Why Are Heart Disease and Stroke STILL Our No. 1 Killers?

The American Heart Association (AHA) has just reported its latest stats on heart disease and stroke (Circulation, Jan. 21, 2026; JACC, Jan. 12, 2026).  It’s bad news! The most recent analysis reveals that 915,973 Americans died from cardiovascular disease (CVD). That represents roughly one-fourth of all deaths in the United States annually. What the heck is going on?

Modern Medicine Has Failed Us

According to the CDC:

“Heart disease has been the leading cause of death in the United States since 1921, and stroke has been the third leading cause since 1938.”

Fast Forward to 2026 and what do we learn from the American Heart Association (Jan. 21, 2026)?

“Heart Disease Is By Far the Leading Cause of Death in the US”

“Heart disease remains the leading cause of death in the U.S., while stroke has moved up to No. 4, replacing COVID-19, which fell to No. 10, according to the update.”

Please stop and consider what you have just read. More than 100 years ago cardiovascular disease (CVD) was our number 1 killer in the United States. Now, over a century later, despite a massive (and successful stop-smoking campaigns) and multiple drugs to lower the presumed cause of CVD, LDL-cholesterol, we have made surprisingly little progress.

A Quick Review of Heart Disease and Stroke

Smoking Cessation Stats:

During the 1950s it is estimated that roughly 45%-55% of American adults smoked. By 2022 the CDC estimated that less than 12% of the adult population were smokers. That’s huge because smoking is a major contributor to cardiovascular deaths.

Lowering Cholesterol:

Modern medicine has blamed cholesterol in general, and LDL-cholesterol in particular, for most of the heart disease and strokes that occur in the United States. The number one tool in the United States has been medications. We have spent billions and billions of dollars on drugs to lower cholesterol in general and LDL cholesterol in particular.

Cholesterol-Lowering Drugs:

1970s

• Cholestyramine (Questran)
• Clofibrate (Atromid-S)
• Niacin

1980s

• Lovastatin (Mevacor)
• Gemfibrozil (Lopid)
• Colestipol (Colestid)

1990s

• Simvastatin (Zocor)
• Pravastatin (Pravachol)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Fenofibrate (Tricor)
• Niacin / nicotinic acid (extended-release) (Niaspan)

2000s

• Rosuvastatin (Crestor)
• Ezetimibe (Zetia)
• Ezetimibe + simvastatin (Vytorin)
• Colesevelam (Welchol)
• Omega-3 acid ethyl esters (Lovaza)

2010s

• Pitavastatin (Livalo)
• Alirocumab (Praluent)
• Evolocumab (Repatha)
• Mipomersen (Kynamro)
• Lomitapide (Juxtapid)

2020s

• Bempedoic acid (Nexletol)
• Bempedoic acid + ezetimibe (Nexlizet)
• Inclisiran (Leqvio)
• Icosapent ethyl (Vascepa)

The most successful drugs have been the statins. As I write this, over 50 million Americans are taking statin-type cholesterol-lowering medications. Atorvastatin is the most prescribed medication in America. Nearly 30 million people fill more than 115 million prescriptions.

Why Haven’t Cholesterol-Lowering Drugs Cured Heart Disease and Stroke?

Most of these medicines work very well. That is to say they effectively lower total and LDL-cholesterol. Healthcare providers can get LDL-cholesterol below 100 mg/dL. If they increase the dose of statins or combine a statin with another medication they can get LDL-cholesterol below 50 mg/dL or even below 30 mg/dL. Keep in mind that there was a time doctors were happy if a patient were able to get LDL-cholesterol below 130 mg/dL.

Heart Disease and Stroke Are Still the No. 1 Killer!

Remember, cardiovascular disease (CVD) has been the number 1 killer in America since 1921. The AHA announced this week that 915,973 people die from CVD annually.

Airplane Deaths Vs. Heart Disease and Stroke

Let’s put statistics into context. There are roughly 105 passengers on a typical airplane flight in America. If you divide 915,973 by 105 you get 8,723. That is how many metaphorical airplane crashes would occur each year to equate to the number of people who die from cardiovascular disease. How long would the airline industry last if there were 50 crashes a year? Even 10 airline crashes would drive America crazy.

If my calculations are correct and 915,973 people died in airplane crashes each year, that would represent about 23 commercial-airliner crashes daily. Would any sane person put up with such a number? Would we allow the people running the Federal Aviation Administration or the National Transportation Safety Board to continue in their jobs? Would the CEOs of major airline companies be permitted to keep working?

And yet after 100 years and billions and billions spent on medications, CVD is still our number 1 killer. Why doesn’t anyone object? What is wrong with this picture? The answer, my friend, is blowing in the wind. You can read about another risk factor besides LDL-cholesterol at this link. It was ignored for decades.

Is Lp(a) the Best Kept Secret in Heart Disease?

Doctors rarely test for Lp(a), even though 1 out of 5 people have high levels. Statins raise Lp(a) but a low-carb diet may lower this key risk factor a bit. There is some relatively new data to suggest that aspirin might be helpful for people with high Lp(a) levels. You can read more about that research at this link. No one should ever take aspirin regularly without medical supervision.

What Can People Do To Reduce the Risk of Heart Disease and Stroke?

There are a great many factors that contribute to heart disease in addition to LDL-cholesterol. In our eGuide to Cholesterol Control & Heart Health we list 26 possible risk factors that can contribute to heart attacks and strokes. When is the last time your cardiologist asked about depression, anger, stress or anxiety?  They can all contribute.

What about infection? Periodontitis (gum disease) can be a contributing factor. So can other infectious diseases. You can read more about the connection between pathogens and heart attacks and strokes at this link.

The Infection Factor: Rethinking Heart Disease and Dementia

Final Words:

Heart disease and stroke remain our No. 1 killers, even after a century of warnings and decades of cholesterol-lowering medications. That doesn’t mean the tools are useless. Statins and other therapies can help many people. But it seems pretty clear that we are missing important parts of the puzzle.

Lp(a), inflammation, infection, metabolic problems, stress, sleep problems and other overlooked risk factors deserve far more attention than they get. If you want to reduce your odds of becoming one more statistic, don’t assume a “normal” LDL number tells the whole story. Work with a knowledgeable clinician to look deeper, measure what matters, and tackle the risks that are too often ignored.

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