Data predict ‘worrisome’ increase in CV risk factors, CVD by 2060
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Researchers project a substantial increase in CV risk factors, including a 40% increase in diabetes and a 30% increase in hypertension, along with a parallel rise in CVD by 2060, likely stressing an already burdened health care system.
Using a model based on 2013-2018 National Health and Nutrition Examination Survey data combined with 2020 U.S. Census projection counts for 2025 to 2060, researchers found the prevalence of CV risk factors and CVD will continue to rise with “worrisome trends.” The analysis, published in the Journal of the American College of Cardiology, also accounted for changes to demographic characteristics in the U.S. over the next 40 years.
“The second and even more concerning finding is that there will be a substantially disproportionate rise in CV risk factors and CVD among racial and ethnic minority groups, populations traditionally with poorer access to quality health care,” James L. Januzzi Jr., MD, FACC, FESC, the Hutter Family Professor of Medicine at Harvard Medical School and director of the Dennis and Marilyn Barry Fellowship in Cardiology Research at Massachusetts General Hospital, told Healio. “At a time when efforts toward prevention should be job No. 1 to stem the rising tide of CVD, our projections of a nearly 40% increase in diabetes, nearly 30% rise in hypertension and high cholesterol and 20% rise in obesity tells us that we are not doing a good enough job. Renewed vigor toward mitigating these modifiable risk factors is needed.”
Assessing survey, census data
Januzzi and colleagues estimated the prevalence of CV risk factors, including diabetes, hypertension, dyslipidemia and obesity, and CVD, defined as ischemic heart disease, HF, MI and stroke, according to age, sex, race and ethnicity using logistic regression models based on 2013-2018 NHANES data, combined with 2020 U.S. Census projection counts for 2025-2060.
Data show that by 2060, compared with 2025, the number of Americans with diabetes will increase by 39.3% (39.2 million to 54.6 million), hypertension by 27.2% (127.8 million to 162.5 million), dyslipidemia by 27.5% (98.6 million to 125.7 million), and obesity by 18.3% (106.3 million to 125.7 million).
Concurrently, projected prevalence will similarly increase compared with 2025 for ischemic heart disease by 31.1% (21.9 million to 28.7 million), HF by 33% (9.7 million to 12.9 million), MI by 30.1% (12.3 million to 16 million), and stroke by 34.3% (10.8 million to 14.5 million).
Researchers projected that the prevalence of CV risk factors and disease will decrease for people who identify as white; however, significant increases are projected among underrepresented groups.
“In an already heavily burdened health care system, the projected increase in CVD is not a welcome finding at all,” Januzzi told Healio. “The findings have substantial financial implications, owing to the high and rising costs from treating CVD. Lastly, and by no means least, given the substantial inequities projected for CV risk factors of disease predicted to more heavily affect minority groups, these results should serve as a motivator for policy development toward improved health literacy, with more equitable access to higher-quality health care for all.”
‘This is an opportunity’
In a related editorial, Andreas P. Kalogeropoulos, MD, MPH, PhD, a clinical and outcomes researcher with Stony Brook University Medical Center, and Cardiology Today Editorial Board Member Javed Butler, MD, MPH, MBA, FACC, FAHA, FESC, president of the Baylor Scott and White Research Institute, senior vice president for Baylor Scott and White Health and distinguished professor of medicine at the University of Mississippi, called the differences in rates of CV risk factors and CVD between white adults and those from underrepresented groups “striking,” noting that the total number of patients among Hispanic, non-Hispanic Black, and other non-Hispanic racial and ethnic groups with CVD will be almost as many as white patients by 2060.
“From a policy perspective, this means that unless appropriate, targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time,” Kalogeropoulos and Butler wrote. “On the positive side, the absolute increase in the percent prevalence of cardiovascular risk factors and conditions is projected to lie within a ‘manageable’ range. ‘Manageable,’ however, assumes that we implement specific policies to prevent the incidence of cardiovascular risk factors (primordial prevention), control prevalent risk factors (primary prevention), and limit the impact of manifest disease (secondary prevention).”
The authors wrote that the data “bring to the forefront” important challenges for policies in CVD prevention and caring for patients with CVD in coming decades.
“This is an opportunity for professional societies, including the cardiovascular care community, to reevaluate priorities and strategies, for both training and practice, to best match the growing demands of a changing demographic landscape in the United States,” Kalogeropoulos and Butler wrote.
Reference:
Kalogeropoulos AP, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.05.035.
For more information:
James L. Januzzi Jr., MD, can be reached at jjanuzzi@partners.org; Twitter: jjheart_doc.
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