Heart Disease Will Surge Over the Coming Decades

Millions more Americans are expected to develop cardiovascular disease (CVD) over the next few decades, according to projections.

Large increases in people with CVD are expected from 2025 to 2060 in line with changing demographics:

• Ischemic heart disease: 21.9 million to 28.7 million
• Heart failure: 9.7 million to 12.9 million
• Myocardial infarction: 12.3 million to 16.0 million
• Stroke: 10.8 million to 14.5 million

Moreover, by 2060, there will be 54.6 million Americans with diabetes, 162.5 million with hypertension, 125.7 million with dyslipidemia, and 125.7 million with obesity, reported James Januzzi, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

While differences between men and women will remain largely stable over time, CVD will disproportionately affect Black and Hispanic people, the authors noted in the Journal of the American College of Cardiology.

The prevalence of cardiovascular (CV) risk factors and disease is projected to fall in white individuals by 2060 and increase in all other races and ethnicities. For example, among Black adults, the estimated prevalence for diabetes, hypertension, dyslipidemia, and obesity will be 19.8%, 59.9%, 35.9%, and 45.6%, respectively.

"With rising total numbers of risk factors and CV disease disproportionately affecting an aging population from populations with restricted access to quality preventative care, the potential burden on the U.S. health care system is large," Januzzi's group wrote.

"Emphasis on education regarding CV risk factors, improving access to quality health care, and facilitating lower cost access to effective therapies for treatment of CV risk factors may stem the rising tide of CV disease in at-risk individuals; such advances need to be applied in a more equitable way throughout the United States, however," they added.

In an accompanying editorial, Andreas Kalogeropoulos, MD, MPH, PhD, of Stony Brook University in New York, and Javed Butler, MD, MPH, MBA, of Baylor University Medical Center in Dallas and the University of Mississippi Medical Center in Jackson, suggested that the tide of worsening heart health can be managed with appropriate targeted policies.

For policymakers, it will be important to stress CVD prevention, optimize cardiovascular care teams, and adapt the training of future cardiologists, they noted, also pointing out the exacerbation of staffing issues among healthcare workers during the COVID-19 pandemic.

"In this line of thought, training a physician workforce from diverse racial, ethnic, and socioeconomic backgrounds could be a solid step toward better primary care and prevention efforts. However, recent data suggest that we still need to do a lot of work in this direction," the duo wrote.

The study's projections were based on 2013-2018 National Health and Nutrition Examination Survey data pooled with 2020 U.S. Census projection counts for the years 2025-2060.

Januzzi and colleagues acknowledged that their modeling assumes unchanging patterns of cardiovascular health and that self-reported data on heart disease are reliable. Moreover, the authors did not account for COVID-19 in their analyses.

"Despite that several assumptions underlie these projections, the importance of this work cannot be overestimated," Kalogeropoulos said in a press release. "Unless targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time."

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