Prevalence, economic burden of heart disease, stroke likely to rise greatly in US by 2050
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Key takeaways:
- The prevalence of many CVD conditions and risk factors is expected to increase greatly by 2050.
- Health care costs are projected to triple for CV risk factors and quadruple for CV conditions by 2050.
Due to demographic changes and a rise in risk factors, the prevalence and economic burden of heart disease and stroke in the United States are expected to increase dramatically by 2050, according to the American Heart Association.
The AHA projections were included in two presidential advisories published in Circulation, one on the prevalence of risk factors and disease and the other on the economic burden of CVD and stroke.
“Supported by efforts led by the [AHA], 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,” Karen E. Joynt Maddox, MD, MPH, FAHA, associate professor of medicine at Washington University in St. Louis and the volunteer chair of the advisories’ writing groups, said in a press 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.”
Prevalence of CVD and stroke by 2050
In the prevalence paper, Joynt Maddox and colleagues estimated that in U.S. adults, the prevalence of the following will increase:
- hypertension, from 51.2% in 2020 to 61% in 2050;
- diabetes, from 16.3% in 2020 to 26.8% in 2050;
- obesity, from 43.1% in 2020 to 60.6% in 2050;
- coronary disease, from 7.8% in 2020 to 9.2% in 2050;
- HF, from 2.7% in 2020 to 3.8% in 2050;
- stroke, from 3.9% in 2020 to 6.4% in 2050;
- atrial fibrillation, from 1.7% in 2020 to 2.4% in 2050; and
- total CVD, from 11.3% in 2020 to 15% in 2050.
The committee projected the prevalence of hypercholesterolemia to fall from 45.8% in 2020 to 24% in 2050. In addition, it predicted the following positive trends: inadequate physical activity declining from 33.5% in 2020 to 24.2% in 2050, cigarette smoking dropping from 15.8% in 2020 to 8.4% in 2050, and having a poor diet dipping slightly from 52.5% in 2020 to 51.1% in 2050.
The committee also projected that clinical CVD will affect more than 45 million U.S. adults and CVD including hypertension will affect more than 184 million U.S. adults in 2050.
Obesity is expected to rise the most in adults aged 20 to 64 years, and more than 70 million young adults will have a poor diet in 2050, the authors wrote.
The adverse trends are expected to have more impact on people who identify as Black, Hispanic, American Indian/Alaska Native or multiracial, according to the authors.
“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,” Joynt Maddox said in the release. “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.”
Economic burden of CVD and stroke by 2050
In the economic burden advisory, Dhruv Kazi, MD, MSc, MS, FAHA, head of health economics and associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and director of the cardiac critical care unit at Beth Israel Deaconess Medical Center and the volunteer vice-chair of the advisories’ writing groups, and colleagues wrote that annual inflation-adjusted health care costs of CV risk factors in the U.S. are expected to triple from $400 billion in 2020 to $1.344 trillion in 2050.
The annual inflation-adjusted health care costs of CV conditions are expected to quadruple from 2020 to 2050, from $393 billion to $1.49 trillion, and productivity losses are predicted to rise from $234 billion in 2020 to $361 billion in 2050, Kazi and colleagues wrote.
The largest absolute increases are expected to come from stroke, they wrote.
“The last of the baby boomers will hit 65 in 2030, so about one in five people in the U.S. will be over 65, outnumbering children for the first time in U.S. history,” Kazi said in the release. “Since cardiovascular risk increases with age, the aging population increases the total burden of cardiovascular disease in the country. And ... we anticipate that Hispanic, Asian and multiracial populations will more than double in the coming decades. 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.”
References:
- Kazi D, et al. Circulation. 2024;doi:10.1161/CIR.0000000000001258.
- Population shifts, risk factors may triple U.S. cardiovascular disease costs by 2050. https://newsroom.heart.org/news/population-shifts-risk-factors-may-triple-u-s-cardiovascular-disease-costs-by-2050. Published June 4, 2024. Accessed June 4, 2024.
Perspective
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Benjamin J. Hirsh, MD, FACC, FAHA, FNLA
When you look at population and demographic trends concerning prevalence of disease states over a certain time period, estimates may not always be perfect, but the authors have done a good job of picking up on a trend that is rising in patients from a variety of different backgrounds. I agree that there will be an increase in risk factors and costs going forward.
There is an overabundance of reliance on processed food that is filled with sugar and saturated fats and create obesity and diabetes, and can even change the genetics of people who are prone to them. These foods are easy and accessible, and consuming them has become the norm in our society. I think that’s why we are where we are. Unfortunately, people from backgrounds of low socioeconomic status may not have the means or the education to obtain the food that they need to, or to even know what to get.
A lot needs to be done to reverse these trends. Banning smoking in more places has been effective at reducing smoking, a major risk factor, though it’s harder to ban sugar, because food consumption is a matter of individual choice. More impactful will be increasing broader awareness, so more public awareness campaigns are needed, and more education early on. We also need to increase access to new therapies such as semaglutide (Ozempic and Wegovy, Novo Nordisk). Organizations such as Million Hearts promote awareness to disadvantaged communities and encourage physical activity and good nutrition. Health systems with programs that identify these susceptible individuals and get them care early and can demonstrate they are improving quality by doing so will receive higher reimbursement from CMS. Corporations are incentivizing employees to adopt certain habits, such as increasing physical activity as measured by step count, and giving them rewards for it, which not only improves their lifestyles but keeps them at work and using fewer sick days.
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