Lori Kubitz’s eyes popped open at 4 a.m. “like an alarm went off in my brain.” She could barely breathe. The pain in her chest felt like a bonfire. Her jaw hurt so much that she thought it would explode. As the sun rose over her lakeside cabin in Pelican Rapids, Minnesota, her husband rushed her to the nearest hospital, some 30 minutes away.
“I was scared,” she says. Her father had died of a heart attack.
But Kubitz was just 54 years old. She didn’t smoke. Her cholesterol was normal, her weight and blood pressure “just a little” high. “I thought heart attacks happened to heavy smokers, people who were 50 pounds overweight and people in their 70s and 80s,” she says.
When she reached the hospital, blood tests and heart scans confirmed her worst fear. Her left anterior descending artery, the heart’s largest, was 99.9 percent blocked. “They were wheeling me into surgery,” she recalls. “I thought, Am I going to die? ”
Kubitz’s out-of-the-blue heart attack illustrates a scary new reality. After decades of steady decline, heart disease — long America’s number 1 killer and the third-leading cause of disability — is screaming back with life-changing and often fatal consequences.
Return of the killer
It was 1948 when President Harry Truman signed the National Heart Act, establishing the National Heart Institute (now the NationalHeart, Lung and Blood Institute). Truman also funded the landmark Framingham Heart Study, the world’s longest-running population study of heart disease.
For the next six decades, thanks to the explosion in both research and treatment, we were winning the war on heart disease. Deaths from heart attacks, heart failure, heart rhythm disorders and related conditions fell a stunning 69 percent between 1950 and 2009. But lately, the good news has been overshadowed by major reversals.
“We’re looking at a crisis in terms of lowering life expectancy for the first time in decades,” says cardiologist Sadiya Khan, M.D., assistant professor of medicine and of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. News reports might point to COVID and the opioid crisis as the drivers of this shift in overall life expectancy, but a 2022 report from the Centers for Disease Control and Prevention (CDC) also lists the rising rate of heart disease deaths as a major reason for that decline.
Among the new heart-health trends that are deeply concerning to Khan and other cardiologists:
- Midlife and younger adults are dying of heart diseases more often. Death rates from heart diseases rose 8.5 percent for adults ages 45 to 64 between 2010 and 2020, says Stephen Sidney, M.D., director of research clinics with Kaiser Permanente Northern California.
- Record numbers of older adults are dying too. Fatalities due to heart disease among 65-plus Americans rose from 475,097 in 2011 to 556,665 in 2020 (more recent data isn’t yet available). Interestingly, the heart-disease death rate fell over those years; however, the big growth in America’s older population means a rise in total deaths.
- The COVID pandemic injected rocket fuel into the heart disease resurgence. In 2020 and 2021, heart attack deaths increased by up to 21 percent for those 45 to 64 and 17.9 percent for people 65 and older, according to a Cedars-Sinai Medical Center study. That might simply be a side effect of the pandemic’s long-term legacy of weight gain, inactivity and stress. But the virus itself may be playing a direct role: A large 2022 study found lingering heart risks a year after COVID infection. Cleveland Clinic cardiologist Larisa Tereshchenko, M.D., told the journal Science that contracting COVID could emerge as the number 1 risk factor for future heart disease.
Beyond heart attacks
In 2011, graphic designer James L. Young II stood in a Detroit parking lot, gasping for air. He was just 40 years old. But years of smoking, beer and lots of fast food had left him with high blood pressure, type 2 diabetes and kidney disease.
He ended up in a hospital emergency room. “The cardiologist on staff said, ‘If you’d waited one more week to come to this facility, we’d be talking about you in the past tense.’ That’s a wake-up call.”
Young wasn’t suffering a heart attack. He had congestive heart failure, a condition in which the heart is unable to pump blood efficiently. Doctors recommended implanting a pacemaker. “What’s option B?” Young asked. The cardiologist gave him about a month to improve his heart function by losing weight and exercising. He swapped breakfast bacon for sautéed kale, quit smoking and drinking, gave up fast food and started walking. At first he made it just a quarter of the way around a local high school track. But he soon built up to 10 to 12 miles a day as he listened to house music through his earbuds.
Over time, Young lost weight, reduced his medications, ran a couple of half-marathons and returned to college. Now 51, he’s a graduate student in public health at Purdue University and an American Heart Association national ambassador, telling his personal story and serving on an AHA committee that awards funds to heart-disease researchers. “Drinking, smoking and heavy eating were my Band-Aids,” Young says. “I had to learn to value myself as a human being.”
As Young discovered, cardiovascular disease isn’t just about heart attacks. It’s a broad category of disorders that covers the blood vessels, muscle, electrical system and valves, as well as the functioning of the heart. (That’s why clots in your leg veins are technically a type of cardiovascular disease.) That said, the primary forms of heart disease include:
- Coronary artery disease (CAD), when plaque narrows or blocks blood vessels that deliver oxygen and fuel to your heart muscle; this is the classic cause of heart attack.
- Heart rhythm problems (such as atrial fibrillation, or A-fib), when the heart’s natural electrical system stops functioningnormally, making heartbeats erratic, too fast or too slow.
- Heart valve malfunctions and heart failure, which is when the heart loses its capacity to pump efficiently, often due to damage from a heart attack, high blood pressure, diabetes or CAD.
Cardiovascular disease also includes stroke, which is caused by blockages or bleeding in blood vessels in the brain. All told, cardiovascular disease is expected to have killed more than 650,000 Americans in 2022. (That’s roughly 1 in every 5 deaths.). Each year, 2.5 million of us are expected to have a heart attack or undergo a procedure to open or bypass clogged coronary arteries, and 7 million more will live with chest pain triggered by narrowing of those blood vessels, according to the CDC.
Overall, 77.5 percent of men and 75.4 percent of women ages 60 to 79 have some form of cardiovascular disease, according to a 2021 report from the American Heart Association; among those of us 80 and older, 90 percent have it.
Victory and loss
Heart disease wasn’t always a major killer. In fact, it was relatively uncommon in the U.S. in 1900, when life expectancy was a cruel 47.3 years and pneumonia, flu and other infections were the top killers. But with the discovery of vaccines and antibiotics, everyday infections and injuries became less lethal. At the same time, another health-related seismic shift occurred: the rise of unhealthy living. During World War II, Americans began to smoke more, sit more at work, eat more saturated fat — and we became enamored with sugar and processed foods. The result: Untold millions of Americans upholstered their coronary arteries with gunky, fatty plaque.
Between 1940 and 1948, heart disease deaths soared by 20 percent. That emerging crisis prompted President Truman to fund the National Heart Act and the Framingham Heart Study. When researchers began the study, so little was known about heart disease that their budget, ironically, included money for office ashtrays.
The early findings of this new research push were bombshells: Smoking, high blood pressure, diabetes and being overweight all contributed to heart attack risk — obvious today but groundbreaking information in its day. And so a worried nation slowly began changing its habits. Heart disease death rates began dropping in 1968 — so fast that in 1978, the National Institutes of Health held a conference to determine whether the improvements were for real.