Over the next four decades, the United States population is expected to see upticks in CV risk factors and disease that will have a disproportionate impact on racial and ethnic minorities. Without enhanced CVD prevention policies and strategies, these surges will stress an already fraying healthcare system, new data suggest.
“An important point we want to stress is that advancements in therapy or medications are not going to decrease this prevalence,” lead author Reza Mohebi, MD (Massachusetts General Hospital, Boston), told TCTMD. “The only way we can stop the increasing trend is by primordial prevention, where we prevent people from developing risk factors for cardiovascular disease.”
Using 2020 US census data, Mohebi and colleagues forecast that the number of US adults with diabetes will increase by nearly 40% by the year 2060, with hypertension increasing by 27%, dyslipidemia by 27.5%, and obesity by 18%. The data were published online ahead of the August 9, 2022, issue of the Journal of the American College of Cardiology.
In an editorial accompanying the study, Andreas Kalogeropoulos, MD, PhD (Stony Brook University, NY), and Javed Butler, MD, MBA (Baylor Scott & White Research Institute, Dallas, TX), say the estimates are “staggering,” noting that the total number of individuals with CV risk factors from Hispanic, non-Hispanic Black, and other non-Hispanic racial and ethnic groups will surpass those of white patients by 2060. The total number of white individuals with CV risk factors and disease is estimated to decrease over time as the numbers among nonwhite individuals increase.
“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,” they write.
Using census data, Mohebi and colleagues projected the overall prevalence of CV risk factors from 2025 to 2060 among the general US population. They estimate that the greatest period of increase in diabetes, hypertension, and dyslipidemia will happen between 2025 and 2030. The rate of increase will slow until 2045 or 2050, after which it will again pick up speed.
While the overall prevalence of obesity in the population is projected to decrease slightly from 39.4% to 38.8%, the absolute number of individuals with obesity will rise. Among the CV risk factors, obesity is the only one for which there are sex differences, remaining consistently higher among women than men over time.
Heart failure, ischemic heart disease, and stroke prevalence are each expected to rise by more than 30% by 2060, and MI will increase by 17%. The greatest period of growth for these also is expected to be between 2025 and 2030.
Given that white individuals currently account for the majority of the US population, they will as a group retain the highest prevalence of CV risk factors over the coming decades despite some anticipated decreases. Among nonwhite populations, Black individuals are expected to see the greatest surge in CV risk factor burden among all races and ethnicities. If the estimates are correct, approximately 20% of the Black adult population will have diabetes by 2060, 60% will have hypertension, 36% will have dyslipidemia, and 45.6% will be obese. Hispanic individuals also will experience large increases in diabetes, hypertension, and dyslipidemia, with the latter increasing in prevalence by nearly 40%.
Mohebi and colleagues speculate that there may be multiple drivers of the significant rise in diabetes among Black and Hispanic individuals. These include immigration and growth of these populations, as well as “disparities in socioeconomic status and other social determinants of health, along with a continued increase in risk factors such as gestational diabetes and environmental risks.”
Kalogeropoulos and Butler caution that the estimated increases “lie within a manageable range,” but only if appropriate steps are taken to implement effective primary and secondary prevention policies in addition to primordial prevention.
“These assumptions are fragile, however, because they require addressing lifestyle education at the public health level and tackling access issues for both primary care and cardiovascular care,” they write. Importantly, Kalogeropoulos and Butler also note that knowledge about these projections and their potential as stressors of primary care and specialty care have important implications for healthcare and medical education.
One potential step in the right direction, they add, may be training a physician workforce from diverse racial, ethnic, and socioeconomic backgrounds. A recent look at the composition of the national medical student body indicated that percentages of Black, Hispanic, and other racial and ethnic groups are underrepresented and well below the percentages of these groups found in census data. Kalogeropoulos and Butler say it may also be necessary to make some changes to the training of future cardiologists, “including alternative (and potentially shorter for certain directions) training pathways, with an emphasis on the appropriate use of diagnostic and therapeutic procedures, and education on healthcare policies and reforms.”
Another suggestion from Kalogeropoulos and Butler is to optimize CV care teams and integrate input from every member of the team—including advanced practice nurses, dietitians, physical and occupational therapists, and social workers—into patient care.
To TCTMD, Mohebi said the numbers should be a “wake-up call” for health policy makers and hopefully can be used to better inform public health efforts.
“I'm always optimistic,” he said. “That's why we did this project, to help the next generations. But this is just a starting point. We need to build the strategies to tackle these health issues and inequalities.”