---
type: source
title: "JACC Data Report: Cardiovascular Disease Mortality Trends in the United States (1999-2023)"
author: "Yan et al. / Journal of the American College of Cardiology"
url: https://www.jacc.org/doi/10.1016/j.jacc.2025.05.018
date: 2025-06-25
domain: health
secondary_domains: []
format: research-paper
status: processed
processed_by: vida
processed_date: 2026-04-03
priority: high
tags: [cardiovascular-disease, mortality-trends, hypertension, heart-failure, ischemic-heart-disease, US-population, 1999-2023, belief-1, CVD-bifurcation]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

JACC Data Report by Yan et al. analyzing CDC WONDER database for CVD mortality trends across subtypes in the United States from 1999 to 2023. Published June 2025.

**Key findings:**

**Overall trend:**
- Age-adjusted mortality rate (AAMR) for underlying CVD deceased 33.5% overall (1999-2023): 350.8 → 218.3 deaths per 100,000
- 2021 COVID pandemic spike: jumped to 233.3 before resuming decline

**By CVD subtype — divergent trends:**

*Declining:*
- **Ischemic heart disease:** AAMR declined over study period — the primary driver of the aggregate CVD improvement
- **Cerebrovascular disease (stroke):** AAMR declined over study period

*Increasing — alarming reversal:*
- **Hypertensive disease:** AAMR doubled from 15.8 (1999) to 31.9 (2023) — "becoming the fastest rising underlying cause of cardiovascular death" and since 2022, the leading CONTRIBUTING cardiovascular cause of death
- **Heart failure:** AAMR originally declined from 20.3 (1999) to 16.9 (2011) — then spiked to 21.6 in 2023, the highest recorded value, exceeding its 1999 baseline

**The bifurcation mechanism:**
The JACC authors identify the structural pattern: improvements in acute ischemic care (stenting, thrombolytics, statins) have reduced ischemic mortality, but these same interventions leave patients alive with underlying metabolic risk burden (obesity, hypertension, diabetes) that drives heart failure and hypertensive mortality over time. Better survival from MI → larger pool of post-MI patients → more heart failure downstream.

**Geographic and demographic note:**
Hypertensive disease and HF increases are disproportionate in:
- Southern states (higher baseline obesity, lower healthcare access)
- Black Americans (structural hypertension treatment gap)
- Rural areas vs. urban areas

**Paired context:**
The ACC Journal Scan summary (June 25, 2025) explicitly headlines: "How Have CVD Mortality Trends in the US Changed Since 1999?" — signaling this data is being interpreted as divergent, not uniformly improving.

## Agent Notes
**Why this matters:** This is the most rigorous single paper establishing the bifurcation pattern in US CVD mortality. The JACC Data Report format means it uses the gold-standard CDC WONDER database with full 1999-2023 time series. It provides the analytical foundation for a specific new claim: the aggregate CVD improvement metric masks structural worsening in the cardiometabolic drivers. This directly bears on whether the CDC 2026 life expectancy record represents genuine structural health progress.
**What surprised me:** Heart failure mortality in 2023 (21.6/100k) now EXCEEDS its 1999 baseline (20.3/100k). HF mortality declined to 16.9 in 2011 — then reversed entirely. The US has gone backward on heart failure over 12 years. This is not in the existing KB and is a significant finding.
**What I expected but didn't find:** Any evidence that the bifurcation is reversing. The 2023 data is the most recent available and shows HF continuing to rise. GLP-1 impact is not yet visible.
**KB connections:** Directly supports and extends: Abrams AJE 2025 (CVD stagnation pervasive); PNAS Shiels 2020 (CVD primary driver); CDC 2026 life expectancy record. Provides the subtype-level decomposition that the KB's existing CVD claims lack.
**Extraction hints:**
- "US heart failure mortality in 2023 (21.6/100k) exceeds its 1999 baseline (20.3/100k) after declining to 16.9 in 2011 — a complete reversal that represents structural cardiometabolic deterioration despite improving acute ischemic care"
- "Hypertensive disease mortality doubled in the US 1999-2023 (15.8 → 31.9/100k), becoming the leading contributing cause of cardiovascular death since 2022 — driven by obesity, sedentary behavior, and treatment gaps that pharmacological acute care cannot address"
**Context:** Yan et al. in JACC; data from CDC WONDER database; companion to AHA 2026 statistics update. Both sources agree on the bifurcation pattern.

## Curator Notes
PRIMARY CONNECTION: AHA 2026 stats (companion); Abrams AJE 2025 (CVD stagnation); PNAS Shiels 2020 (CVD primary driver)
WHY ARCHIVED: Provides rigorous 25-year subtype-level decomposition of CVD mortality — most granular evidence for bifurcation claim. The HF reversal finding (back above 1999 baseline by 2023) is new and significant.
EXTRACTION HINT: The "bifurcation claim" (ischemic declining / HF+HTN worsening) should be extracted as a new claim with high confidence — this is proven, multi-source, CDC WONDER data.
