New data from the American Heart Association highlights the major impact of COVID-19 on cardiovascular health and death rates in the first year of the pandemic.
At least 928,741 Americans died from cardiovascular disease-related causes in 2020, the annual statistical report found. This marks the largest year-on-year increase since 2015 and surpasses the previous record of 910,000 deaths recorded in 2003, according to the American Heart Association.
“This is our first real evidence based on the impact of the early years of the pandemic,” said Dr. Connie Tsao, chair of the statistical update writing group and assistant professor of medicine at Harvard Medical. School.
This is something the experts had predicted.
«It wasn’t surprising,» Dr. Michelle Albert, volunteer president of the American Heart Association and chair of cardiology and professor of medicine at the University of California, San Francisco, told ABC News.
COVID-19 has had both direct and indirect impacts on increasing death rates from cardiovascular disease, experts have said.
Cardiovascular disease and risk factors may be linked to the severity and mortality of COVID-19, and the virus itself may have exacerbated some symptoms in people with cardiovascular disease. The precise relationship between the two still needs more research, experts said.
COVID-19 also had an indirect impact on heart health – early on people were avoiding doctor’s offices and hospitals.
«We isolated ourselves. People were afraid to come to the hospital for treatment and when people came for treatment they presented with more advanced disease,» Albert said.
Asian, Black and Hispanic communities were disproportionately affected by the deaths seen in 2020, which also reflects the toll of the pandemic, she said. These groups already had poorer heart health outcomes due to socioeconomic issues, stigma, and lack of access to quality health care.
«As we look at groups that are traditionally disadvantaged and bear a disproportionate share of health disparities, the pandemic has further amplified their disadvantages,» Albert said.
The report also highlighted other factors beyond COVID-19 that contributed to deaths from cardiovascular disease in 2020.
Low exercise rates among adults and adolescents continue to be of concern. Only about 1 in 4 Americans meet both muscle-strengthening and aerobic exercise guidelines, and less than half of high school students exercise for at least an hour a day, five days a week, according to the report.
The data also showed that women were at higher risk of heart complications or death than men. They were less likely to undergo procedures to treat conditions such as heart attacks and less likely to be prescribed drugs to lower cholesterol.
Experts have pointed out a few ways people can better control their heart health in light of these findings.
In terms of physical activity, even if they don’t quite meet the recommended amount of exercise, something is better than nothing.
«The real message, especially among people who may be older adults and used to being sedentary, is that it’s good to be active even if you’re not meeting your goals. «Tsao said.
For women, according to Albert, it is imperative to be educated about heart disease. Women mistakenly believe that cancer poses a greater risk to them than heart disease, when the reverse is true.
The presentation of a heart attack may differ slightly in women compared to men, and it’s important for women to be aware of the full range of possible symptoms, Albert said.
«Traditionally speaking, when we think of the symptoms of a heart attack, for example, patients think of chest pain, chest pressure, pain going down the left arm and these are symptoms that have been classically learned from research in men,» Albert said. «But women are more likely to have symptoms related to the gastrointestinal tract, like indigestion or shortness of breath, and ignore it.»
Pregnancy can also uniquely serve as a window into women’s cardiovascular health, according to Albert, as well as an opportunity to get screened for cardiovascular risk factors before and during pregnancy.
Diet may also support heart health, experts said. The Mediterranean diet — which emphasizes plant-based foods, healthy fats, moderate amounts of fish and lean meats — is linked to lower rates and risk of cardiovascular disease.
Sleep is also an «essential part of life,» the heart association said. The amount and quality of people’s sleep can impact their cardiovascular health.
Although individual lifestyle choices contribute significantly to the risk of cardiovascular disease, the report highlights larger inequalities that have propagated worse health outcomes in certain groups.
People living in low-income communities faced more barriers to receiving lifesaving care if they have cardiovascular health issues, as well as accessing resources that can help prevent these conditions. Experts said they were working to understand why these risks exist in the most vulnerable populations and to advocate for increased research funding and structural and policy changes.
Cardiovascular disease is the No. 1 killer in the world, and it will take targeting both individual and societal factors to bring the numbers down, Albert said.
«Despite the statistics, people shouldn’t feel helpless,» she said. «I think there is hope, but I also don’t see the numbers changing without societal changes.»
Eden David studied neuroscience at Columbia University and is currently a third-year medical student and a member of ABC News’ medical unit.
Jennifer Miao, MD, is an associate cardiology physician at Yale School of Medicine/Yale New Haven Hospital and a member of the ABC News Medical Unit.