Deaths attributable to pulmonary embolism among patients with atherosclerotic cardiovascular disease rose from 3.62 to 4.96 deaths per 100,000 people between 2010 and 2023, according to an analysis of US data published in the Journal of the American Heart Association. The shifts in mortality accelerated sharply after 2018, disproportionately affecting young adults, racial and ethnic minority groups, and residents in the Western region.
Pulmonary Embolism Mortality Rates Climb Among ASCVD Patients
Led by Marco Zuin of the University of Padova, the study utilized the US Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database alongside the National Health and Nutrition Examination Survey. Researchers tracked age-adjusted pulmonary embolism mortality among atherosclerotic cardiovascular disease patients aged 15 and older. Between 2010 and 2023, a total of 942,784 people died from pulmonary embolism, with atherosclerotic cardiovascular disease patients accounting for 152,386 of those deaths, representing 16% of total pulmonary embolism fatalities.
The age-adjusted mortality rate climbed at an average annual percentage change of 3.1% over the study period. The increase remained modest between 2010 and 2018 with an average annual percentage change of 0.7%, before shifting into a sharp rise between 2018 and 2023 at an average annual percentage change of 12.8%. Most of those deaths, specifically 34.2%, occurred in the South.
Demographic Shifts in Young Adults and Minority Populations
The study found that mortality growth occurred primarily in younger cohorts rather than elderly populations. Adults younger than 65 years experienced the most pronounced increases with an average annual percentage change of 4.0%. For men with atherosclerotic cardiovascular disease, the age-adjusted mortality rate rose from 4.31 to 6.12 deaths per 100,000 people, while women saw an increase from 3.07 to 4.02 deaths per 100,000 people.
By race and ethnicity, non-Hispanic Black individuals recorded the highest age-adjusted mortality rate, climbing from 4.63 to 6.28 deaths per 100,000 people. The steepest increases appeared in American Indian and Alaska Native populations alongside Hispanic and Latinx populations, registering average annual percentage changes of 4.6% and 4.2%, respectively. Geographically, rural residents and people living in the Western United States experienced average annual percentage increases of 3.9% and 3.7%.
Cardiometabolic Risk Factors Drive Prevalence Increases
The rising mortality trends ran parallel to an increasing prevalence of atherosclerotic cardiovascular disease, which grew from 6.5% in 2010 to 8.5% in 2023. This rise was driven by hypertension, obesity, diabetes, and chronic kidney disease. Excess adiposity and abdominal obesity serve as primary components linking metabolic syndrome with venous thromboembolic risk, according to the researchers.
Gregory Piazza of Brigham and Women’s Hospital, senior author of the study, noted that despite literature linking the two conditions, few clinicians recognize that venous and arterial disorders interact. Piazza stated that recognizing the connection is actionable, advising clinicians to evaluate pulmonary embolism risk factors in atherosclerotic cardiovascular disease patients and screen for pulmonary embolism when patients decompensate clinically.
Cardiovascular Disease Mortality Rates Rise Across Study Periods
- Overall AAMR Change: Rose from 3.62 to 4.96 per 100,000 people between 2010 and 2023.
- Acceleration Period: Average annual percentage change jumped from +0.7% (2010–2018) to +12.8% (2018–2023).
- Demographic Impact: Adults under 65 showed the steepest rise at +4.0% average annual percentage change.
- Disease Prevalence: Age-adjusted atherosclerotic cardiovascular disease prevalence increased from 6.5% to 8.5%.
Frequently Asked Questions About Pulmonary Embolism and ASCVD Risks
What data sources did the researchers use for this analysis?
The study used the CDC WONDER database to gather information on age-adjusted pulmonary embolism-attributable mortality among patients ages 15 and up. Researchers also obtained data on age-adjusted atherosclerotic cardiovascular disease prevalence and risk factors from NHANES between 2010 and 2023.
How many total pulmonary embolism deaths were linked to atherosclerotic cardiovascular disease?
Between 2010 and 2023, out of 942,784 total pulmonary embolism deaths, 152,386 involved patients with known atherosclerotic cardiovascular disease. This group represented 16% of all pulmonary embolism deaths during that timeframe.
Which geographic region recorded the highest proportion of these deaths?
Most of the pulmonary embolism deaths among atherosclerotic cardiovascular disease patients, specifically 34.2%, occurred in the Southern United States.
What specific risk factors paralleled the rising mortality rates?
The increase in mortality paralleled a rising prevalence of atherosclerotic cardiovascular disease driven by hypertension, obesity, diabetes, and chronic kidney disease. Adjusted for overall population metrics, disease prevalence climbed from 6.5% in 2010 to 8.5% in 2023.