- More than 61% of American adults are projected to have some type of cardiovascular disease by 2050, American Heart Association research shows.
- This will be driven by an aging and more diverse population, as well as an increase in risk factors such as obesity and high blood pressure.
- Some risk factors for cardiovascular disease, though, will decline, including smoking and lack of regular physical activity.
More than 61% of American adults are expected to have some type of cardiovascular disease by 2050, according to new research from the American Heart Association (AHA). The healthcare and related costs resulting from this are projected to be $1.8 trillion.
This trend will be driven by an older, more diverse population and a large increase in risk factors such as high blood pressure and obesity.
Cardiovascular disease includes heart disease, heart attack, stroke, heart failure, abnormal heart rhythm such as atrial fibrillation or AFib, and heart valve problems. High blood pressure is also a type of cardiovascular disease, as well as a major risk factor for heart disease and stroke.
In spite of advances in treatments for these conditions, heart disease has been the leading cause of death in the United States for decades, resulting in 695,000 deaths in 2021. Stroke is the fifth leading cause of death.
In research published June 4, the AHA predicts that in 2050, 15% of American adults will have cardiovascular disease — including stroke, but excluding high blood pressure — up from 11.3% in 2020.
The percentage of people affected by stroke will nearly double during that time, from 3.9% to 6.4% of adults, AHA research shows. In addition, 61% of adults will have high blood pressure in 2050, an increase from 51.2% in 2020.
Changing population a key driver
An aging population is one of the key factors behind these trends — as people age, their chance of developing cardiovascular disease increases.
By 2050, 22% of Americans will be over the age of 65, an increase from 17% in 2020, according to the U.S. Census Bureau.
The United States is also becoming more diverse, and communities of color tend to be impacted more by cardiovascular disease.
By 2060, people who identify as Hispanic will make up 27.5% of the population, versus 17.8% in 2016, and people who identify as Black will be 15% of the population, up from 13.3% in 2016. The share who identify as Asian will increase from 5.7% to 9.1% during that time.
In 2050, Hispanic adults are projected to have the largest increase in cardiovascular disease, in terms of total numbers of people, the AHA research shows.
In addition, Black adults are projected to have the highest rates of high blood pressure, diabetes and obesity. They also are expected to have the highest rates of inadequate sleep and poor diet. These all contribute to the development of cardiovascular disease.
“Many Americans live with food insecurity, often in food ‘deserts’ without access to nutritious fruits and vegetables, subsisting on calorie-dense, nutrient-poor, unhealthy processed and fast food,” said Nate E. Lebowitz, MD, a cardiologist at Hackensack University Medical Center, who was not involved in the AHA research.
“According to the AHA research, the underserved populations subject to these food deserts are expected to suffer a magnified impact,” he told Healthline.
Increasing risk factors for heart disease
In addition to the expected increase in the rate of high blood pressure, other risk factors for cardiovascular disease are likely to rise over the next two decades.
Obesity is projected to increase from 43.1% of adults in 2020 to 60.6% in 2050, and diabetes will increase from 16.3% to 26.8%. Adults under 65 will see the highest growth for obesity, with the AHA research predicting that more than 70 million young adults will have a poor diet in 2050.
The research also looked at projections for children, finding concerning trends for certain risk factors. For example, obesity among 2- to 19-year-olds is projected to rise from 20.6% in 2020 to 33% in 2050.
In addition, poor diet and inadequate physical activity among children is expected to remain at nearly 60% each, the research found.
Americans, however, will see progress on certain risk factors. The percentage of adults with inadequate physical activity levels will drop from 33.5% in 2020 to 24.2% in 2050. Cigarette smoking rates are projected to drop by nearly half during that time, from 15.8% to 8.4%.
In addition, rates of high cholesterol will drop from 45.8% to 24.0%, in part due to an increase in the number of people taking cholesterol-lowering drugs called statins.
A 2023 study found that 92 million adults 40 years or older, or 35% of that age group, took a statin in 2018-2019, an increase from 12% in 2008-2009.
“I wish I could say that [the projected decline in high cholesterol] is due to improving diet and dropping obesity rates, but in reality it’s thanks to new, highly advanced medications we are starting to employ that dramatically lower cholesterol,” said Lebowitz.
“We know that [lowering cholesterol] drops the rates of coronary artery disease, so the report could have been much worse,” he said.
Turning things around
While the AHA projections paint a stark picture of cardiovascular disease two-and-a-half decades from now, study author Dhruv S. Kazi, MD, director of the cardiac critical care unit at Beth Israel Deaconess Medical Center in Boston, said in a release that these trends can be slowed, but “this will require strategic investments in cardiovascular prevention and treatment.”
Right now, though, preventing cardiovascular disease may not get as much attention as treatment.
“The U.S. spends a massive amount on high tech expensive interventions for acute cardiovascular illness, but doesn’t spend anywhere near as much on the far less expensive measures that could prevent the need for those interventions,” said Lebowitz.
For example, “after a heart attack or an acute coronary hospitalization with a stent or bypass surgery, half of patients don’t even get their cholesterol checked and there is a 42% readmission rate by 6 months,” he said.
In contrast, Cuba spends a fraction of what the United States does on healthcare, yet the two countries have similar average life expectancies.
In Cuba, doctors are “responsible for making sure the basics are covered for a certain number of people in their neighborhood,” said Lebowitz. “The majority of their responsibility focuses on blood pressure, body weight, cholesterol, nutrition, smoking cessation, etc. — the very basics that we don’t put enough effort into [in the United States].”
Also, “there is less processed food [in Cuba],” he said. “This reduces the development of chronic diseases, and as a result there is less need for high-tech expensive interventions for which [Americans] spend all that money.”
Lebowitz thinks more resources should be put into ensuring everyone has access to fresh, nutritious food, such as supporting community gardens.
“Simply switching calories by 20% from ultra-processed and fast foods to fruits and vegetables, lean meats and eggs (unprocessed food) can have a proven, magnified impact in disease prevention,” he said. “We need to make doing so cheaper and a priority, especially in the underserved food deserts.”
Takeaway
New research by the American Heart Association projected future rates of cardiovascular disease and risk factors. The study found that in 2050, more than 61% of American adults will have some type of cardiovascular disease, including high blood pressure.
This trend is driven by an aging population and a more diverse population. Communities of color tend to be impacted more by cardiovascular disease.
Rates of cigarette smoking, inadequate physical activity and high cholesterol are projected to drop by 2050. But experts say more work is needed to slow these trends, including ensuring that all Americans have access to healthy foods.
