(CNN) — Nearly half of all adults in the United States have some type of cardiovascular disease, according to the American Heart Association, defining the condition as coronary heart disease, heart failure, stroke or high blood pressure.

And after decades of declines, deaths from cardiovascular disease are on the rise again, with 840,678 deaths recorded in 2016, up from 836,546 in 2015, according to the association’s annual report Heart and Stroke Statistics, published Thursday in the medical journal Circulation.

“Cardiovascular disease produces immense health and economic burdens in the United States and globally,” the authors wrote.

The 48% prevalence of cardiovascular disease — nearly 121.5 million adults — is a significant uptick over the rate cited last year, although this was mainly driven by the way high blood pressure is defined. Hypertension guidelines were updated so that people whose blood pressure is 130/80 or above are now considered “hypertensive”; previously, the definition was 140/90.

Excluding high blood pressure, prevalence of cardiovascular disease among US adults is 9% overall, a decline from 11.5% in 2015.

Dr. David Zhao, chief of cardiology medicine and executive director of the Heart and Vascular Center at Wake Forest Baptist Health in Winston-Salem, North Carolina, described the new report as a “painful reminder” that heart disease is still the No. 1 cause of death and disease in the nation.

“Overall, we have made a lot of progress,” said Zhao, who was not involved in the report. Still, “we have not yet made substantial advancement in obesity, diabetes, and unhealthy behavior,” which includes smoking, not exercising, poor diet and being overweight. About 8 of every 10 cases of cardiovascular disease can be prevented by controlling high blood pressure, diabetes and high cholesterol and maintaining a healthy lifestyle, according to the heart association.

The scorecard also shows some terrific gains. Self-reported inactivity among adults has been declining since 1998, with the trend escalating in recent years. Passivity plummeted from 40.1% to 26.9% between 2007 and 2016, the report shows.

Over the past five decades, smoking rates have also declined: About 51% of males and 34% of females smoked in 1965, compared with just 16.7% of males and 13.6% of females in 2015.

The new report includes a new recommendation that adults get at least seven hours of sleep per night to promote optimal health. One recent study found that too much or too little — more than eight hours or less than seven hours per night — was linked with a greater risk of death from all causes.

“We really have to work harder to reduce all the risk factors in order to reduce rates of cardiovascular disease,” Zhao said, highlighting obesity. Nearly 4 out of 10 US adults and nearly 1 out of 5 youths is obese, while 7.7% of adults and 5.6% of youth are severely so, the report finds.

Additionally, not all groups have made equal strides in quitting or never smoking cigarettes.

“Substantially higher tobacco use prevalence rates are observed in American Indian/Alaska Natives and lesbian, gay, bisexual, and transgender populations, as well as among individuals with low socioeconomic status, those with mental illness, individuals with HIV who are receiving medical care, and those who are active-duty military,” the report notes. “Over the past 6 years, there has been a sharp increase in e-cigarette use among adolescents.”

Overall, Zhao believes that “lots of work still needs to be done.”

We may be seeing downward trajectory in some risk factors and cardiovascular disease itself, “but we’re not there yet,” he said. “That’s something all of us need to start to think about: What can we do together to really improve our health, our healthy behavior, and reduce our weight?”

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