Cardiovascular disease prevalence will soar between 2025 and 2060 in the U.S., according to a new population study, which also predicts that racial and ethnic minorities will be disproportionately affected.
The study – which also predicts a sharp incline in rates of cardiovascular risk factors for the U.S. population – was published Monday online, ahead of the Aug. 9 issue of the Journal of the American College of Cardiology.
It was based on logistic regression models of 2013-2018 U.S. National Health and Nutrition Examination Survey (NHANES) data combined with 2020 U.S. Census projection counts for years 2025-2060.
“Ultimately, as prevention is imperative to tackle the future burden of cardiovascular disease, the results from this study pose an important challenge,” said the study’s lead author Reza Mohebi, MD, of Massachusetts General Hospital, in an accompanying press statement.
“In order to reduce the burden of cardiovascular disease in the U.S. 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.”
The research follows rising global rates of cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and obesity during the past 50 years, together with rising prevalence of ischemic heart disease, heart failure, myocardial infarction and stroke.
Despite more recent preventive measures and public health initiatives leading to declines in cardiovascular mortality rates and a gradual increase in the age at first event, the aging population and increasing rates of diabetes and obesity in particular “undermine these gains,” the authors added.
Editorialists pointed out that the current study’s projections are underlined by several assumptions; still, “the importance of this work cannot be overestimated,” Andreas Kalogeropoulos, MD, MPH, PhD, of Stony Brook University Medical Center, stressed in the press release.
The researchers used a logistic regression model based on NHANES data to estimate the prevalence of cardiovascular risk factors (including diabetes mellitus, hypertension, dyslipidemia and obesity) and cardiovascular disease (including ischemic heart disease, heart failure, myocardial infarction and stroke) according to age, sex, race and ethnicity in the general adult population.
These were further combined with the Census projections.
Between 2025 and 2060, the researchers projected that the number of people with diabetes mellitus would increase by 39.3%, from 39.2 million to 54.6 million.
The number of people with hypertension is expected to rise by 27.2%, from 127.8 million to 162.5 million in the same period, while dyslipidemia rates are expected to grow by 27.5%, from 98.6 million to 125.7 million people.
Obesity is similarly due to rise in the period by 18.3%, from 106.3 million in 2025 to 125.7 million people in 2060.
Concurrently with rising risk factors, cardiovascular disease prevalence is due to rise in 2060 vs. 2025, growing 31.1% for ischemic heart disease, from 21.9 million affected to 28.7million, and by 33% for heart failure, from 9.7 million to 12.9 million people.
Myocardial infarction will grow by 30.1%, the data project, from 12.3 million to 16 million people, and stroke will rise by 32.3%, from 10.8 million to 14.5 million.
Racial and ethnic disproportionality
Yet, despite rising risk and disease prevalence, these rates are projected to decrease for white individuals and rise significantly for people who are “racial and ethnic minorities.”
“By 2060, the highest prevalence of CV [cardiovascular] risk factors will remain among the White population due to its overall size, despite a gradual decrease in prevalence of CV risk factors. Conversely, the projected prevalence of CV risk factors is expected to rise among all other race and ethnicities,” the researchers said.
The projected race and ethnic-specific prevalence of diabetes, hypertension and obesity will be highest in the Black population from 2025 to 2060, the researchers said, by which time 19.8% of all Black adults are forecast to have diabetes, 59.9% hypertension and 45.6% to be obese.
The fact that relative risk factor and disease prevalence increases disproportionately affect Black and Hispanic populations is attributed partly to these groups having “low representation in clinical trials of [heart failure] therapies and experiencing substantial gaps in treatment”.
“Stroke will also be increasingly common among multiple racial and ethnic minority groups, owing to shared risk factors with other CV diseases; these at-risk populations are also more likely to experience stroke at a younger age and develop recurrent stroke,” said the researchers.
“The results from this study suggest an ongoing shift in prevalence of CV disease that was initially predicted from the 2008 U.S. Census by Heidenreich et al using the same methodology but with even more worrisome projections to the year 2060,” the researchers said.
They stressed that strategies are needed for healthcare professionals and policy makers to target preventive and treatment measures to specific populations at greater risk.
In the accompanying editorial, Kalogeropoulos and colleague Javed Butler, MD, MPH, MBA, from Baylor University Medical Center and University of Mississippi Medical Center, added that the paper is an opportunity for professional societies, including the cardiovascular care community, to re-evaluate priorities and strategies in training and practice.
“The absolute numbers are staggering and suggest that by year 2060, compared to 2025, the numbers of people, particularly minorities, with CV 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,” Kalogeropoulos added in the press statement.
Mohebi R, Chen C, Ibrahim NE, et al. Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates. J Am Coll Cardiol 2022;80:565-578.
Kalogeropoulos AP, Butler J. Worsening Cardiovascular Disease Epidemiology in the United States: The Time for Preparation Is Now. J Am Coll Cardiol 2022;80:579-583.
Image Credit: appledesign – stock.adobe.