Just 1 in 10 Americans Have ‘Optimal’ Heart Health, AHA Report Finds

Nearly Half Of Adults Have Heart Disease. The Bigger Problem: Fewer People Have It Under Control

Americans are losing ground in managing heart disease, and the problem isn’t just that more people are getting sick. The share of people keeping their conditions under control is in serious decline as well.

A sweeping new report from the American Heart Association reveals that 130.6 million American adults (nearly half the population) now have some form of cardiovascular disease. At the same time, blood pressure control among people with hypertension has dropped from 54% in 2013-2014 to just 48% by 2017-2020. The share of people with diabetes who had their condition under consistent control also fell, from 54% in 2017-2020 to 44% in 2021-2023.

So, even as hypertension rates held steady at about 32% of adults, the proportion of patients keeping their blood pressure under control got worse.

Moreover, the forecast through 2050 looks grim if current trends continue. Researchers project that six in ten American adults will have high blood pressure, obesity will climb to 61%, and more than one in four adults will have diabetes. Right now, those rates sit at 51%, 43%, and 16% respectively.

When Your Doctor Starts Treatment May Depend on Your Race

The blood pressure number that triggers treatment isn’t the same for everyone. In a study of nearly 240,000 people, White patients were started on medications when their systolic pressure hit 131 mm Hg on average. Black patients? They didn’t get prescriptions until 136 mm Hg. Hispanic patients had to wait until 136.3 mm Hg.

That five or six-point difference might not sound like much, but every point of blood pressure elevation increases stroke and heart attack risk. The disparities don’t end there. Only 61% of Black patients received the blood pressure medications that treatment guidelines recommend as first-line therapy, compared with 74% of White patients and 81% of Hispanic patients.

The report, published in Circulation, doesn’t pin down why these gaps happen, but it shows they occur in real care decisions. The pattern repeats across cardiovascular care. Among 300,000 Medicare patients with aortic stenosis (a dangerous heart valve condition) Black, Hispanic, and Asian American patients were all less likely than White patients to receive valve replacement surgery within six months of being hospitalized.

Only 1 in 10 Americans Is Truly Heart Healthy

The report introduces a new way of measuring health called cardiovascular-kidney-metabolic syndrome, which looks at how your heart, kidneys, and metabolism work together. The results are sobering: just 11% of American adults qualify as being in optimal health.

Among younger adults ages 20 to 44, only 18% make the cut. By age 65 and older, more than half have advanced disease affecting multiple organ systems. The odds are particularly stacked against American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities, where advanced disease rates top 20%.

What happens when these systems start breaking down? Women with the most advanced disease face more than eight times the risk of dying from cardiovascular causes compared to healthy women. For men, the risk multiplies nearly seven-fold. Those numbers come from tracking nearly 34,000 adults over three decades.

Kids Are Moving Less, and Teens Are Vaping More

Only one in five American kids gets the recommended 60 minutes of daily physical activity. The numbers get worse as children age: a quarter of elementary schoolers hit the target, but just 14% of middle and high schoolers do.

The tobacco landscape, meanwhile, has shifted dramatically in recent years. Traditional cigarette smoking among adults has dropped from 11% to 8% since 2017. But e-cigarette use has exploded in the same period, quadrupling from 1.2% to 4.1%. Among high school students, one in four has tried tobacco products, with e-cigarettes leading the way at 18%.

The Sleep Problem Nobody’s Talking About

The study points to another heart factor that rarely gets enough attention: nearly one in three American adults is sleep-deprived during the work week, getting at least an hour less sleep than they do on free days. Ten percent are running on two or more hours of sleep debt.

A massive study of more than 500,000 Spanish workers found that poor sleep doesn’t just make you tired, it makes you sick. People with sleep problems had triple the odds of being physically inactive. They also showed higher rates of high blood pressure, diabetes, high cholesterol, and obesity. On the flip side, British adults who maintained healthy sleep patterns over nine years cut their cardiovascular disease risk by nearly a third.

When Pregnancy Becomes Deadly

Maternal mortality fell across all racial groups between 2021 and 2022, but the gaps remain stark. Black women face a maternal death rate of 50 per 100,000 live births. That’s more than 2.5 times higher than White women and nearly three times higher than Hispanic women.

Meanwhile, a study of nearly 80,000 pregnant women in Japan found that women who maintained five healthy habits before pregnancy (healthy weight, good diet, regular exercise, no smoking, no drinking) cut their risk of pregnancy complications by a third. If American women achieved similar results, it could prevent thousands of cases of gestational diabetes, pregnancy-related high blood pressure, and preterm births each year.

The Bills Are Coming Due

Cardiovascular disease costs Americans $415 billion annually when you add up medical bills and lost productivity. That’s just the average. Direct medical costs alone have jumped 16% in a decade, from $193 billion to $223 billion.

Stroke costs are projected to balloon from $31 billion in 2020 to $351 billion by 2050, an eleven-fold increase. The number of stroke survivors is expected to double from 9.7 million to 19.4 million over the same period.

Here’s a sliver of good news: dementia rates among older Americans have been falling, dropping from 12% in 2011 to 8% in 2021. High-intensity exercise looked especially helpful in studies that tracked thinking and memory over time, particularly when done three times a week in sessions under an hour. But globally, the absolute number of dementia cases in people over 80 nearly doubled between 1990 and 2019, driven by people living longer.

America’s heart health is deteriorating on multiple fronts at once. More people are getting sick, fewer are getting their conditions under control, and financial costs keep climbing. Without major changes in how we prevent and treat cardiovascular disease, and without addressing the racial disparities in care, these trends will only get worse.

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