It isn’t too late to sustain a 50-year-long reduction in cardiovascular disease-related deaths, according to research published in Clinical Cardiology—but with rising rates of obesity and diabetes, we’re closer than ever to reversing that progress.
A study led by Jesse D. Ortendahl and colleagues at the Partnership for Health Analytic Research in Beverly Hills found that, without the uptake of new pharmacological or technological innovations in the near future, CVD-related deaths in the United States could almost double by 2040 when factoring in population growth. By 2030, they estimate the disease will also rack up more than $1 trillion annually in direct and indirect costs.
“CVD mortality has decreased over 60 percent over the past 50 years in the United States,” Ortendahl and co-authors wrote. “However, emerging data indicate CVD incidence may be rising because of shifting demographics, increasing risk factor prevalence and competing needs for limited resources.”
The researchers developed a microsimulation model using National Health and Nutrition Examination Survey (NHANES) data to project CVD mortality trends decades into the future. Using NHANES information to estimate population-level trends in CVD risk factors, the team generated Framingham Risk Scores for cohorts of 1 million individuals and predicted annual CV incidence, prevalence and mortality for a range of different scenarios. Scenarios were built around predicted pharmaceutical innovations with variable efficacy, risk factor prevalence, changes in health disparities and the uptake of currently available therapies.
In the first scenario, Ortendahl et al. fixed risk factor prevalence at 2015 levels and estimated CVD mortality levels would increase from 218 per 100,000 individuals in 2015 to 355 per 100,000 people in 2040—a 62 percent hike driven by an increase in CVD prevalence from 9.8 percent to 16 percent. When the authors also considered population growth, annual CVD deaths were projected to rise from 462,122 in 2015 to 916,014 by 2040.
Another scenario that varied all risk factors estimated a 15 percent increase in CVD deaths by 2020, a 34 percent increase by 2030 and a 41 percent increase by 2040. While the outcome was better, the authors pointed out their second model still predicted a steep rise in mortality.
Ortendahl and co-authors estimated that the introduction of cholesterol-lowering therapies that could reduce average cholesterol by at least 20 percent would lead to a CVD mortality rate of 260 per 100,000 in 2040—an improvement over their first projection, which determined the rate would rise to 355 per 100,000 people by 2040. Reducing average systolic blood pressure by 5 percent would pave the way for a 286-per-100,000 mortality rate, but that’s a feat the authors said would require “significant effort” (average SBP decreased by just 4 percent between 1980 and 2000).
“If development of therapeutic alternatives is prioritized and new treatments are used effectively in the right patient populations, the decline in CVD mortality could continue,” they said. “Nevertheless, death is inevitable. As progress is made in one disease area, more individuals are susceptible to competing causes of mortality.”
When the team considered interventions that would reduce CVD through any mechanism of action, they found that a 20 percent reduction in incidence led to mortality rates of 255 per 100,000 individuals in 2030 and 262 per 100,000 in 2040. Extending that reduction to 40 percent would keep mortality rates steady through 2040.
The authors said they expect little to change without a concomitant decrease in obesity rates in the U.S., which have pushed type 2 diabetes diagnoses to an all-time high.
“While evidence has shown that CVD risk increases with an increased duration of diabetes, earlier diagnosis leading to effective treatment could allow glucose levels to be controlled before individuals become elderly and face an elevated age-related risk,” they wrote. “Preventing an increase in CVD mortality will require either dramatic shifts in risk factor prevalence or development and diffusion of additional efficacious treatments.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.