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AHA 2021 Statistical Update: Pandemic Impact on CVD Will Be "Exponential"



Heart disease, again the leading cause of death worldwide, may remain so for many years as a result of COVID-19 pandemic conditions, says AHA Update Writing Committee Chair.



Heart disease continues to be the leading cause of death worldwide, according to the American Heart Association’s (AHA) 2021 Statistical Update. Moreover, the report cautions, the universal impact of the coronavirus disease 2019 (COVID-19) pandemic may secure that #1 spot for years to come.

Published in the AHA’s journal Circulation, in late January, the Heart Disease and Stroke Statistical Update reports a global cardiovascular disease- (CVD) related death toll of nearly 18.6 million for 2019, the latest year for which worldwide statistics are calculated—a 17.1% increase over the past decade, according to a statement from the AHA. Cases of CVD in 2019 increased by 26.6% compared with 2010, reaching a total of more than 500 million.

The long-term effects of the COVID-19 pandemic, experts warn, may cause rates of CVD and associated mortality to grow “exponentially” over the next few years, notes the press release.

“COVID-19 has taken a huge toll on human life worldwide and is on track to become one of the top 3 to 5 causes of death in 2020. But its influence will directly and indirectly impact rates of cardiovascular disease prevalence and deaths for years to come,” said Salim S. Virani, MD, PhD, chair of the writing committee for the 2021 Statistical Update and an associate professor in cardiology and cardiovascular research sections at Baylor College of Medicine in Houston, Texas.

“Research is showing that the unique coronavirus can cause damage to the heart. Importantly, we also know people have delayed getting care for heart attacks and strokes, which can result in poorer outcomes.”

Salim S. Virani, MD, PhD,
Writing Committee Chair,
AHA 2021 Statistical Update

Virus-related damage to the heart and the potential for damage caused by lack of timely medical care will be compounded, says Virani in the AHA statement, by the impact of behaviors known to increase the risk of CVD and stroke, including poor eating habits, increased use of alcohol, decreased physical activity, and the emotional stress of isolation. Virani says these trends must be followed carefully and addressed as the “full ramifications” of the past and present conditions evolve over time. 

US statistics

Data for the United States included in the Update is from 2018 and shows that CVD was the leading cause of death (42.1%), followed by stroke (17.0%), hypertension (11.0%), heart failure (9.6%), diseases of the arteries (2.9%), and other CVD (17.4%). Heart disease in the US is responsible for more fatalities than all forms of cancer and chronic lower respiratory disease combined.


The 2021 report includes an enhanced focus on social determinants of health, with a section in each chapter detailing the impact of socioeconomic inequities on health. In the US, data from 2015 to 2018 showed that 58.8% of non-Hispanic (NH) Black females and 60.1% of NH Black males had some form of CVD. The prevalence of prediabetes was also higher in NH Black adolescents (21.0%) and Hispanic adolescents (22.9%) than in NH whites (15.1%).


In the US, 34.2% of children aged 2 to 19 years were overweight or obese, according to data from 2013 to 2016. Data from the same time frame showed that 69.9% of US adults over the age of 20 were overweight or obese; 38.3% were obese.

Pregnancy outcomes and heart disease

For the first time, a chapter was included on adverse pregnancy outcomes. In the US, cardiovascular deaths are the most common cause (26.5%) of maternal death. Ten percent to 20% of US pregnancies have included complications such as hypertensive disorders, gestational diabetes, preterm births, and small for gestational age at birth.

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