A new analysis projects steep increases by 2060 in the prevalence of cardiovascular (CV) risk factors and disease that will disproportionately affect nonwhite populations who have 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 August 9 edition of the Journal of the American College of Cardiology .
“Although several assumptions underlie these projections, the importance of this work cannot be underestimated,” write Andreas P. Kalogeropoulos, MD, MPH, PhD, and Javed Butler, MD, MPH, MBA, in a accompanying editorial. “The absolute numbers are staggering.”
From 2025 to 2060, the number of people with any of the four CV risk factors: type 2 diabetes, hypertensiondyslipidemia and obesity — is projected to increase by 15.4 million to 34.7 million.
And the number of people with any of the four types of CV disease: ischemic heart disease, heart failure, myocardial infarctionY race — 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 due to its overall size.
In contrast, 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 cardiovascular disease is projected to decrease in the white population and increase among all other races/ethnicities, particularly black and Hispanic populations.
“Our results project a concerning increase with a particularly ominous increase in risk factors and disease in our most vulnerable patients, including blacks and Hispanics,” lead author James L. Januzzi, Jr, MD, summarized in a video issued by the company.
“The sharp increase in CV risk factors and disease reflects the generally higher prevalence in populations that are projected to increase in the United States, due to immigration and growth, including Black or Hispanic people,” explained Januzzi, also of Massachusetts General and Harvard, to elcorazon.org | Medscape Cardiology in an email.
“In a sense, the disproportionate size of the risk is expected, as minority populations are disproportionately disadvantaged with respect to their health care,” he said. “But whether expected or not, the projected increase in prevalence is nonetheless concerning and a call to action.”
This study identifies “areas of opportunity for change in the US health care system,” he continued. “If we continue as before, we will find a large number of people with risk factors and CV diseases.”
The results of the current analysis assume there will be no changes in health care policies or changes in access to care for at-risk populations, Mohebi and colleagues note.
To “stop the rising tide of CV disease in individuals at risk,” strategies such as “emphasizing education about CV risk factors, improving access to quality health care, and facilitating low-cost access to effective therapies would be required.” for the treatment of CV risk”. factors,” according to the researchers.
“However, such advances must be applied in a more equitable manner throughout the United States,” they warn.
Census data plus NHANES
The researchers used data from the 2020 US Census and projected growth and US National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018 to estimate the number of people with risk factors. CV risk and CV diseases from 2025 to 2060.
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 | ||
| Illness | Increase (%) | Absolute increase (millions) |
|---|---|---|
| Ischemic heart disease | 30.7 | 6.8 |
| Heart failure | 33.4 | 3.2 |
| Myocardial infarction | 16.9 | 3.7 |
| Race | 33.8 | 3.7 |
Projected changes in CV risk factors and disease over time were similar in men and women.
The researchers acknowledge that limitations of the study include the assumption that prevalence patterns of CV risk factors and disease will be stable.
“To the extent that disease and risk factor frequency are not likely to remain static, that assumption may reduce the accuracy of the projections,” Januzzi said. “However, we would like to point out that the goals of our analysis were to establish broad trends and not seek to project exact numbers.”
In addition, they did not take into account the effect of COVID-19. CV disease was also based on self-report and CV risk factors might have been underestimated in minority populations not accessing health care.
Changing demographic landscape
It is “surprising” that the number of nonwhites with CV risk factors is projected to exceed the number of whites over time, and the number of nonwhites with CV disease will nearly equal the number of whites by the year 2060, the editorialists point out.
“From a policy perspective, this means that unless appropriate and targeted action is taken, disparities in the burden of cardiovascular disease will only be exacerbated over time,” write Kalogeropoulos, of Stony Brook University, New York. , and Butler, of Baylor. University, Dallas.
“On the positive side,” they continue, “the absolute increase in the percentage prevalence of cardiovascular risk factors and conditions are projected within a manageable range,” assuming specific prevention policies are implemented.
“This is an opportunity for professional societies, including the cardiovascular care community, to reassess priorities and strategies, both for training and practice, to better meet the increasing 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 Chair; he is a Trustee of the American College of Cardiology; he is a member of the board of Imbria Pharmaceuticals; has received grants from Abbott Diagnostics, Applied Therapeutics, Innolife, and Novartis; he has received consulting fees from Abbott Diagnostics, Boehringer Ingelheim, Janssen, Novartis and Roche Diagnostics; and participates in clinical endpoint committees/data security monitoring boards for AbbVie, Siemens, Takeda, and Vifor. The other authors’ disclosures 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 consulted 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. Summary, Editorial
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