Is pulmonary embolism the third leading cause of heart heaths

1. The claim and the straight answer

Major U.S. cardiovascular literature states that PE represents the third most common cause of cardiovascular death after heart attack and stroke, which supports the claim in a U.S.-centric sense ^[1]. That statement comes from nationally focused analyses and reviews cited by the American Heart Association and in the Journal of the American Heart Association ^[1]. However, because global mortality coding and reporting differ, it is incorrect to treat the U.S.-based ranking as a universal, worldwide order of causes without caveats ^[3].

2. The U.S. evidence that underpins the “third” ranking

Analyses of U.S. multiple-cause mortality databases and cardiovascular reviews have repeatedly listed PE as a leading cardiovascular cause and have explicitly described it as third behind myocardial infarction and stroke; these statements are grounded in CDC and registry-based studies and are cited in cardiology literature ^{[1] [5] [2]}. Recent U.S. trend work also documented rising PE-related mortality in younger adults and a jump in 2020 that was partly linked to COVID-19, which demonstrates that PE is a numerically important contributor to cardiovascular death in the U.S. ^{[6] [7]}.

3. Global data, variability and reporting gaps

Global analyses using WHO mortality data and vital registration from many countries show large between-country differences in PE coding, and the literature explicitly warns that PE “has not been accounted for as a cause of death contributing to cause-specific mortality in global reports,” making simple global rank statements precarious ^{[3] [4]}. Newer multinational work through 2023–2025 confirms broad declines in some regions but increases or stagnation in others and highlights misclassification and underreporting as persistent problems in global PE mortality estimates ^[8].

4. Why rankings can be misleading: coding, multiple causes and setting

Death certificates often list multiple causes and use different ICD codes for pulmonary embolism, deep vein thrombosis and related disorders, so whether a death is attributed to PE versus another cardiovascular condition can vary by country, clinician and coding rules ^{[3] [8]}. Studies based on multiple-cause mortality coding versus single underlying-cause coding produce different counts and trends, and registries focused on hospitalized or high‑risk patients will overrepresent severe PE outcomes compared with population registries ^{[2] [9]}.

5. Clinical and temporal context that affects rankings

PE mortality is sensitive to changes in detection, prevention and comorbid conditions: increased imaging can boost diagnosis, improved anticoagulation and thrombolytic strategies can reduce case fatality, while rising obesity, sedentary behavior and a prothrombotic disease like COVID-19 have driven recent increases in some age groups and regions ^{[10] [11] [7]}. High‑risk PE retains high short‑term mortality, and temporal spikes (for example during the pandemic) can temporarily shift its rank among cardiovascular causes ^{[12] [7]}.

6. Bottom line — a qualified verdict

The precise, unqualified statement “pulmonary embolism is the third leading cause of heart deaths” is supportable in the context of influential U.S. analyses and cardiology reviews that list PE after myocardial infarction and stroke ^{[1] [2]}, but it is not an incontrovertible global fact because of international variation, coding differences and underreporting ^{[3] [8]}. Any use of the “third” label should explicitly note the data source, the country or registry, and the methodological limits of mortality statistics cited ^{[3] [4]}.