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Substantial increases in cardiovascular trends may contribute to a rising burden on the US healthcare system and highlight the need for equitable access to prevention education and treatments now to prevent future disease, authors of the study, Reza Mohebi (Harvard Medical School, Boston, USA) et al have warned.

The researchers arrived at their conclusion using data from the 2020 US Census Bureau report for the years 2025 to 2060, and combined these census counts with the prevalence of cardiovascular risk factors or disease based on the US National Health and Nutrition Examination Survey. Based upon these estimates, the investigators evaluated projected cardiovascular risk factors and diseases in groups based on sex, age (18‒44 years; 45‒64; 67‒79; >80) and race and ethnicity (Asian, Black, Hispanic, white and other). The researchers analysed projected rates for the following cardiovascular risk factors: diabetes, hypertension, dyslipidaemia, obesity; and the following cardiovascular diseases: ischaemic heart disease, heart failure, heart attack and stroke.

Among the general US population, all four cardiovascular risk factors are expected to increase from 2025 to 2060, with the largest percentage increase in diabetes (39.3% increase to 55 million persons), followed by dyslipidaemia (27.6% to 126 million), hypertension (25.1% to 162 million) and obesity (18.3% to 126 million). The researchers found that stroke (33.8% to 15 million) and heart failure (33.4% to 13 million) were the highest projected increases in rates of cardiovascular diseases, followed by ischaemic heart disease (30.7% to 29 million) and heart attack (16.9% to 16 million).

Projections for cardiovascular risk factors or diseases from 2025 to 2060 are expected to stabilise for males versus females (apart from obesity, where women are projected to continue to have higher prevalence) as well as across age. However, all projections for race and ethnicity minority groups exponentially rose, while projections for White persons gradually decreased. The Black population is expected to experience the highest CV risk factor burden among all race and ethnicity increases. In addition, CVD rate increases are projected to have the highest impact on the Black and Hispanic populations.

“Our analysis projects that that the prevalence of cardiovascular risk factors and diseases will continue to rise with worrisome trends,” said James L Januzzi (Harvard Medical School, Boston, USA), senior author of the study. “These striking projections will disproportionately affect racial and ethnic minority populations in the USA. Understanding these results will hopefully inform future public health policy efforts and allow us to implement prevention and treatment measures in an equitable manner.”

The researchers recommend emphasising education regarding cardiovascular risk factors, improving access to quality health care and facilitating lower-cost access to effective treatment therapies to stem the rising tide of cardiovascular disease in at-risk individuals. In addition, health policy will need to be developed to improve health care access to historically neglected populations, implement customised preventive strategies and dismantle broader systems leaving racial and ethnic minorities with inferior care.

“Ultimately, as prevention is imperative to tackle the future burden of cardiovascular disease, the results from this study pose an important challenge,” said Mohebi. “In order to reduce the burden of cardiovascular disease in the US population, healthcare 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 study has several limitations, including the conventional method of generating predictions for future CV disease by assuming future patterns of cardiovascular risk factors. The study authors did not factor in COVID-19 to the estimates or potential long-term impacts of COVID-19 on the cardiovascular system. Lastly, cardiovascular diseases were defined based on self-report.

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