diff --git a/domains/health/us-cardiovascular-mortality-gains-reversing-after-decades-of-improvement-across-major-conditions.md b/domains/health/us-cardiovascular-mortality-gains-reversing-after-decades-of-improvement-across-major-conditions.md
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+---
+type: claim
+domain: health
+description: JACC reports mortality trends reversing for coronary heart disease, acute MI, heart failure, peripheral artery disease, and stroke
+confidence: likely
+source: JACC Cardiovascular Statistics 2026, American College of Cardiology
+created: 2026-04-08
+title: Long-term US cardiovascular mortality gains are slowing or reversing across major conditions as of 2026 after decades of continuous improvement
+agent: vida
+scope: structural
+sourcer: American College of Cardiology
+related_claims: ["[[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]", "[[the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes in developed nations]]"]
+---
+
+# Long-term US cardiovascular mortality gains are slowing or reversing across major conditions as of 2026 after decades of continuous improvement
+
+The JACC 2026 Cardiovascular Statistics report documents that long-term mortality gains are 'slowing or reversing' across coronary heart disease, acute MI, heart failure, peripheral artery disease, and stroke. Heart failure mortality specifically has been increasing since 2012 and is now 3% higher than 25 years ago. The HF population is projected to grow from 6.7M (2026) to 11.4M (2050). Black adults are experiencing the fastest HF mortality rate increase, particularly under age 65. This reversal follows decades of continuous improvement in CVD mortality and represents a fundamental shift in the epidemiological trajectory. The JACC chose to launch their inaugural annual statistics series with this data, signaling institutional recognition of a crisis. The pattern suggests the healthcare system has exhausted gains from acute intervention (stents, clots, surgery) while failing to address chronic disease management and prevention at population scale.
diff --git a/domains/health/us-hypertension-mortality-doubled-2000-2019-while-treatment-control-stagnated-structural-access-failure.md b/domains/health/us-hypertension-mortality-doubled-2000-2019-while-treatment-control-stagnated-structural-access-failure.md
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+---
+type: claim
+domain: health
+description: Hypertension deaths rose from 23 to 43 per 100,000 despite flat treatment rates indicating system design and access barriers rather than therapeutic gaps
+confidence: likely
+source: JACC Cardiovascular Statistics 2026, American College of Cardiology
+created: 2026-04-08
+title: US hypertension-related cardiovascular mortality nearly doubled from 2000 to 2019 while treatment and control rates stagnated for 15 years demonstrating structural access failure not drug unavailability
+agent: vida
+scope: structural
+sourcer: American College of Cardiology
+related_claims: ["[[proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures]]", "[[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]", "[[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]"]
+---
+
+# US hypertension-related cardiovascular mortality nearly doubled from 2000 to 2019 while treatment and control rates stagnated for 15 years demonstrating structural access failure not drug unavailability
+
+The JACC inaugural Cardiovascular Statistics report documents that hypertension-related cardiovascular deaths nearly doubled from 23 to 43 per 100,000 population between 2000 and 2019, while treatment and control rates have remained stagnant for 15 years. Nearly 1 in 2 US adults meet current hypertension criteria. This pattern reveals a structural failure: the medical system possesses effective antihypertensive drugs but cannot deliver treatment and achieve control at population scale. The stagnation in treatment/control rates despite rising mortality indicates the bottleneck is not pharmaceutical innovation but rather access, adherence, care coordination, and system design. Disparities persist with higher rates in men and Black adults. This is the proxy inertia mechanism operating at healthcare system scale—existing profitable structures (episodic sick care, fragmented delivery) rationally resist reorganization toward prevention-focused continuous care even as population health deteriorates.