It is the best of times and the worst of times in the battle against cardiovascular disease. On the one hand, mortality rates from cardiovascular disease in the US have dropped by more than half in the last 30 years, likely due in large part to improvements in treatment for elevated blood pressure and cholesterol levels and big declines in smoking. On the other hand, it is uncertain whether these gains will continue, and many experts think that cardiovascular disease may well be on the rise once again, largely due to the aging of the population and to increases in obesity and diabetes.
In an article in Health Affairs, Ankur Pandya and colleagues (including cardiologist Thomas Gaziano of the Brigham and Women’s Hospital) forecast cardiovascular disease trends through the year 2030 using data from the National Health and Nutrition Examination Survey. They project that although the age-adjusted risk for cardiovascular disease is likely to continue to decline through 2030, because of an aging population and the increase in obesity the overall incidence of cardiovascular disease will increase.
The authors considered various scenarios relating to control of obesity, high blood pressure, and cholesterol. One important unknown factor is whether the recent stabilization in obesity will continue. If the trend holds, they write, 1.6 million fewer people would develop cardiovascular disease in 2030.
The authors warn that “the United States should expect to see a sharp rise in the health care costs, disability, and reductions in quality of life due to increases in the prevalence of cardiovascular disease.
The study may also have an impact on the often controversial question of whether resources are better devoted to treatment or prevention: “our findings suggest that substantial reductions in incidence are crucial: Otherwise, improvements in mortality from cardiovascular disease (along with aging and obesity trends) will lead to a troubling increase in prevalence.”
They recommend the adoption of policies to reduce obesity and improve treatments of high blood pressure and cholesterol”to curb the imminent spike in prevalence of cardiovascular disease.”