Stethoscope and red heart on American flag

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DALLAS — By 2050, a new study warns that the majority of America’s adult population will likely have some type of cardiovascular disease (CVD). Moreover, projections show that total CVD-related costs will triple to $1.8 trillion. Researchers working with the American Heart Association (AHA) say their dire findings are fueled by an older, more diverse population, along with a significant rise in risk factors, including high blood pressure and obesity.

“As we mark the American Heart Association’s centennial, we recognize monumental accomplishments in the fight against cardiovascular disease which includes all types of heart and vascular disease, along with stroke. Supported by efforts led by the Association, death rates from heart disease have been cut in half in the past 100 years. Deaths from stroke have been cut by a third since the creation of the American Stroke Association in 1998,” says the volunteer chair of the advisories’ writing groups, Karen E. Joynt Maddox, M.D., M.P.H., FAHA, in a media release.

“Yet, these are still leading causes of death and disability in the U.S. So, in analyzing the data for these advisories, we set out to learn just what we may expect over the next 30 years, and to identify specific issues that need to be addressed to ensure that we continue our forward progress. Armed with these findings, we can take steps to turn the tide on this dire forecast,” Dr. Joynt Maddox continues. The findings are published in the journal Circulation.

Cardiovascular disease is an umbrella term. It refers to a number of different conditions, including coronary heart disease (heart attacks all under this category), heart failure, heart arrhythmias (including atrial fibrillation), vascular disease, congenital heart defects, stroke, and high blood pressure. However, while high blood pressure is considered a type of cardiovascular disease, it is also a leading risk factor contributing to nearly all types of heart disease and stroke. As such, the new analysis examined high blood pressure separately from CVD, which is in alignment with the American Heart Association’s Life’s Essential 8 – key measures of health factors and health behaviors recognized for improving and maintaining cardiovascular health.

Since the formation of the AHA in 1924, heart disease has been the leading cause of death in the United States. Stroke is the fifth leading cause. Both of these kill more people than all cancers and chronic respiratory illnesses combined. It’s no wonder researchers, dietitians, physicians, and others in healthcare are doing their part to lower these statistics. There are also many people who live with heart disease for years and many others who survive after a stroke. As such, for these patients, it’s not only about preventing death but improving the quality of life and overall care provided to them.

“As the American Heart Association enters its second century, our future is about improving yours,” says American Heart Association Chief Executive Officer Nancy Brown. “It is crucial to quantify the full burden of cardiovascular disease so we can better inform the policies and community-level and health system interventions needed to change this current path. We recognize that the landscape of cardiovascular health will change over the next three decades because of the coming tsunami of rising health care costs, an older population living longer and increasing numbers of people from under-resourced populations. The findings of these important advisories predict a dire human and economic toll from heart disease and stroke if changes are not made. However, this does not have to be the reality of our future.”

From 2020 (the most recent data available) to 2050, the study projects:

  • High blood pressure will increase from 51.2% to 61.0%, which translates to over 184 million people having a clinical diagnosis of CVD by 2050, compared to 128 million in 2020. This is because high blood pressure is a type of CVD.
  • CVD (including stroke but not high blood pressure) will increase from 11.3% to 15.0%, from 28 million to 45 million adults.
  • Stroke prevalence will almost double from 10 million to nearly 20 million adults.
  • Obesity will increase from 43.1% to 60.6%, affecting more than 180 million people.
  • Diabetes will increase from 16.3% to 26.8%, affecting more than 80 million people.
  • High blood pressure will be most prevalent in those 80 years and older, but the number of people with hypertension will be highest in younger and middle-aged adults (ages 20-64).
  • People between 20 and 64 will have the highest prevalence and highest growth for obesity, with over 70 million young adults having a poor diet.

These statistics may sound scary, but there’s also some good news:

  • Physical inactivity rates will drop from 33.5% to 24.2%.
  • Cigarette smoking rates will be slashed by almost half, from 15.8% to 8.4%.
  • While more than 150 million people will follow a poor diet, that’s actually a small improvement, going from 52.5% to 51.1%.

“It is extremely promising to see these health behaviors improve, as it indicates a movement by individuals taking control of their health and making positive change. I’m especially pleased to see smoking rates drop substantially, as tobacco addiction is one of the deadliest factors impacting cardiovascular disease over the past century,” says Joseph C. Wu, M.D., Ph.D., FAHA, the current volunteer president of the American Heart Association, director of the Stanford Cardiovascular Institute, and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. “Yet, even as we can celebrate these wins, we must realize that new challenges continue to threaten many decades of progress. Findings from these advisories identify a disturbing trend that many of these increases are projected to occur among our younger population – setting up a formidable future.”

The analysis also explored trends in kids, showing:

  • Obesity among children under the age of 19 is estimated to increase from 20.6% in 2020 to 33.0% in 2050, going from 15 million to 26 million children with obesity. The highest increases will be seen among those two to five years of age and 12 to 19 years of age.
  • The prevalence of insufficient physical activity and poor diet among children is projected to stay high at nearly 60% for each group, which is over 45 million children by 2050.

There are also clear racial disparities that exist, and it’s no surprise that they show in the trends.

“We found larger increases in the prevalence of CVD and risk factors, and in the number of people with these conditions, among people from racially and ethnically diverse backgrounds,” says Joynt Maddox, who is an associate professor of medicine at Washington University School of Medicine in St. Louis. “Some of this is due to demographic shifts in the U.S., with projections suggesting that Asian and Hispanic populations will nearly double by 2060. However, much of the inequity we see in CVD and risk factors remains attributed to systemic racism, as well as socioeconomic factors and access to care.”

Among adults over the age of 20, the projections show:

  • Black adults have the highest prevalence of hypertension, diabetes, and obesity, as well as the highest projected prevalence of inadequate sleep and diet.
  • The total number of people with CVD will rise most among Hispanic adults, a trend seen among Asian populations, too.
  • Asian adults have the highest projected prevalence of inadequate physical activity.
  • American Indians/Alaskan Natives (AI/AN)/multiracial adults will have the highest projected prevalence of smoking.

Among children, the 2050 projections reveal:

  • Black children will have the highest prevalence of hypertension and diabetes.
  • Hispanic children will have the highest prevalence of obesity and the greatest projected growth in hypertension, diabetes, and obesity.
  • Asian children and Hispanic children had the highest prevalence of insufficient physical activity.
  • AI/AN/multiracial children will have the highest prevalence of smoking.
  • Both Black children and White children will have the highest prevalence of poor diet.
  • The absolute increase in each risk factor will be largest for Hispanic children.

“It is not surprising that an enormous increase in cardiovascular risk factors and diseases will produce a substantial economic burden – to the tune of a $1.8 trillion price tag for cardiovascular disease projected by 2050,” says volunteer vice-chair of the advisory writing groups Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA. “This is a near tripling of the total direct and indirect costs of cardiovascular disease over the coming three decades, and almost doubles the economic impact of CVD as a proportion of the U.S. gross domestic product, increasing from 2.7% in 2020 to 4.6% in 2050.”

A man with heartburn
High blood pressure will increase from 51.2% to 61.0%, which translates to over 184 million people having a clinical diagnosis of CVD by 2050. (Photo by Towfiqu barbhuiya on Pexels)

Economic projections look like this:

  • The increase in total costs for CVD care is primarily fueled by a near quadrupling of direct health care costs, which are expected to increase from $393 billion in 2020 to $1.4 trillion in 2050.
  • Because healthcare costs are projected to rise much faster than productivity losses, they will constitute a larger proportion of the total cost of CVD in the future, going from 63% in 2020 to 80% in 2050.
  • Stroke will be a major driver in the increased health costs, jumping to a staggering 535%, from $67 billion to $423 billion. This is due to the aging of the population, given strokes tend to occur on average ten years later than coronary events, and increases in hypertension, a major risk factor for stroke.

As a society, we are living longer, which is also playing a huge role.

“The last of the Baby Boomers will hit 65 in 2030, so about 1 in 5 people in the U.S. will be over 65, outnumbering children for the first time in U.S. history. Since cardiovascular risk increases with age, the aging population increases the total burden of cardiovascular disease in the country. And finally, we anticipate that Hispanic, Asian and multiracial populations will more than double in the coming decades,” explains Kazi. “By 2060, more than two-thirds of children will belong to underserved, disenfranchised populations which traditionally have higher rates of cardiovascular disease and risk factors. Even after adjusting out the effect of inflation, we project a quadrupling specific to the health care costs related to cardiovascular disease, along with an extensive cost of lost productivity due to early death and disability.”

While all of this can sound daunting and frightening, appropriate interventions and aggressive treatments and protocols can turn the tide. The writing group of this project even noted some scenarios where we could see progress if the right things are put into place:

“We can bend the cost curve on cardiovascular disease, but this will require strategic investments in cardiovascular prevention and treatment,” Kazi concludes. “Some of this work is in the health care system – ensuring effective therapies reach patients most likely to benefit from them – but some of the work is upstream of the health system: ensuring that people have access to the resources they need to live healthful lives, to achieve the Life’s Essential 8 factors that are the core of cardiovascular health. It will take all of us working together to make this happen.”

A dietitian’s take

As a dietitian, CVD patients are the ones I see most often. A lot of dietitians could say the same. There’s so much to heart disease and related deaths that is beyond what meets the eye. It isn’t as simple as “just eat better” or “just work out more.” People need to have the access, means, and education to make those decisions for themselves.

A single mother living in a dangerous area may not be able to just go outside for a walk or afford the freshest food. She may not have access to a dietitian or a physician/health care team that provides her with resources and tools that she can implement within her means. There are many such cases like this, and it’s why such drastic statistics are seen among minorities. As Kazi says, it will require a team effort to turn these numbers around.

About Shyla Cadogan, RD

Shyla Cadogan is a DMV-Based acute care Registered Dietitian. She holds specialized interests in integrative nutrition and communicating nutrition concepts in a nuanced, approachable way.

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