Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

Each year, the American Heart Association, in conjunction with the National Institutes of Health and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors in the AHA’s Life’s Essential 8 ( Figure ), 1 which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease produces immense health and economic burdens in the United States and globally. The Statistical Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular heart disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have been cited >20 000 times in the literature. Each annual version of the Statistical Update undergoes revisions to include the newest nationally representative available data, add additional relevant published scientific findings, remove older information, add new sections or chapters, and increase the number of ways to access and use the assembled information. This year-long process, which begins as soon as the previous Statistical Update is published, is performed by the AHA Statistics Committee faculty volunteers and staff and government agency partners. Below are a few highlights from this year’s Statistical Update. Please see each chapter for references, confidence intervals for statistics reported below, and additional information. From 2013 to March 2020, the overall CVH score combining health scores of all 8 components of the Life’s Essential 8 was, on average, 73.6 for all US children between 16 and 19 years of age. The corresponding mean overall CVH score was 78.4 for NH Asian, 74.1 for NH White, and 71.3 for NH Black children. During the same period, the mean overall CVH score was 65.2 for all US adults, with a mean score of 69.6 for NH Asian, 66.0 for NH White, and 59.7 for NH Black adults. A report based on data from the UK Biobank found that having ideal CVH over poor CVH attenuated the all-cause and cardiometabolic disease–related mortality for males and females and was associated with life expectancy gains of 5.50 years for males and 4.20 years for females, at an index age of 45 years, among participants with cardiometabolic diseases and correspondingly 4.55 years in males and 4.89 years in females for people without cardiometabolic diseases. As of July 1, 2022, the cumulative number of COVID-19 (coronavirus disease 2019) deaths in the United States was 1 014 620, which equates to ≈306 deaths per 100 000 people. In metropolitan areas in the United States, the cumulative COVID-19 death rate was ≈292 deaths per 100 000 compared with ≈392 deaths per 100 000 in nonmetropolitan areas. In US counties with a high percentage (>17.3%) of the population in poverty, the cumulative COVID-19 death rate was ≈394 deaths per 100 000 compared with ≈248 deaths per 100 000 in counties with a low percentage (0.0%–12.3%) of the population that is living in poverty. As a result of the high COVID-19 mortality rates, life expectancy (at birth) in the United States decreased from 78.8 years in 2019 to 77.0 years in 2020 (−1.8 years) overall, and the corresponding life expectancy decreased from 76.3 to 74.2 years (−2.1 years) in males and decreased from 81.4 to 79.9 years (−1.5 years) in females. The prevalence of cigarette use in the past 30 days among middle and high school students in the United States was 1.0% and 1.9%, respectively, in 2021. Although there has been a consistent decline in adult and youth cigarette use in the United States in the past 2 decades, significant disparities persist. In 2020, substantially higher tobacco use prevalence rates were observed in American Indian/Alaska Native and lesbian, gay, and bisexual adults compared with White and heterosexual/straight adults (27.1% American Indian/Alaska Native versus 13.3% White; 16.1% lesbian, gay, and bisexual versus 12.3% heterosexual/straight adults). Electronic cigarettes were the most commonly used tobacco product among adolescents in 2021; the prevalence of use in the past 30 days among middle and high school students in the United States was 2.8% and 11.3%, respectively, with the majority of adolescent users using flavored electronic cigarettes (85.8% of high school students and 79.2% of middle school students). According to parental report in 2019 to 2020, the nationwide prevalence of youth 6 to 17 years of age who were active ≥60 minutes every day of the week was 20.6%. According to self-report in 2018, the age-adjusted proportion of adults who reported meeting the aerobic PA guidelines for Americans (≥150 min/wk of moderate PA, ≥75 min/wk of vigorous PA, or an equivalent combination of the two) through leisure-time activities was 54.2%. Among 67 762 adults with >20 years of follow-up, 8.7% of all-cause mortality was attributed to a PA level of <150 min/wk of moderate-intensity PA. The first study to use the AHA’s Life’s Essential 8 to quantify the CVH levels of adults and children in the United States included data from 23 409 individuals 2 through 79 years of age (13 521 adults and 9888 children) participating in NHANES (National Health and Nutrition Examination Survey). The adults in the study population represent 201 728 000 adults, and the children in the study represent 74 435 000 children. The composite CVH score ranges from 0 (lowest) to 100 (highest). Of the 8 metrics, diet was among the 4 with the lowest scores. The range of scores for diet across demographic groups was 23.8 to 47.7. Among children 2 to 5 years of age, a mean diet score of 61.1 was observed. The score for children 12 to 19 years of age was 28.5. A meta-analysis of 38 prospective cohort studies showed that the relative risk (RR) for the highest versus the lowest categories of Mediterranean diet adherence was 0.79 for total CVD mortality, 0.73 for CHD incidence, 0.83 for CHD mortality, 0.80 for stroke incidence, 0.87 for stroke mortality, and 0.73 for myocardial infarction incidence. Compared with a usual Western diet, a Dietary Approaches to Stop Hypertension–type dietary pattern with low sodium reduced systolic blood pressure (SBP) by 5.3, 7.5, 9.7, and 20.8 mm Hg in adults with baseline SBP <130, 130 to 139, 140 to 149, and ≥150 mm Hg, respectively. According to data from NHANES from 2017 until March 2020, among US children and adolescents 2 to 19 years of age, the prevalence of being either overweight or obese was 36.8%, with obesity prevalence of 19.8%. The highest prevalence of obesity was seen among Hispanic male and NH Black female youth. According to data from NHANES from 2017 until March 2020, the age-adjusted prevalence of overweight or obesity among adults ≥20 years of age in the United States was 71.2%, and the prevalence of obesity was 41.4%. The highest prevalence of obesity was among NH Black females. A large umbrella review in 2021 found that every 5–kg/m 2 increase in body mass index was associated with a 15% increased risk for CHD, 23% increased risk for atrial fibrillation (AF), 41% increased risk for HF, and 49% increased risk for hypertension. Among adolescents in 2017 to 2020, low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL occurred in 5.0% of male adolescents and 4.6% of female adolescents, LDL-C levels <40 mg/dL occurred in 19.3% of male adolescents and 8.6% of female adolescents, and triglycerides ≥130 mg/dL occurred in 7.2% of male adolescents and 6.2% of female adolescents. In 2017 to 2020, among adults, total cholesterol ≥200 mg/dL occurred in 32.8% of males and 36.2% of females, LDL-C ≥130 mg/dL occurred in 25.6% of males and 25.4% of females, and high-density lipoprotein cholesterol <40 mg/dL occurred in 24.9% of males and 9.3% of females. With the use of the most recent 2017 definition, the age-adjusted prevalence of hypertension among US adults ≥20 years of age was estimated to be 46.7% in NHANES in 2017 to 2020 (50.4% for males and 43.0% for females). This equates to an estimated 122.4 million adults ≥20 years of age who have high blood pressure (62.8 million males and 59.6 million females). A higher percentage of males than females had hypertension up to 64 years of age, but for those ≥65 years of age, the percentage of females with hypertension was higher than for males. In an individual patient meta-analysis of 33 trials including 260 447 participants with 15 012 cancer events, no associations were identified between any antihypertensive drug class and risk of any cancer (hazard ratio [HR], 0.99 for angiotensin-converting enzyme inhibitors; HR, 0.96 for angiotensin receptor blockers; HR, 0.98 for β-blockers; HR, 1.01 for thiazides), except for calcium channel blockers (HR, 1.06). In a network meta-analysis comparing each drug class with placebo, no drug class was associated with an excess cancer risk (HR, 1.00 for angiotensin-converting enzyme inhibitors; HR, 0.99 for angiotensin receptor blockers; HR, 0.99 for β-blockers; HR, 1.04 for calcium channel blockers; HR, 1.00 for thiazides). In an open-label, cluster-randomized trial involving 20995 individuals from 600 villages in rural China, the use of a salt substitute (75% sodium chloride and 25% potassium chloride by mass) compared with the use of regular salt (100% sodium chloride) resulted in a lower incidence of stroke (RR, 0.86), all-cause mortality (RR, 0.88), and major adverse cardiovascular event (RR, 0.87). There was no increase in rates of hyperkalemia with use of the salt substitute (RR, 1.04). Overall, on the basis of 2017 to 2020 data, 29.3 million adults (10.6%) in the United States had diagnosed diabetes. Data from the CALIBER UK cohort show the most common initial CVD complications for those with diabetes to be peripheral artery disease (16.2%) and HF (14.1%), followed by stable angina (11.9%), nonfatal myocardial infarction (11.5%), and stroke (10.3%). Data from the US Diabetes Collaborative Registry of 74 393 adults with diabetes demonstrate a prevalence of 74% with hemoglobin A1c <7%, 40% with blood pressure <130/80 mm Hg, and 49% with LDL-C <100 mg/dL (<70 mg/dL if with atherosclerotic cardiovascular disease), but only 15% at target for all 3 factors. From 1999 to 2018, the prevalence of metabolic syndrome among US youths remained stable at 4.36%. Among adults, the prevalence of metabolic syndrome increased from 36.2% to 47.3%. According to the data from NHANES 1999 to 2018, the prevalence of metabolic syndrome among youths 12 to 19 years of age was 4.34% for NH White, 3.66% for NH Black, 7.70% for Mexican American, 4.84% for other Hispanic, and 1.84 for other race youths. In 2017 to 2018, Mexican American adults generally had the highest prevalence of metabolic syndrome at 52.2%, whereas NH White adults had 46.6%, NH Black adults had 47.6%, other Hispanic adults had 45.9%, and Asian/other adults had 46.7%. Rates of overall hypertensive disorders of pregnancy are increasing. Analysis of delivery hospitalizations from the National Readmission Database reported a rate of hypertensive disorders of pregnancy of 912.4 per 10 000 delivery hospitalizations in 2014 compared with 528.9 in 1993 in the United States. Specific aspirin dosage and preeclampsia prevention were studied in 23 randomized trials (32 370 females). Females assigned at random to 150 mg experienced a 62% reduction in risk of preterm preeclampsia (RR, 0.38). Aspirin doses <150 mg produced no significant reductions. The number needed to treat with 150 mg of aspirin was 39. There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses. In a cohort of 595 pregnant females in 4 US cities, perceived discrimination (self-reported as based on sex, race, income level or social status, age, and physical appearance) was associated with development of gestational diabetes. Gestational diabetes occurred in 12.8% of females in the top quartile of a self-reported discrimination scale versus 7.0% in all others (adjusted odds ratio [OR], 2.11, adjusted for age, income, parity, race and ethnicity, and study site); 22.6% of this association was statistically mediated by obesity. The overall prevalence of chronic kidney disease (estimated glomerular filtration rate <60 mL·min −1 ·1.73 m −2 or albumin-to-creatinine ratio ≥30 mg/g) in 2015 to 2018 was 14.9%. In 2019, the age-, race-, and sex-adjusted prevalence of end-stage renal disease in the United States was 2302 per 1 million people, an increase of 1.4% over 2018. Total hospitalization expenditures in Medicare fee-for-service beneficiaries with end-stage renal disease was $12.2 billion in 2019, and outpatient spending was $13.1 billion in 2019. The proportion of adults reporting insufficient sleep (65 years of age, report the lowest prevalence of insufficient sleep. NH Black adults had the highest percentage of respondents reporting sleeping <7 h/night (43.5%), whereas NH Asian adults (30.5%) and NH White adults (30.7%) had the lowest percentage of respondents reporting sleeping 65 years of age, report the lowest prevalence of insufficient sleep. NH Black adults had the highest percentage of respondents reporting sleeping <7 h/night (43.5%), whereas NH Asian adults (30.5%) and NH White adults (30.7%) had the lowest percentage of respondents reporting sleeping <7 hours. Females report never or some of the days feeling well rested on awakening in the past days more frequently than males (46.9% versus 40.4%). Data from the MIDUS study (Midlife in the United States) examined the association of a composite sleep health measure (sleep regularity, satisfaction, alertness, timing, efficiency, and duration) with risk of HD (yes/no to a question on diagnosis of HD). Each unit increase in the self-reported sleep health composite was associated with a 54% higher risk of HD, whereas the objectively measured actigraphy sleep health composite was associated with 141% higher risk. On the basis of NHANES 2017 to March 2020 data, the prevalence of CVD (comprising CHD, HF, stroke, and hypertension) in adults ≥20 years of age was 48.6% overall (127.9 million in 2020) and increases with age in both males and females. On the basis of 2020 mortality data, HD and stroke currently claim more lives each year than cancer and chronic lower respiratory disease combined. In 2020, 207.1 of 100 000 people died of HD and stroke. In 2020, 19.05 million deaths were estimated for CVD globally, which amounted to an increase of 8.71% from 2010. The age-standardized death rate per 100 000 population was 239.80, which represents a decrease of 12.19% from 2010. Overall, the crude prevalence of CVD was 607.64 million cases in 2020, an increase of 29.01% compared with 2010. However, the age-standardized prevalence rate was 7354.05 per 100 000, an increase of 0.73% from 2010. An analysis of data from the GBD 2019 study found that from 1990 to 2019, the absolute number of incident strokes increased by 70.0, whereas the age-standardized incidence rate for total stroke decreased by 17.0%. The age-standardized incidence rate for ischemic stroke decreased by 10% and intracerebral hemorrhage decreased by 29% during the same period. A meta-analysis of 11 clinical trials from 1970 to 2021 with 20 163 patients with stroke found that intensive LDL-C–lowering statin-based therapies reduced the risk of recurrent ischemic stroke (RR, 0.88) compared with less intensive LDL-C–lowering statin-based therapies. This relationship was even stronger in populations with atherosclerosis (RR, 0.79). In a meta-analysis of 66 trials of SBP-lowering interventions including 324 812 participants and 11 437 strokes over an average follow-up of 3.3 years, SBP lowering was associated with 21% lower odds of stroke compared with control. In meta-analyses of stroke types, SBP lowering was associated with 14% lower odds of ischemic stroke (6 trials), 28% lower odds of hemorrhagic stroke (6 trials), and 28% lower odds of fatal or disabling stroke (18 trials). The GBD study estimated secular trends from 1990 to 2017 in dementia prevalence, incidence, disability-adjusted life-years (DALYs), and mortality globally and for high-income countries. Globally, prevalent cases increased by 119%, annual incident cases increased by 113%, DALYs increased by 115%, and annual deaths increased by 146%. However, global age-standardized prevalence decreased by 4%, age-standardized annual incidence decreased by 5%, age-standardized DALYs decreased by 6%, and age-standardized annual mortality decreased by 4%. For high-income countries, percent increases in absolute burden measures were smaller than globally: Prevalent cases increased by 93%, annual incident cases increased by 87%, DALYs increased by 90%, and annual deaths increased by 126%. The age-standardized prevalence in high-income countries decreased by 5%, age-standardized annual incidence rate decreased by 6%, age-standardized DALYs decreased by 7%, and age-standardized annual mortality rate decreased by 4%. Among 229 976 participants in the UK Biobank, with 2143 cases of incident dementia over a median follow-up of 9 years, each 1-point increment in Life's Simple 7 score was associated with an 11% lower hazard of dementia (HR, 0.89). Each 1-point increment in the biological component score (based on blood pressure, cholesterol, and glucose) was associated with a 7% lower hazard of dementia (HR, 0.93). However, a 1-point increment in the lifestyle component score (based on smoking, body mass index, diet, and physical activity) was not associated with dementia (HR, 0.99). In the HRS (Health and Retirement Study), cognitive impairment-free life expectancy at 55 years of age was estimated as 23.0 years for participants with no hypertension, HD, diabetes, or stroke; 21.2 years for those with any 1 of those conditions; 18.1 years for those with any 2 conditions; and 14.0 years for those with any 3 or all 4 conditions. The association of CVD burden with lower cognitive impairment-free life expectancy was also observed at 65, 75, and 85 years of age, with lower absolute life expectancies. 2020 mortality related to congenital cardiovascular defects was 2817 deaths in the United States, an 11.9% decrease from the number of deaths in 2010. Socioeconomic status (SES) is a major contributor to identified differences in infant mortality among infants with critical congenital cardiovascular defects, with greater mortality among socioeconomically deprived patients (OR, 1.7). Since May 2020, the Centers for Disease Control and Prevention has been tracking reports of multisystem inflammatory syndrome in children. As of March 1, 2022, 7459 cases and 63 attributable deaths (0.84%) have been reported. Median age of cases was 9 years; 58% of cases have occurred in children who are Hispanic or Latino (1846 cases) or Black (2206 cases); 98% tested positive for SARS-2 (severe acute respiratory syndrome coronavirus 2; reverse transcriptase–polymerase chain reaction, serology, or antigen test); and 60% of reported patients were male. An analysis of the Korea National Health Insurance Service (N=66 692) classified individuals by exercise status before and after AF diagnosis. Those who maintained exercise were significantly less likely to have ischemic stroke (HR, 0.86), HF (HR, 0.92), or mortality (HR, 0.61) than those who continued to abstain from exercise after AF diagnosis. The study of social determinants and AF remains limited. In a limited-sized cohort (N=339) followed up for a median of 2.6 years (range, 0–3.4 years), individuals in the lowest income category (≤$19 999/y) had a 2.0-fold greater hospitalization risk (OR, 2.11) compared with those in the highest income category (≥$100 000/y). A multicenter trial randomized individuals with at least 1 stroke risk factor and without AF in a 1:3 ratio to receive long-term rhythm monitoring with an implanted loop recorder (n=1501) or usual care (n=4503). Over a median follow-up of 64.5 months, those randomized to monitoring were 3-fold more likely to be diagnosed with AF (HR, 3.17). Recent data describing cardiac arrest or sudden cardiac death after an acute myocardial infarction suggest that contemporary short-term (3-month) risk is 0.29% or 116 per 100 000 person-years. Laypeople in the United States initiated cardiopulmonary resuscitation in 40.2% of out-of-hospital cardiac arrests in 2021. In the United States, individuals from underrepresented racial and ethnic groups are at substantially higher risk of sudden cardiac arrest and experience worse survival and neurological outcomes after sudden cardiac arrest compared with White individuals. In the ARIC study (Atherosclerosis Risk in Communities), the sex-adjusted HR for sudden cardiac death comparing Black with White participants was 2.12, and the fully adjusted HR was 1.38. In San Francisco, Black females had a 2.55 higher incidence of sudden arrhythmic death than White females. In a study-level meta-analysis involving 10 867 participants (6699 HIV positive, 4168 HIV negative; mean age, 52 years; 86% male; 32% Black), the prevalence of noncalcified plaque was 49% in HIV-positive individuals versus 20% in HIV-negative individuals (OR, 1.23). In individuals without diabetes or CVD, higher hemoglobin A1c was associated with the extent of subclinical atherosclerosis assessed by intima-media thickness; atherosclerotic plaque of the carotids, abdominal aorta, and iliofemoral arteries; and coronary artery calcification (OR, 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for hemoglobin A1c 4.9%–5.0%, 5.1%–5.2%, 5.3%–5.4%, 5.5%–5.6%, 5.7%–5.8%, 5.9%–6.0%, and 6.1%–6.4%, respectively; reference hemoglobin A1c ≤4.8%). In the Rotterdam Study of older adults, the presence of intraplaque hemorrhage (but not calcification or lipid-rich core) by high-resolution magnetic resonance imaging demonstrated an association with incident stroke and CHD (HR, 2.42 and 1.95, respectively). According to data from the 2005 to 2014 ARIC study, the estimated annual incidence of myocardial infarction is 605 000 new attacks and 200 000 recurrent attacks. Of these 805 000 first and recurrent events, it is estimated that 170 000 are silent. An NIS (National Inpatient Sample) analysis of sex differences spanning 2004 to 2015 identified 7 026 432 hospitalizations for acute myocardial infarction. Compared with males, females were less likely to undergo coronary angiography (adjusted OR, 0.92) and percutaneous coronary intervention (adjusted OR, 0.82), Females had a higher risk of mortality (adjusted OR, 1.03) compared with males. In 2020, CHD age-adjusted death rates per 100 000 were 128.5 for NH White males, 153.6 for NH Black males, and 102.2 for Hispanic males. For NH White females, the rate was 63.8; for NH Black females, it was 85.9; and for Hispanic females, it was 54.2. On the basis of data from NHANES 2017 to 2020, ≈6.7 million Americans ≥20 years of age had HF, which is increased from ≈6.0 million according to NHANES 2015 to 2018. The lifetime risk of HF at 50 years of age increased among participants of the FHS (Framingham Heart Study) when comparing two 25-year epochs (1965–1989 versus 1990–2014) from 18.9% to 22.6% in females and 19.1% to 25.3% in males. Some data suggest that improvements in survival in individuals with HF could be leveling off over time. Data from the Rochester Epidemiology Project in Olmsted County, Minnesota, showed improved survival after HF diagnosis between 1979 and 2000; however, estimated 5-year mortality for those with HF did not decline from 2000 to 2010 and remained high (52.6% overall; 24.4% for those 60 years of age; and 54.4% for those 80 years of age). The number of elderly patients with calcific aortic stenosis is projected to more than double by 2050 in both the United States and Europe according to a simulation model in 7 decision analysis studies. The pooled prevalence of all aortic stenosis in the elderly was 12.4%, and the prevalence of severe aortic stenosis was 3.4%. In 1000 patients with severe aortic stenosis at low surgical risk randomized in the PARTNER 3 trial (Placement of Aortic Transcatheter Valve 3) to either balloon-expandable transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement, the primary composite end point (death, stroke, or rehospitalization) rate was significantly lower in the TAVR versus surgical aortic valve replacement group (8.5% versus 15.1%; absolute difference, −6.6 percentage points for noninferiority; HR, 0.54). At 2 years, the primary end point was significantly reduced after TAVR compared with surgical aortic valve replacement (11.5% versus 17.4%; HR, 0.63), although TAVR valve thrombosis at 2 years was increased (2.6%; 13 events) compared with surgery (0.7%; 3 events). Among 96 256 transfemoral TAVR procedures, adjusted 30-day mortality was higher at institutions with low procedural volume (3.19%) than at institutions with high procedural volume (2.66%; OR, 1.21). In 2019, there were an estimated ≈393 000 cases of pulmonary embolism, ≈643 000 cases of deep vein thrombosis, and ≈1 036 000 total venous thromboembolism cases in the United States. In patients with COVID-19, there is a double risk of death after venous thromboembolism. In those admitted to the intensive care unit, this risk is 2.63 times higher, with a 3-fold increase in patients on mechanical ventilation. In 2018, there were 578 000 outpatient visits for pulmonary hypertension as the principal diagnosis. In addition, there were 14 000 hospital discharges with pulmonary hypertension as the principal diagnosis. Data from MarketScan and Medicare databases showed that only 33.9% of patients with peripheral artery disease were prescribed statins compared with 51.7% of patients with coronary artery disease, and only 24.5% of patients with peripheral artery disease in the MarketScan database achieved a target LDL-C <70 mg/dL. Among Medicare beneficiaries, zip codes in the top quartile of amputation rates had a larger mean proportion of Black residents than zip codes in the bottom quartile (17.5% versus 4.4%). In older individuals 60 to 74 years of age, male sex (OR, 1.9), hypertension (OR, 1.8), and family history (OR, 1.6) are the strongest contributors to risk of thoracic aortic aneurysm. Despite substantial disruptions to cardiovascular care delivery during the COVID-19 pandemic, among patients in the GWTG Registry (Get With The Guidelines) who were hospitalized for HF in 2021, 91.7% received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge; 93.4% received evidence-based specific β-blockers; 99.2% had a measurement of left ventricular function; and 85.5% had a scheduled postdischarge appointment. In 18 262 adults with hypertension, the age-adjusted estimated proportion with controlled blood pressure (blood pressure <140/90 mm Hg) improved from 31.8% in 1999 to 2000 to 48.5% in 2007 to 2008, was similar in 2013 to 2014 (53.8%), and then declined to 43.7% in 2017 to 2018. In 390 692 patients receiving care at 586 hospitals from July 2008 to December 2013, patients residing in lower-SES neighborhoods had longer median arrival-to-angiography time (lowest quintile of SES, 8.0 hours; highest quintile of SES, 3.4 hours) and a higher rate of fibrinolysis (versus primary angioplasty) for ST-segment–elevation myocardial infarction (lowest quintile of SES, 23.1%; highest quintile of SES, 5.9%) compared with higher-SES neighborhoods. Patients from lower-SES neighborhoods had greater independent risk of in-hospital mortality and major bleeding and a lower quality of discharge care. According to Healthcare Cost and Utilization Project data from the Agency for Healthcare Research and Quality for the year 2018, 481 780 percutaneous coronary interventions were performed on an inpatient basis in the United States. Data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database, which voluntarily collects data from ≈80% of all hospitals that perform coronary artery bypass grafts in the United States, indicate that a total of 161 816 procedures involved isolated coronary artery bypass graft in 2019. In 2021, 3817 heart transplantations were performed in the United States, the most ever. The highest numbers of heart transplantations were performed in California (529), Texas (359), New York (307), and Florida (263). The average annual direct and indirect cost of CVD in the United States was an estimated $407.3 billion in 2018 to 2019. The estimated direct costs of CVD in the United States increased from $103.5 billion in 1996 to 1997 to $251.4 billion in 2018 to 2019. By event type, hospital inpatient stays accounted for the highest direct cost ($111.4 billion) in 2018 to 2019 in the United States. The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the Statistical Update. The 2023 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members, without whom publication of this valuable resource would be impossible. Their contributions are gratefully acknowledged.

Abbreviations used only in charts and tables do not appear in this table.