In a recent study published in the journal Circulation, researchers forecasted the prevalence of cardiovascular risk factors and clinical events in the United States (U.S.) through 2050 and assessed the impact by age, race, and ethnicity using national health survey data.
Study: Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association. Image Credit: Lightspring / Shutterstock
Background
In 2020, cardiovascular disease (CVD) and stroke affected 9.9% of U.S. adults over 20, impacting 28.6 million individuals. As leading causes of death, they result in significant morbidity, impaired quality of life, and high costs. Recent trends indicate a reversal in progress against CVD-related morbidity and mortality, with worsening factors like hypertension and obesity exacerbated by racial and socioeconomic disparities. An aging, diversifying population necessitates innovative strategies and detailed data projections for effective healthcare planning and interventions. Further research is essential to address the rising prevalence and disparities in cardiovascular disease and stroke.
About the study
In the present study, researchers estimated the prevalence of adverse levels of American Heart Association’s (AHA) Life’s Essential 8, including hypertension, diabetes, hypercholesterolemia, suboptimal sleep, physical activity, obesity, smoking, and diet. They also assessed coronary heart disease (CHD), heart failure (HF), stroke, and atrial fibrillation (AF), along with total CVD and stroke.
Using logit regression models, the researchers adjusted for demographics to predict prevalence in various groups, accounting for the population in long-term care facilities. Projections for 2020-2050 were based on National Health and Nutrition Examination Survey (NHANES) data from 2010-2020, estimating growth or decline in prevalence separately for adults and children. These prevalence estimates were combined with 2010 Census projections to predict the number of affected individuals by demographic characteristics.
Uncertainty was addressed using a bootstrapping approach with 1,000 iterations to generate 90% credible ranges. Two intervention scenarios using the Cardiovascular Policy Model for Prevention and Treatment Simulation (PRISM) tool explored potential health improvements: achieving Healthy People 2030 targets and more aggressive interventions. Analyses were conducted by Research Triangle Institute International for the AHA, with statistical analysis performed using Stata version 17.0.
Study results
The study projected significant increases in adverse cardiovascular health factors among adults aged 20 and older by 2050. Hypertension is expected to rise from 51.2% in 2020 to 61.0% in 2050, diabetes from 16.3% to 26.8%, and obesity from 43.1% to 60.6%. Hypercholesterolemia, however, is projected to decline from 45.8% to 24.0%. While improvements are anticipated in poor diet, physical inactivity, and smoking prevalence, inadequate sleep is expected to worsen.
Clinical diagnoses of CVD and stroke are projected to increase, with CHD rising from 7.8% to 9.2%, HF from 2.7% to 3.8%, stroke from 3.9% to 6.4%, and total CVD and stroke from 11.3% to 15.0%. Combining clinical CVD and hypertension, the prevalence is projected to exceed 61%. By 2050, the adult U.S. population is expected to reach nearly 302 million, with hypertension and obesity each affecting over 180 million adults and diabetes affecting over 80 million. Poor diet and inadequate sleep are projected to affect over 150 million and 125 million adults, respectively. The number of adults with overall CVD and stroke is projected to increase from 28 million to 45 million, with stroke cases nearly doubling from 10 million to 20 million.
Age-specific projections indicate that while hypertension is most prevalent in individuals aged 80 and older, the highest number of cases is in younger and middle-aged adults. Diabetes and hypercholesterolemia are most prevalent in the 65-79 age group, but obesity is most prevalent and growing fastest in the 20-44 and 45-64 age groups. Poor sleep and inadequate physical activity are most prevalent in those aged 80 and older, while younger age groups have higher rates of smoking and poor diet. By 2050, nearly 70 million young adults are projected to have poor diets.
Racial and ethnic disparities show Black adults with the highest prevalence of hypertension, diabetes, and obesity but the lowest hypercholesterolemia. Hispanic populations exhibit the greatest absolute prevalence increases, while Asian populations show high relative growth. Black adults also have the highest prevalence of inadequate sleep and poor diet, Asian adults the highest physical inactivity, and American Indian (AI)/Alaska Native (AN)/multiracial adults the highest smoking prevalence.
Obesity among children aged 2 to 19 is projected to rise from 20.6% in 2020 to 33.0% in 2050. Scenario analyses using the PRISM tool suggest that achieving Healthy People 2030 targets could significantly reduce cardiovascular events and mortality.
Conclusions
To summarize, the forecast for cardiovascular health through 2050 is alarming without significant interventions. Key cardiovascular risk factors, especially obesity, are expected to increase markedly. Hypertension and obesity prevalence rates could exceed 50%, impacting CVD and stroke incidence. Demographic shifts and aging will exacerbate the overall burden of CVD and stroke, disproportionately affecting minority groups. Declines in smoking and hypercholesterolemia are promising but may be offset by rising hypertension, diabetes, and obesity rates. Meaningful improvements are achievable with focused efforts, but a substantial disease burden will remain. Addressing inequities, particularly systemic racism, and improving access to care and tailored interventions are crucial.
Journal reference:
- Karen E. Joynt Maddox, Mitchell S.V. Elkind, Hugo J. Aparicio, et al. Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association, Circulation (2024), DOI - 10.1161/CIR.0000000000001256, https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001256
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