Although cardiovascular disease is the leading cause of death in the U.S., the overall mortality rate of cardiovascular disease has continued to decline over the last decade, driven mostly by a decrease in coronary heart disease (CHD) mortality, according to a research letter published Nov. 16 in the  Journal of the American Medical Association.

Spearheaded by Matthew Ritchey, DPT, and his team of co-authors, mortality data was obtained from the U.S. Centers for Disease Control and Prevention's WONDER database, containing death certificate information from every U.S. state and the District of Columbia. Analyzing the window between 2000-2010 among U.S resident aged 35 years or older with an underlying cause of death identified by CHD, heart failure, hypertensive heart disease, valvular heart disease, arrhythmia, pulmonary heart disease, or other heart disease, each subtype's percentage contribution to total heart disease deaths was calculated.

Results showed that during 2000-2010, there were 7,102,778 heart disease deaths, with a mean of 645,707 per year. Each year however, the mortality rates declined for total heart disease (-3.8 percent [95 percent CI, -4.0 percent to -3.5 percent; P<.001) and coronary heart disease (-5.1 percent [95 percent CI, -5.3 percent to -4.8 percent]; P<.001). Though the mortality from most other subtypes declined, mortality showed evident annual increase for hypertensive heart disease (1.3 percent [95 percent CI, 0.8 percent to 1.8 percent]; P<.001) and arrhythmia (1.0 percent [95 percent CI, 0.3 percent to 1.7 percent]; P<.001). Demographically, while hypertensive heart disease rates increased among non-Hispanic whites and remained unchanged among non-Hispanic blacks, it was higher among non-Hispanic blacks in 2010 (50.9 per 100,000 vs. 17.9 per 100,00 among non-Hispanic whites). By 2010, excluding coronary heart disease and other heart disease, the leading cause of heart disease-related death was hypertensive heart disease among adults aged 35-54 years (12.1 percent) and those aged 55 to 74 years (6.7 percent); for those aged 75 years or older, it was heart failure (12.2 percent).

Ultimately, Ritchey and his co-authors argue that "despite a continued decrease in overall heart disease mortality, considerable burden still exists. Public health and clinical communities should continue to develop and rigorously apply evidence-based interventions to prevent and treat coronary heart disease as well as other heart disease subtypes such as hypertensive heart disease and arrhythmia."

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