ages where they occur and partly because obesity and diabetes have risen in the cohorts now reaching them.

Detection has improved unevenly. Blood-pressure and cholesterol measurement is routine, yet in most countries a large share of hypertension is still undiagnosed or untreated, and the health-check programmes meant to find it reach the people least at risk best. Newer tools — lipoprotein(a) testing, polygenic scores, algorithms that read electrocardiograms — are in trials rather than in population use.

Treatment and prevention are where the evidence is strongest and the population effect least visible. Statins, blood-pressure drugs and the decline of smoking account for most of the gains already banked; the GLP-1 trials add a new term, a drug class that reduces cardiovascular events in people with obesity, whose effect has not yet appeared in any national series. Studies decompose the slowdown differently depending on which they measure, and no cross-country decomposition has apportioned it.

The deaths themselves say two things. The pandemic disrupted diagnosis and treatment for two years and produced excess deaths at home from cardiovascular causes in 2020 and 2021. The post-pandemic years are the test: whether improvement resumes at its earlier rate, continues at the slower one, or has been reset. The first years of data point 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 at pre-2011 rates.

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.