A new analysis predicts a sharp rise by 2060 in the prevalence of cardiovascular (CV) risk factors and diseases that will disproportionately affect non-white populations with limited access to health care.
The study by Reza Mohebi, MD, Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues was published in the Aug. 9 issue of the Journal of the American College of Cardiology .
“While several assumptions underlie these projections, the importance of this work cannot be overstated,” write Andreas P. Kalogeropoulos, MD, MPH, PhD and Javed Butler, MD, MPH, MBA in an accompanying editorial. “The absolute numbers are staggering.”
From 2025 to 2060, the number of people with one of four CV risk factors – type 2 diabetes, hypertension, dyslipidemia and obesity – is expected to increase by 15.4 million to 34.7 million.
And the number of people with one of the four types of CV disease – ischemic heart disease, heart failure, myocardial infarction and stroke – is expected to increase by 3.2 million to 6.8 million.
While the model predicts that the prevalence of CV risk factors will gradually decline among white Americans, the highest prevalence of CV risk factors will be among the white population due to its overall size.
Conversely, the expected prevalence of CV risk factors is expected to increase in Black, Hispanic, Asian and other race/ethnicity populations.
At the same time, the prevalence of CV disease is expected to decrease in the white population and increase in all other races/ethnicities, especially in the black and Hispanic populations.
“Our results predict a worrying increase with a particularly ominous increase in risk factors and disease in our most vulnerable patients, including blacks and Hispanics,” summarized senior author James L. Januzzi, Jr, MD, in a video released by the Society.
“The sharp rise in CV risk factors and disease reflects the generally higher prevalence in populations expected to increase in the United States, due to immigration and growth, including black or Hispanic individuals,” said Januzzi, also of Massachusetts General and Harvard, to theheart.org | Medscape Cardiology in an email.
“The disproportionate magnitude of the risk is expected in a sense as minorities are disproportionately disadvantaged with regard to their health care,” he said. “But whether expected or not, the increase in expected prevalence is nonetheless worrying and a call to action.”
This study identifies “areas of opportunity for change in the US health care system,” he continued. “Business as usual will lead us to encounter a large number of individuals with CV risk factors and diseases.”
The results of the current analysis assume there will be no change in health care policy or changes in access to care for at-risk groups, Mohebi and colleagues note.
To “counter the rising tide of CV disease in at-risk individuals,” strategies would be needed such as “emphasizing education about CV risk factors, improving access to quality health care, and facilitating cheaper access to effective therapies for treating cardiovascular disease.” CV risk factors,” the researchers said.
“However, such advances must be applied in a more equitable manner in the United States,” they warn.
Census Plus NHANES Data
The researchers used 2020 US census data and projected growth and 2013-2018 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 US 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 US 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 |
| Heart attack | 33.8 | 3.7 |
The expected 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 prevalence patterns for CV risk factors and disease will be stable.
“To the extent that the frequency of risk factors and disease is unlikely to remain static, that assumption may reduce the accuracy of the projections,” Januzzi said. “However, we would like to point out that the aim of our analysis was to determine general trends and not to project exact numbers.”
They also did not take into account the effect of COVID-19. CV disease was also based on self-report and CV risk factors may have been underestimated in minority populations without access to health care.
Changing the demographic landscape
It is “striking” that the number of non-white individuals with CV risk factors is expected to outnumber white individuals over time, and the number of non-white individuals with CV disease will be nearly as much as white individuals according to the year 2060, the editors note.
“From a policy perspective, this means that unless appropriate, targeted action is taken, the disparities in the burden of cardiovascular disease will only worsen over time,” write Kalogeropoulos, of Stony Brook University, New York, and Butler, of Baylor University, Dallas.
“On the plus side,” they continue, “the absolute increase in the percentage prevalence of cardiovascular risk factors and conditions is expected to be within a manageable range,” assuming specific prevention policies are implemented.
“This is an opportunity for professional associations, including the cardiovascular care community, to re-evaluate priorities and strategies, both for training and practice, to best meet the growing demands of a changing demographic landscape in the United States,” conclude Kalogeropoulos and Butler. .
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 grants from Abbott Diagnostics, Applied Therapeutics, Innolife and Novartis; has received consultancy income from Abbott Diagnostics, Boehringer Ingelheim, Janssen, Novartis and Roche Diagnostics; and serves on 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 to 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 Cardio. 2022;80: 565-578, 579-583. Abstract, Editorial
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