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‘Staggering’ CVD Rise Projected in US, Especially in Minorities

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The new analysis predicts a dramatic increase by 2060 in the prevalence of cardiovascular 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 in Boston, and colleagues was published in the Aug. 9 issue of the Journal of the American College of Cardiology.

“While these projections are based on several assumptions, the importance of this work cannot be overstated,” write Andreas P. Kalogeropoulos, MD, MD, and Javed Butler, MD, MD, MD, in an accompanying editorial. business administration. “The absolute numbers are staggering.”

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From 2025 to 2060, the number of people with any of the four risk factors for cardiovascular disease — 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 any of the four types of cardiovascular disease — coronary 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 CVD risk factors will gradually decrease among White Americans, the highest prevalence of CVD risk factors will be in the white population due to its general population.

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Conversely, the predicted prevalence of CVD risk factors is expected to increase among Blacks, Hispanics, Asians, and other race/ethnic populations.

In parallel, CVD prevalence is projected to decrease in the white population and increase in all other races/ethnic groups, especially black and Hispanic populations.

“Our results predict an alarming rise, with a particularly ominous increase in risk factors and diseases in our most vulnerable patients, including blacks and Hispanics,” senior author James L. Gianuzzi Jr. concluded in a video released by the society.

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“The surge in risk factors for cardiovascular disease and disease reflects a generally higher prevalence in the population, which is projected to increase in the United States due to immigration and growth, including blacks or Hispanics,” explained Gianuzzi, also of the Massachusetts General and Harvard Universities. .org | Medscape Cardiology via email.

“In some ways, a disproportionate amount of risk is expected as minorities are disproportionately disadvantaged in terms of their health care,” he said. “But expected or not, the increase in predicted prevalence is nonetheless a concern and a call to action.”

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This study identifies “areas of opportunity for change in the US healthcare system,” he continued. “Business, as usual, will lead us to face a huge number of people with risk factors and diseases of cardiovascular disease.”

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The results of the current analysis suggest that there will be no changes in health care policy or changes in access to care for at-risk groups, Mohebi and colleagues note.

To “halt the rising tide of CVD in at-risk individuals” will require strategies such as “emphasis on education about CVD risk factors, improving access to quality health care, and facilitating access to cheaper therapies to treat the risk of cardiovascular disease. factors,” the researchers said.

“However, such advances should apply more fairly throughout the United States,” they warn.

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Census plus NHANES data

The researchers used the 2020 US Census data and projected growth, as well as the 2013-2018 US National Health and Nutrition Survey (NHANES) data, to estimate the number of people with CVD risk factors and CVD from 2025 to 2060. year.

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

Projected change in risk factors for cardiovascular disease 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 cardiovascular disease in the US population from 2025 to 2060
Disease Increase (%) Absolute increase (millions)
Cardiac ischemia 30.7 6.8
Heart failure 33.4 3.2
myocardial infarction 16.9 3.7
Stroke 33.8 3.7

Predicted changes in CVD risk factors and disease over time were similar in men and women.

The researchers acknowledge that the study’s limitations include the assumption that prevalence patterns of CVD risk factors and diseases will be stable.

“Because the frequency of risk factors and diseases is unlikely to remain unchanged, this assumption may reduce the accuracy of predictions,” Gianuzzi said. “However, we would like to point out that the goals of our analysis were to establish general trends and not try to predict exact numbers.”

They also did not take into account the impact of COVID-19. CVD was also self-reported and CVD risk factors may have been underestimated in minority groups with no access to health care.

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Changing demographic landscape

It is “amazing” that the number of non-white people with risk factors for cardiovascular disease is projected to outnumber white people over time, and the number of non-white people with cardiovascular disease will be almost the same as white people by 2060, the authors note.

“From a policy standpoint, this means that if appropriate targeted action is not taken, disparities in the burden of cardiovascular disease will only get worse over time,” write Kalogeropoulos of Stony Brook University, New York, and Butler of Baylor. University, Dallas.

“On the positive side,” they continue, “the absolute percentage increase in the prevalence of cardiovascular risk factors and conditions is projected to be within a manageable range,” provided specific prevention measures are implemented.

“This is an opportunity for professional communities, including the cardiovascular community, to reassess priorities and strategies for both education and practice to best meet the growing demands of the changing demographic landscape in the United States,” Kalogeropoulos and Butler conclude. .

Mohebi is supported by the Barry Partnership. Gianuzzi is supported by the Hutter family professorship; is a trustee of the American College of Cardiology; is a board member of Imbria Pharmaceuticals; received grant support from Abbott Diagnostics, Applied Therapeutics, Innolife and Novartis; received consulting income from Abbott Diagnostics, Boehringer Ingelheim, Janssen, Novartis and Roche Diagnostics; and participates in clinical endpoint committees/data security monitoring councils for AbbVie, Siemens, Takeda, and Vifor. Disclosures by 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 at 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

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