'Staggering' CVD Rise Projected in US, Especially in Minorities

 A new analysis projects steep increases by 2060 in the prevalence of cardiovascular (CV) risk factors and disease that will disproportionately affect non-White populations who have limited access to healthcare.

The study by Reza Mohebi, MD, Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues was published in the August 9 issue of the Journal of the American College of Cardiology .

"Even though several assumptions underlie these projections, the importance of this work cannot be overestimated," Andreas P. Kalogeropoulos, MD, MPH, PhD, and Javed Butler, MD, MPH, MBA, write in an accompanying editorial. "The absolute numbers are staggering."

From 2025 to 2060, the number of people with any one of four CV risk factors — type 2 diabetes, hypertension, dyslipidemia, and obesity — is projected to increase by 15.4 million, to 34.7 million.

And the number of people with of any one of four CV disease types — ischemic heart disease, heart failure, myocardial infarction, and stroke — is projected to increase by 3.2 million, to 6.8 million.

Although the model predicts that the prevalence of CV risk factors will gradually decrease among White Americans, the highest prevalence of CV risk factors will be among the White population because of its overall size.

Conversely, the projected prevalence of CV risk factors is expected to increase in Black, Hispanic, Asian, and other race/ethnicity populations.

In parallel, the prevalence of CV disease is projected to decrease in the White population and increase among all other race/ethnicities, particularly in the Black and Hispanic populations.

"Our results project a worrisome increase with a particularly ominous increase in risk factors and disease in our most vulnerable patients, including Blacks and Hispanics," senior author James L. Januzzi, Jr, MD, summarized in a video issued by the society.

"The steep rise in CV risk factors and disease reflects the generally higher prevalence in populations projected to increase in the United States, owing to immigration and growth, including Black or Hispanic individuals," Januzzi, also from Massachusetts General and Harvard, explained to theheart.org | Medscape Cardiology in an email.

"The disproportionate size of the risk is expected in a sense, as minority populations are disproportionately disadvantaged with respect to their healthcare," he said. "But whether it is expected or not, the increase in projected prevalence is, nonetheless, concerning and a call to action."

This study identifies "areas of opportunity for change in the US healthcare system," he continued. "Business as usual will result in us encountering a huge number of individuals with CV risk factors and diseases."

The results from the current analysis assume there will be no modification in healthcare policies or changes in access to care for at-risk populations, Mohebi and colleagues note.

To "stem the rising tide of CV disease in at-risk individuals," would require strategies such as "emphasis on education regarding CV risk factors, improving access to quality healthcare, and facilitating lower-cost access to effective therapies for treatment of CV risk factors," according to the researchers.

"Such advances need to be applied in a more equitable way throughout the United States, however," they caution.

Census Plus NHANES Data

The researchers used 2020 US census data and projected growth and 2013 to 2018 US National Health and Nutrition Survey (NHANES) data to estimate the number of people with CV risk factors and CV disease from 2025 to 2060.

The estimates are based on a growing population and a fixed frequency.

Projected Change in CV Risk Factors in the American Population From 2025 to 2060
Risk Factor	Increase (%)	Absolute Increase (Millions)
Type 2 diabetes	39.3	15.4
Hypertension	27.1	34.7
Dyslipidemia	27.6	27.1
Obesity	18.3	19.4

 

Projected Change in CVD in the American Population From 2025 to 2060
Disease	Increase (%)	Absolute Increase (Millions)
Ischemic heart disease	30.7	6.8
Heart failure	33.4	3.2
Myocardial infarction	16.9	3.7
Stroke	33.8	3.7

The projected changes in CV risk factors and disease over time were similar in men and women.

The researchers acknowledge that study limitations include the assumption that the prevalence patterns for CV risk factors and disease will be stable.

"To the extent the frequency of risk factors and disease are not likely to remain static, that assumption may reduce the accuracy of the projections," Januzzi said. "However, we would point out that the goals of our analysis were to set general trends, and not to seek to project exact figures."

Also, they did not take into account the effect of COVID-19. CV diseases were also based on self-report and CV risk factors could have been underestimated in minority populations that do not access healthcare.

Changing Demographic Landscape

It is "striking" that the numbers of non-White individuals with CV risk factors is projected to surpass the number of White individuals over time, and the number of non-White individuals with CV disease will be almost as many as White individuals by the year 2060, the editorialists note.

"From a policy perspective, this means that unless appropriate, targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time," write Kalogeropoulos, from Stony Brook University, New York, and Butler, from Baylor University, Dallas.

"On the positive side," they continue, "the absolute increase in the percent prevalence of cardiovascular risk factors and conditions is projected to lie within a manageable range," assuming that specific prevention policies are implemented.

"This is an opportunity for professional societies, including the cardiovascular care community, to re-evaluate priorities and strategies, for both training and practice, to best match the growing demands of a changing demographic landscape in the United States," Kalogeropoulos and Butler conclude.

Mohebi is supported by the Barry Fellowship. Januzzi is supported by the Hutter Family Professorship; is a Trustee of the American College of Cardiology; is a board member of Imbria Pharmaceuticals; has received grant support from Abbott Diagnostics, Applied Therapeutics, Innolife, and Novartis; has received consulting income from Abbott Diagnostics, Boehringer Ingelheim, Janssen, Novartis, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for AbbVie, Siemens, Takeda, and Vifor. The disclosures of the other authors are listed with the article. Kalogeropoulos has received research funding from the National Heart, Lung, and Blood Institute, the American Heart Association, and the Centers for Disease Control and Prevention. Butler has been a consultant for Abbott, Amgen, American Regent, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Medtronic, Merck, Novartis, Novo Nordisk, Pfizer, Roche, and Vifor.

J Am Coll Cardiol. 2022;80: 565-578, 579-583. Abstract, Editorial

https://www.medscape.com/viewarticle/978366