American Heart Association – June 4, 2024

Driven by an older, more diverse population, along with a significant increase in risk factors including high blood pressure and obesity, total costs related to cardiovascular disease (CVD) conditions are likely to triple by 2050, according to projections from the American Heart Association, observing 100 years of lifesaving service as the world’s leading nonprofit organization focused on heart and brain health for all. At least 6 in 10 U.S. adults (61%), more than 184 million people, are expected to have some type of CVD within the next 30 years, reflecting a disease prevalence that will have a $1.8 trillion price tag in direct and indirect costs.

The new data comes from two new presidential advisories published today in the Association’s flagship peer-reviewed journal, Circulation – Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease and Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States through 2050. The companion papers build upon prior work by the Association to assess projections of the future cardiovascular disease prevalence and subsequent economic burden based on the current landscape.

“As we mark the American Heart Association’s centennial, we recognize monumental accomplishments in the fight against cardiovascular disease which includes all types of heart and vascular disease, along with stroke. Supported by efforts led by the Association, 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,” said the volunteer chair of the advisories’ writing groups, Karen E. Joynt Maddox, M.D., M.P.H., FAHA. “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.”

Heart disease has been the leading cause of death in the U.S. since the inception of the American Heart Association in 1924. Stroke is currently the fifth leading cause of death in the U.S. Together, they kill more people than all forms of cancers and chronic respiratory illnesses combined, with annual deaths from cardiovascular disease now approaching 1 million nationwide.

“As the American Heart Association enters its second century, our future is about improving yours,” said American Heart Association Chief Executive Officer Nancy Brown. “It is crucial to quantify the full burden of cardiovascular disease so we can better inform the policies and community-level and health system interventions needed to change this current path. We recognize that the landscape of cardiovascular health will change over the next three decades because of the coming tsunami of rising health care costs, an older population living longer and increasing numbers of people from under-resourced populations. The findings of these important advisories predict a dire human and economic toll from heart disease and stroke if changes are not made. However, this does not have to be the reality of our future.”

Increases in high blood pressure, diabetes and obesity will drive CVD prevalence.

Clinically, cardiovascular disease refers to a number of specific conditions, including coronary heart disease (including heart attack), heart failure, heart arrhythmias (including atrial fibrillation), vascular disease, congenital heart defects, stroke and hypertension (high blood pressure). However, while high blood pressure is considered a type of cardiovascular disease, it is also a major risk factor contributing to nearly all types of heart disease and stroke, so for the purposes of these analyses, high blood pressure was predicted separately from all CVD. This aligns with the American Heart Association’s Life’s Essential 8™ – key measures of health factors and health behaviors identified for improving and maintaining cardiovascular health.

From 2020 (the most recent data available) to 2050, projected increases of CVD and risk factors contributing to it in the U.S. include:

• High blood pressure will increase from 51.2% to 61.0%, and since high blood pressure is a type of CVD, that means more than 184 million people will have a clinical diagnosis of CVD by 2050, compared to 128 million in 2020.
• Cardiovascular disease, including stroke, (but not including high blood pressure) will increase from 11.3% to 15.0%, from 28 million to 45 million adults.
• Stroke prevalence will nearly double from 10 million to almost 20 million adults.
• Obesity will increase from 43.1% to 60.6%, impacting more than 180 million people.
• Diabetes will increase from 16.3% to 26.8%, impacting more than 80 million people.
• High blood pressure will be most prevalent in individuals 80 years and older, however, the number of people with hypertension will be highest – and rising – in younger and middle-aged adults (20-64 years of age).
• People aged 20-64 years also will have the highest prevalence and highest growth for obesity, with more than 70 million young adults having a poor diet.

Good news: People are choosing to live healthier.

Despite the predicted increase for cardiovascular disease prevalence and costs, there are some positive trends to report. More adults in the U.S. are embracing the healthy behaviors of the American Heart Association’s Life’s Essential 8, as prevalence rates for most are expected to improve:

• Inadequate physical inactivity rates will improve from 33.5% to 24.2%.
• Cigarette smoking rates will drop nearly by half, from 15.8% to 8.4%.
• While more than 150 million people will have a poor diet, that is at least a slight improvement from 52.5% to 51.1%.

“It is extremely promising to see these health behaviors improve, as it indicates a movement by individuals taking control of their health and making positive change. I’m especially pleased to see smoking rates drop substantially, as tobacco addiction is one of the deadliest factors impacting cardiovascular disease over the past century,” said Joseph C. Wu, M.D., Ph.D., FAHA, the current volunteer president of the American Heart Association, director of the Stanford Cardiovascular Institute and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. “Yet, even as we can celebrate these wins, we must realize that new challenges continue to threaten many decades of progress. Findings from these advisories identify a disturbing trend that many of these increases are projected to occur among our younger population – setting up a formidable future.”

Future generation at risk: Concerns CVD risk factor trends in kids

The analysis also looked at projections for children, with concerning trends among key risk factors that were also notable in the adult population.

• Obesity among children (age 2-19 years of age) is estimated to rise from 20.6% in 2020 to 33.0% in 2050, increasing from 15 million to 26 million children with obesity; highest increases will be seen among children 2 to 5 years of age and 12 to 19 years of age.
• The prevalence of inadequate physical activity and poor diet among children is projected to remain high at nearly 60% each, exceeding 45 million children by 2050.

Racial and ethnic disparities persist

Continues …