The long fight against heart disease in the United States is losing momentum. New data from the American Heart Association show that mortality gains against coronary heart disease, heart failure and stroke have slowed, and in some age groups reversed.
The AHA's 2026 Heart Disease and Stroke Statistics were published January 21 in Circulation. The annual report is the country's most closely watched snapshot of cardiovascular health, and this year's message is mixed.
Cardiovascular disease killed 915,973 Americans in 2023, down from 941,652 the year before. The age-adjusted death rate dipped from 224.3 to 218.3 per 100,000.
But the report warns that most of the underlying risk factors, from blood pressure control to physical activity, are moving in the wrong direction.
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Writing committee chair Latha P. Palaniappan, a Stanford University cardiovascular medicine professor, said the top-line trend is a bright spot.
"The good news is that, overall, fewer people are dying from any cause, and death rates are improving as life expectancy continues to rebound after the COVID-19 pandemic," she said.
Nearly half of adults live with cardiovascular disease
Heart disease accounted for about 22 percent of US deaths in 2023, with coronary heart disease alone causing 349,470 of them. Stroke killed 162,639 people and is now the fourth-leading cause of death, replacing COVID-19.
Between 2021 and 2023, roughly 130.6 million US adults, or 48.9 percent, had some form of cardiovascular disease.
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Some age groups are getting worse, not better. Stroke deaths among adults ages 25 to 34 rose 8.3 percent from 2013 to 2023, and among those over 85 they climbed 18.2 percent.
Vice-chair Sadiya S. Khan, of Northwestern University Feinberg School of Medicine, said the trend in younger adults is a warning.
"These numbers should ring alarm bells, particularly among young adults, because that's a snapshot into our future," she said.
Up to 40 percent of these deaths could be avoided
The report's most actionable finding comes from the AHA's Life's Essential 8, the cluster of eight measures that describe cardiovascular health.
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According to the update, optimal scores on these measures could prevent up to 40 percent of annual all-cause and cardiovascular deaths in US adults.
The eight measures are healthy diet, physical activity, avoiding nicotine, healthy sleep, healthy weight, healthy blood lipids, healthy blood glucose, and healthy blood pressure. On most of them, Americans are falling short.
Only 25.3 percent of adults meet national physical activity guidelines, and diet scores are the lowest of the eight measures among adults and youth, Palaniappan said.
Blood pressure control among treated adults fell from 54.1 percent in 2013 to 48.3 percent in 2023. About 47.3 percent of adults now have high blood pressure.
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Not everything is worsening. Adult cigarette smoking dropped from 10.8 percent in 2017 to 7.9 percent in 2023, one of the few Life's Essential 8 metrics moving in the right direction.
The eight behaviors that reduce risk
For readers looking for a practical checklist, the AHA groups Life's Essential 8 into everyday habits and health numbers to track with a clinician.
The daily habits are eating a diet heavy in vegetables, fruit, whole grains, beans, nuts and lean protein; being physically active most days of the week; staying off cigarettes, e-cigarettes and other nicotine; and sleeping seven to nine hours a night for most adults.
The numbers to watch are body mass index, non-HDL cholesterol, fasting blood glucose, and blood pressure, with an optimal target of below 120/80 mm Hg.
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Diet and physical activity carry particular weight in the preventable share, because they scored lowest across the population and directly shape weight, blood pressure, cholesterol and blood sugar. AHA president Stacey E. Rosen framed the ceiling this way.
"We know that as much as 80% of heart disease and stroke is preventable with lifestyle changes," she said.
People with symptoms of heart disease or stroke, or with a family history that worries them, should talk with their doctor before making major changes to diet, exercise or medication.