United States Population Study Projects Steep Rise in Cardiovascular Diseases by 2060

August 11, 2022—The American College of Cardiology (ACC) recently announced the publication of a study showing that by 2060 the projected rates of cardiovascular risk factors and disease will increase significantly in the United States. ACC advised that the study suggests substantial increases in cardiovascular trends may contribute to a rising burden on the United States health care system and highlight the need for equitable access to prevention education and treatments now to prevent future disease.

Reza Mohebi, MD, et al published the study, “Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates,” in the Journal of the American College of Cardiology (2022;80:565-578).

Dr. Mohebi is the Dennis and Marilyn Barry Fellow in Cardiology at Massachusetts General Hospital in Boston, Massachusetts. The study’s senior investigator is James L. Januzzi Jr, MD, a cardiologist at Massachusetts General Hospital, Cardiology Division; Hutter Family Professor of Medicine at Harvard Medical School; and Trustee of the ACC.

According to ACC, the investigators used data from the 2020 United States Census Bureau report for the years 2025 to 2060 and combined these census counts with the prevalence of cardiovascular risk factors or disease based on the United States National Health and Nutrition Examination Survey.

From these estimates, the investigators evaluated projected cardiovascular risk factors and diseases in groups based on sex (male and female), age (18-44 years, 45-64 years, 67-79 years, and > 80 years), and race and ethnicity (Asian, Black, Hispanic, White, and other). The investigators analyzed projected rates for cardiovascular risk factors (diabetes, hypertension, dyslipidemia, and obesity) and cardiovascular diseases (ischemic heart disease, heart failure, heart attack, and stroke).

ACC reported that the investigators found that in the general United States population, all four of the cardiovascular risk factors are expected to increase from 2025 to 2060, with the largest percentage increase in diabetes (39.3% to 55 million persons), followed by dyslipidemia (27.6% to 126 million), hypertension (25.1% to 162 million), and obesity (18.3% to 126 million).

Additionally, the study showed that the highest projected increases in rates of cardiovascular diseases were stroke (33.8% to 15 million) and heart failure (33.4% to 13 million), followed by ischemic heart disease (30.7% to 29 million) and heart attack (16.9% to 16 million).

Projections for cardiovascular risk factors or diseases from 2025 to 2060 are expected to stabilize for males versus females (apart from obesity, where women are projected to continue to have higher prevalence) as well as across age.

However, all projections for race and ethnicity minority groups exponentially rose, while projections for White persons gradually decreased. The Black population is expected to experience the highest cardiovascular risk factor burden among all race and ethnicity increases. In addition, cardiovascular disease rate increases are projected to have the highest impact on the Black and Hispanic populations, the study showed.

According to ACC, the investigators recommend emphasizing education regarding cardiovascular risk factors, improving access to quality health care, and facilitating lower-cost access to effective treatment therapies to stem the rising tide of cardiovascular disease in at-risk individuals. In addition, health policy will need to be developed to improve health care access to historically neglected populations, implement customized preventive strategies, and dismantle broader systems leaving racial and ethnic minorities with inferior care.

As noted in the ACC press release, the study has several limitations, including the conventional method of generating predictions for future cardiovascular disease by assuming future patterns of cardiovascular risk factors. The study authors did not factor in COVID-19 to the estimates or potential long-term impacts of COVID-19 on the cardiovascular system. Lastly, cardiovascular diseases were defined based on self-report.

Dr. Januzzi commented in the ACC press release, “Our analysis projects that the prevalence of cardiovascular risk factors and diseases will continue to rise with worrisome trends. These striking projections will disproportionately affect racial and ethnic minority populations in the United States. Understanding these results will hopefully inform future public health policy efforts and allow us to implement prevention and treatment measures in an equitable manner.”

Dr. Mohebi added, “Ultimately, as prevention is imperative to tackle the future burden of cardiovascular disease, the results from this study pose an important challenge. In order to reduce the burden of cardiovascular disease in the United States population, health care policymakers will need to allocate preventive measures and health care resources to the more vulnerable populations we projected to have higher percentage rise in disease.”

ACC also advised that an accompanying editorial, “Worsening Cardiovascular Disease Epidemiology in the United States: The Time for Preparation Is Now,” was published by Andreas P. Kalogeropoulos, MD, and Javed Butler, MD, in Journal of the American College of Cardiology (2022;80:579-583).

Dr. Kalogeropoulos, who is a clinical and outcomes researcher at Stony Brook University Medical Center in Stony Brook, New York, stated in the ACC press release, “Despite that several assumptions underlie these projections, the importance of this work cannot be overestimated. The absolute numbers are staggering and suggest that by year 2060, compared to 2025, the numbers of people, particularly minorities, with cardiovascular risk factors are expected to increase dramatically. Unless targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time.”