Total deaths from heart disease, stroke, diabetes and hypertension—known collectively as cardiometabolic disease—have been increasing since 2011, a new Northwestern Medicine study shows. Cardiometabolic disease is the leading cause of preventable death worldwide.

While the overall rate of heart disease deaths decreased over time, the rate of decline slowed after 2010, the study found. Deaths from stroke and diabetes declined from 1999 to 2010 but leveled off after that. Deaths from high blood pressure increased between 1999 and 2017. Cardiometabolic death rates for black Americans remain higher than those for white Americans, the study found.

The findings will be published August 27 in JAMA.

"We know the majority of deaths attributable to cardiometabolic disease are preventable," said senior author Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. "Our findings make it clear that we are losing ground in the battle against cardiovascular disease. We need to shift our focus as a nation toward prevention to achieve our goal of living longer, healthier and free of cardiovascular disease."

Until 2011, advancements in the diagnosis and medical and surgical treatment of cardiovascular disease had led to significant declines in deaths related to heart disease, stroke, diabetes and high blood pressure Khan said. Since then, however, age-adjusted mortality rates due to heart disease, stroke and diabetes have flattened, and death rates due to hypertension are increasing.

The scientists examined data from all United States deaths between 1999 and 2017 from the Centers for Disease Control's Wide-Ranging Online Database for Epidemiological Research (WONDER), with a specific focus on deaths caused by heart disease, stroke, diabetes and hypertension. They adjusted for age to account for different ages in the population.

The culprit, Khan said, may be the rise in obesity in recent decades. Although this dataset did not allow for identification of the causes of the worsening cardiometabolic disease trends, the prevalence of obesity has risen significantly since 2011, and obesity is a major risk factor for heart disease, Khan said.

"Cornerstones of good cardiometabolic health include maintaining a normal body weight, eating a healthful diet, staying physically active and not smoking," said first author Dr. Nilay Shah, a cardiology fellow at Feinberg and Northwestern Medicine. "These actions are important to preventing heart disease, no matter your age."

It is critical that prevention and management of risk factors for cardiometabolic health begins early in life, Khan said. This means consulting your doctor to assess your risk factors and engaging in heart-healthy behaviors.

Additionally, Khan said policy makers need to develop public health prevention strategies to support Americans in eating a healthy diet and having safe places to exercise in their neighborhoods, and increasing Americans' access to affordable health care and medications to equitably improve cardiovascular health on the population level.