Lifestyle choices are driving America’s heart disease epidemic, AHA warns

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Jan 28 2025

Despite medical advances, America’s heart disease crisis worsens—alarming new data reveals how lifestyle choices, racial disparities, and rising obesity rates are driving an unprecedented public health challenge.

Study: 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Image Credit: Mr Dasenna / Shutterstock

In a recent report published in the journal Circulation, the American Heart Association (AHA) released the latest iteration of their annual stroke, heart, and cardiovascular disease (CVD) statistics. Compiled with the United States (US) National Institutes of Health (NIH), the 620-page report provides American citizens with insights into the changing landscape of cardiovascular health.

It includes detailed statistics on circulatory and heart-associated disease conditions, risk factors (e.g., smoking status and physical activity trends), and treatment outcomes. This article highlights the report's key findings across both American and global contexts.

Background

The American Heart Association (AHA) is a non-profit organization based in the United States (US). It is primarily involved in conducting, supporting, and funding cardiovascular research. The organization was founded in 1924 (Chicago) and has its current headquarters in Dallas, Texas.

The AHA focuses on five key objectives: 1. Research, 2. Health equity, 3. Heart and brain health, 4. Professional education, and 5. Advocacy. It is best known for its annual heart and stroke statistics report. It provides detailed cardiovascular and associated disease data, up-to-date disease risk metrics, and treatment outcomes to educate researchers, policymakers, and consumers on ideal lifestyle choices to combat today's unprecedented cardiovascular disease (CVD) surge.

About the report

The present report is a collaborative effort between the AHA, the US National Institutes of Health (NIH), and several other government agencies. It aims to provide professionals and the interested lay public with accurate and up-to-date heart disease (HD) information, particularly those related to AHA's Life's Essential 8 (2022).

The concept, represented in a circle divided into eight parts, describes the key lifestyle decisions required for optimal cardiovascular health. They include: 1. Eat better, 2. Be more active, 3. Quit tobacco, 4. Get healthy sleep, 5. Manage weight, 6. Control cholesterol, 7. Manage blood sugar, and 8. Manage blood pressure.

The report focuses on different aspects of AHA's Life's Essential 8 before delving into clinical risk associations and treatment outcomes. Study data was primarily acquired from the NIH database and the National Health and Nutrition Examination Survey (NHANES) supplement for national and global studies (e.g., the UK Biobank and Framingham Heart Study (FHS)). Key highlights from the report are listed below.

AHA's Life's Essential 8 and cardiovascular health

Several data sources, including the NHANES survey, the UK Biobank, and the Framingham Heart Study (FHS), validated the recommendations of Life's Essential 8, with up to 11 years of follow-up revealing that multinational study participants with better Life's Essential 8 scores were at lower risk (and presented reduced prevalence) of CVDs, major adverse cardiovascular events (MACEs), and circulatory system-associated mortality. Encouragingly, cigarette use in the US has declined significantly in the past 20 years. However, the recent influx of electronic cigarettes has offset these benefits, particularly among middle and high school students (4.6% and 10.0%, respectively, with 25.2% of high school users reporting daily use).

High school students also demonstrated increased sedentary behavior, with only 23.9% participating in ≥60 minutes of daily physical exertion in 2021, compared to 28.9% in 2011. Sleep data revealed that females were 1.5–2.3x more likely to suffer from insomnia than their male counterparts, with healthy diets showing the strongest associations with adequate and restful sleep.

Unfortunately, nutritional statistics continue this bleak trend, with most of the American population consuming suboptimal diets that are poor in fresh fruits and vegetables and rich in sugars and processed food. The average Healthy Eating Index score in the US is 59 (on a scale of 0–100). Consequently, 41.8% of the American adult population is estimated to be obese compared to 16% from global datasets.

Together, these suboptimal health decisions have resulted in many Americans suffering from dyslipidemia, excessive blood pressure, and comorbidities (e.g., diabetes, metabolic syndrome, kidney diseases, stroke, CVDs, and HDs).

Treatment outcomes and economic costs

While treatment outcomes have improved compared to previous years, significant gender and racial disparities remain evident. For example, women were 13% more likely to experience heart failure-related hospital readmission following acute myocardial infarction (MI) than men. Additionally, Black and Hispanic individuals were 27% less likely to receive bystander aid (cardiopulmonary resuscitation) in public locations compared to White individuals (45.6% vs. 60.0%).

The average annual costs of CVD in the US are staggering – $417.9 billion was spent directly or indirectly on CVD treatment between 2020 and 2021. Direct costs alone increased from $189.7 billion in 2012 to $233.3 billion in 2021, with 30% of these costs attributed to prescription medications.

Conclusions

The worrisome trend of suboptimal health behaviors in the US must change to reduce the nation's mounting economic and mortality burden. Reports such as AHA's present one can educate citizens about the ongoing silent pandemic, equipping them with the knowledge required to protect themselves and their families through simple nutrition, physical activity, and sleep modifications.