However, there’s another important shift happening that’s not getting enough attention: the types of heart and blood vessel problems people are developing are changing too.
A New Mix of Heart Conditions
Recent large-scale studies involving millions of people have revealed a striking trend. While heart attacks and strokes have continued to decline, other cardiovascular problems are on the rise.
Conditions such as irregular heart rhythms (like atrial fibrillation), heart failure, valve diseases, and blood clots in the veins (known as venous thromboembolism) are becoming more common. In fact, atrial fibrillation is now the single most frequently diagnosed heart condition in many countries.
This means that diseases once considered “less common” are now making up a much bigger share of the overall heart disease burden. Together, these conditions now account for more than half of all new cardiovascular diagnoses.
Why the Change?
Part of the reason is positive: we’re getting better at detecting and treating heart problems. Advances in diagnostic technology, greater awareness, and improved survival after heart attacks mean more people live long enough to develop other heart-related conditions.
But biological and lifestyle factors also play a part. Obesity, inactivity, and aging all increase the risk of developing non-atherosclerotic heart conditions - those not directly caused by blocked arteries.
Prevention Needs to Catch Up
Current prevention strategies and risk calculators are still mainly designed around preventing heart attacks and strokes. But if we want to reduce the full burden of heart disease, we need to think more broadly.
That means investing in research to understand what causes other types of heart disease (like arrhythmias or valve problems) and finding ways to prevent them before they start. Some risk factors, like high blood pressure and smoking, likely contribute to these conditions too, but their effects have not been studied as well as for heart attacks and stroke. Other risk factors, cholesterol for example, increase the risk of a heart attack but may have less of an effect on rhythm disorders.
Emerging evidence also points to new contributors to heart disease, such as chronic inflammation, autoimmune conditions, and even some cancer treatments. Understanding these links could open the door to new preventive treatments.
A Glimpse of the Future
There’s reason for optimism. Several promising therapies (some already in use for other conditions) are being tested for their potential to prevent non-traditional forms of heart disease. For example:
- Lipoprotein(a) and vitamin K are being explored as potential targets for preventing valve disease.
- SGLT2 inhibitors and GLP-1 receptor agonists, drugs originally designed for diabetes, show signs of protecting against heart failure and rhythm problems.
- Blood pressure and cholesterol-lowering medications may help prevent aortic aneurysms and heart failure.
In the future, prevention could become much more personalised. New tools might estimate not just your risk of a heart attack, but your likelihood of developing a specific condition (like atrial fibrillation or valve disease) and suggest tailored ways to reduce it.
Looking Ahead
Heart disease hasn’t disappeared - it’s evolving. To keep saving lives, prevention strategies must evolve too. Recognising this changing landscape can guide future research, inform better health policies, and ultimately help more people live longer, healthier lives. Free not only from heart attacks and strokes, but from the full spectrum of cardiovascular disease.
Learn more: The Lancet: The changing spectrum of cardiovascular diseases
Nathalie Conrada,∙Kazem Rahimib, John J V McMurrayc, Barbara Casadeide