Driven by an aging and increasingly diverse population, alongside a significant rise in risk factors such as high blood pressure and obesity, the total costs associated with cardiovascular disease (CVD) conditions in the United States are expected to triple by 2050. According to new projections from the American Heart Association (AHA), marking a century of lifesaving service, more than 184 million people, or 61% of the U.S. population, are anticipated to have some form of CVD by mid-century. This alarming prevalence of CVD is projected to result in direct and indirect costs totaling $1.8 trillion.
These insights stem from two new presidential advisories published in Circulation, the AHA’s flagship peer-reviewed journal. The reports, titled “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,” build on prior research to project the future prevalence and economic impact of CVD based on current trends.
Dr. Karen E. Joynt Maddox, M.D., M.P.H., FAHA, volunteer chair of the advisory writing groups, highlighted the significant progress made in combating cardiovascular disease over the past century. “Supported by efforts led by the AHA, death rates from heart disease have been halved, and deaths from stroke have been reduced by a third since the creation of the American Stroke Association in 1998,” she said. “Yet, heart disease and stroke remain leading causes of death and disability in the U.S. The data from these advisories illuminate the challenges we face over the next 30 years and underscore the need for targeted interventions.”
Alarming Projections for CVD Prevalence and Risk Factors
Heart disease has been the leading cause of death in the U.S. since the AHA’s inception in 1924, and stroke is currently the fifth leading cause of death. Together, they account for more fatalities than all forms of cancer and chronic respiratory illnesses combined, with nearly one million deaths annually.
The prevalence of key CVD risk factors is expected to rise sharply by 2050:
- High blood pressure is projected to increase from 51.2% to 61.0%, affecting over 184 million people.
- Cardiovascular disease, excluding high blood pressure, will increase from 11.3% to 15.0%, affecting 45 million adults.
- Stroke prevalence will nearly double, from 10 million to almost 20 million adults.
- Obesity is expected to rise from 43.1% to 60.6%, impacting over 180 million people.
- Diabetes prevalence will increase from 16.3% to 26.8%, affecting more than 80 million people.
Positive Trends Amid Dire Predictions
Despite the bleak outlook, there are encouraging trends. More U.S. adults are adopting healthier behaviors aligned with the AHA’s Life’s Essential 8™, leading to improvements in several areas:
- Inadequate physical inactivity rates are projected to drop from 33.5% to 24.2%.
- Cigarette smoking rates are expected to decline from 15.8% to 8.4%.
- Poor diet prevalence is anticipated to decrease slightly from 52.5% to 51.1%.
Dr. Joseph C. Wu, M.D., Ph.D., FAHA, the AHA’s current volunteer president, emphasized the importance of these positive trends. “It’s promising to see more individuals taking control of their health, particularly with the substantial reduction in smoking rates. However, we must remain vigilant as new challenges threaten decades of progress,” he stated.
Concerns for Future Generations
The analysis also highlighted troubling projections for children, with significant increases in obesity and other risk factors:
- Childhood obesity (ages 2-19) is expected to rise from 20.6% to 33.0%, affecting 26 million children.
- Inadequate physical activity and poor diet among children are projected to remain high, exceeding 45 million by 2050.
Racial and ethnic disparities persist, with larger increases in CVD prevalence and risk factors among diverse populations. Black adults are expected to have the highest prevalence of hypertension, diabetes, and obesity, while Hispanic adults will see the most significant increases in CVD numbers. Asian adults will have the highest projected rates of inadequate physical activity.
Economic Impact of CVD
The projected rise in CVD and its risk factors is expected to impose a substantial economic burden:
- Total CVD costs, driven primarily by direct healthcare costs, are expected to increase from $393 billion in 2020 to $1.4 trillion in 2050.
- Stroke-related health costs will see a 535% increase, from $67 billion to $423 billion.
Dr. Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA, vice-chair of the advisory writing groups, noted the economic implications. “The projected near-tripling of CVD costs will double its economic impact as a proportion of the U.S. GDP, rising from 2.7% in 2020 to 4.6% in 2050,” he said.
A Call to Action
The AHA emphasizes that these projections are not inevitable. Strategic interventions and aggressive risk factor reduction could significantly alter the course. Scenarios include:
- Reducing high blood pressure, high cholesterol, diabetes, and obesity prevalence by about 10% and improving control of these conditions by about 20% could reduce CVD cases and deaths by 17% to 23%, equating to 1.2 million fewer CVD events and 240,000 fewer deaths annually by 2050.
- Further reductions, such as halving obesity and doubling risk factor control, could result in up to 2.3 million fewer CVD events and over 450,000 lives saved annually by 2050.
Dr. Kazi highlighted the need for comprehensive approaches. “We must invest in cardiovascular prevention and treatment and ensure people have access to resources for healthy living. This requires a collective effort from healthcare systems, policymakers, and communities.”
Nancy Brown, CEO of the AHA, stressed the importance of addressing root causes like poverty and structural racism. “Our mission extends beyond healthcare to ensuring every person in the U.S. can live their healthiest life,” she said. “As we enter our second century, we call on individuals, companies, schools, and communities to unite in changing the future of health for all.”
The AHA’s centennial marks a milestone of progress and a renewed commitment to combating cardiovascular disease. With continued innovation, research, and community engagement, there is hope to turn the tide on the dire projections and ensure a healthier future for all.
