Key aspects of the statement:

• Over the next 25 years, the number of women with cardiovascular disease is expected to increase considerably, with nearly 60% of women in the U.S. potentially having high blood pressure by 2050, compared to an estimated 5 out of 10 women in 2020, according to projections outlined in a new scientific statement from the American Heart Association.
• Nearly a third of women aged 22 to 44 will have some type of cardiovascular disease, compared with less than 1 in 4 today.
• The rise in cardiovascular disease will also be driven by the increase in other health risk factors, such as diabetes and obesity.
• This trend will affect even younger generations, as it is estimated that nearly 32% of girls aged 2 to 19 could be obese by 2050.

Due to rising rates of high blood pressure , nearly 6 out of 10 women in the U.S. will have some form of cardiovascular disease (CVD) within the next 25 years, according to a new scientific statement published today in Circulation , the leading peer-reviewed scientific journal of the American Heart Association, a global organization working to transform the future of health for all people.

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease (website in English) expands on previous work by the Association and analyzes estimates of the future prevalence of cardiovascular disease in women, as well as the associated economic impact, based on the current situation.

“One in three women will die from cardiovascular disease: it could be your grandmother, your mother, or your daughter,” said Karen E. Joynt Maddox, MD, MPH, FAHA, volunteer chair of the American Heart Association’s scientific statement writing group, professor of medicine and public health, and co-director of the Center for Advancing Health Services, Policy & Economics Research at Washington University School of Medicine in St. Louis. “More than 62 million women in the U.S. have some form of cardiovascular disease, which costs at least $200 billion annually. Our estimates indicate that if we continue on this path, these numbers will increase dramatically over the next 25 to 30 years.”

The report’s findings indicate significant increases among women for all types of cardiovascular disease, including heart disease , heart failure , atrial fibrillation , and stroke . Increases are also projected among women for many of the major health risk factors that contribute to cardiovascular disease, such as high blood pressure, obesity , and diabetes .

Joynt Maddox pointed out that the following is even more worrying:

• The prevalence of some health factors is also increasing among girls and adolescents aged 2 to 19.
• The increases are even more significant among women and girls who identify as American Indian/Alaska Native, Black, Hispanic, or multiracial.

“Cardiovascular disease is the leading cause of death in women and continues to be the leading risk factor for overall health,” said Stacey E. Rosen, MD, FAHA, volunteer president of the American Heart Association and executive director of the Katz Institute for Women’s Health, as well as senior vice president of women’s health at Northwell Health in New York City. “While many people may think that these conditions, such as high blood pressure, only occur in older women, we know that this is not the case. The factors that contribute to heart disease and strokes appear at early stages of life, including among young women and girls. The impact is even greater for those with adverse social determinants of health, such as poverty, low literacy, rural residence, and other psychosocial stressors. Identifying the types of trends described in this report is critical to implementing meaningful changes to reverse this trend.”

Figures

The report concludes that, if current trends continue, the following will happen by 2050:

• Nearly 60% of women will have high blood pressure, compared to less than half today.
• More than 25% of women will have diabetes, compared to approximately 15% today.
• More than 60% of women will be obese, compared to about 44% today.

Projections among women of color show some of the largest increases; by 2050, the following will happen:

• High blood pressure will increase to a greater extent among Hispanic women, with an increase of more than 15%.
• Obesity will register the greatest increase among Asian women, with a rise of nearly 26%.
• The prevalence rates of cardiovascular disease risk factors will remain, for the most part, higher among Black women. More than 70% of Black women will have high blood pressure, more than 71% will have obesity, and nearly 28% will have diabetes.

Although older women will continue to have some of the highest rates of cardiovascular disease and associated risk factors, the numbers will increase considerably among younger women. By 2025, the following will occur:

• Nearly a third of women aged 22 to 44 will have some type of cardiovascular disease, compared with less than 1 in 4 today.
• Diabetes rates in women aged 22 to 44 will more than double, rising from 6% to nearly 16%.
• More than a third of women aged 22 to 44 will have high blood pressure, representing an increase of more than 11%.
• More than 1 in 6 women aged 22 to 44 will be obese, which implies an increase of more than 18%.

The report also analyzes cardiovascular health risk factors among girls and adolescents:

• By 2050, almost 32% of girls aged 2-19 will be obese, an increase of more than 12%.
• This is likely driven by the fact that over 60% of these girls will have insufficient levels of physical activity and more than half will maintain an unhealthy diet; these rates are estimated to improve only slightly in the coming decades.
• As with adult women, these rates tend to be higher among girls of color, particularly among black girls, 40% of whom will be obese by 2050.

“This trend of increased health risks among girls and young women is especially concerning, as it indicates they will face chronic health problems for most of their lives. Women are already at higher risk for many of these conditions due to factors that affect them throughout their lives,” Rosen said. “The significant health changes that occur during pregnancy, perimenopause, and menopause make it particularly important to pay close attention to the increased risk factors during those periods.”

A positive outlook

There is some encouraging news, as high cholesterol rates are expected to decline in almost all groups of women. Improvements are also anticipated in some of the health-related behaviors that influence cardiovascular disease, such as healthier eating, increased physical activity, and a lower prevalence of smoking.

“We know that people are living longer because diseases are being better managed. As a medical community, we have done a great job of reducing deaths from major cardiovascular events, such as heart attacks and strokes; however, this data suggests that we must truly refocus our efforts on health, wellness, and prevention,” said Joynt Maddox. “We need to prevent girls and women from developing cardiovascular risk factors so they can live long, healthy lives, free from cardiovascular disease; and that requires a strong commitment to focusing on optimal cardiovascular health throughout life.”

The American Heart Association defines optimal health through Life’s Essential 8™ , which comprises four health behaviors (eating better, being more active, quitting smoking, and sleeping healthily) and four health factors (maintaining a healthy weight, controlling cholesterol, regulating blood sugar, and controlling blood pressure).

“These ideal cardiovascular health metrics are based on extensive scientific research that recognizes that the majority of cases (up to 80%) of heart disease and strokes are preventable,” Rosen said. “I like to call Life’s Essential 8 a prescription for health. And one of the most encouraging aspects is that we have tailored guidance for these metrics at different stages of a woman’s life, from childhood through menopause and beyond. This report projects a concerning future; however, we still have time to take the first steps toward healthier outcomes.”

A call to action

“The most efficient, effective, and least costly way to reduce the prevalence and impact of cardiovascular disease is through prevention. However, these projections indicate that our current prevention efforts are inadequate, particularly for women of color and younger women,” said Joynt Maddox. “In the report, we have identified several considerations for improving prevention, treatment, and sustained lifelong care for all women.”

Healthy behaviors: Preventing health problems before they start is one of the best ways to protect cardiovascular health.

• Healthy choices should be promoted in environments where people learn, live, and receive care, such as schools, community centers, pediatric clinics, and gynecological offices.
• When useful, digital tools can be used to encourage and reinforce positive lifestyle changes.

Control of health factors : Early control of chronic conditions such as high blood pressure, diabetes, and obesity can make a big difference, especially in women at higher risk.

• Healthcare teams and policymakers should prioritize long-term support for chronic disease management in women, including early screening, team-based care, and the use of digital tools that facilitate access to care.
• Studies should also evaluate how new obesity drugs work specifically in women, to ensure their safety and effectiveness.

Clinical cardiovascular disease: Optimal care and high-quality treatments are required for women who have any type of cardiovascular disease, including heart attack, heart failure, atrial fibrillation, and stroke.

• When women go to the hospital for a heart attack, heart failure, or stroke, quality improvement programs, such as the American Heart Association’s Get With The Guidelines® website, need to be implemented to ensure they receive prompt, effective, and equitable treatment.
• In the case of long-term conditions such as atrial fibrillation and heart failure, care plans should take into account factors specific to women, so that shared treatment decisions are better tailored to their needs.
• Brain health, particularly dementia, should be considered an important component of blood pressure control, along with the prevention and treatment of cardiovascular disease in women.

Attention at every stage of life: Each stage of life offers an opportunity to detect risks early and protect cardiovascular health.

• Pediatricians should be aware that early menarche can be an indicator of increased cardiovascular risk in adulthood. Menstrual cycle history should be part of routine evaluations at any age.
• Coordinated care between different specialties must be integrated into the pre-pregnancy, gestational and postpartum periods, and ensure that needs are met in each phase.
• Furthermore, research should continue to investigate how lifestyle changes and hormone therapy around menopause influence women’s cardiovascular health.

Understanding the role of social and demographic factors: Social and environmental factors affect women differently.

• Programs specifically designed for Black women are urgently needed to help address the higher rates of cardiovascular disease they experience.
• Health systems must consider how social challenges, such as access to healthy food, transportation, or safe housing, combine with medical risks, and design interventions that improve cardiovascular health in each context.

A future that can change

Joynt Maddox is also the author of the American Heart Association’s 2024 presidential advisory, ” Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease” (website in English). The report included several simulation studies that identified ways to reverse current trends.

• A 10% reduction in risk factors such as high blood pressure, high cholesterol, diabetes and obesity, along with a 20% improvement in the control of blood pressure, blood sugar and cholesterol, could decrease CVD events and strokes, including mortality, by between 17% and 23%.
• Halving obesity and doubling the control of risk factors could decrease CVD events and deaths by 30% to 40%.

“Society has made tremendous progress in medical advancements, but the same cannot be said for innovation and progress in cardiovascular health, wellness, and prevention. These projections highlight how critical it is that we begin to focus on how to help everyone stay healthy,” said Joynt Maddox. “In this new era of digital health, artificial intelligence, and new metabolic drug options, healthcare professionals increasingly have the tools to do so, but they still lack the necessary systems.”

Rosen noted that, at a time when awareness of cardiovascular disease among women has been declining (website in English), the picture described in this report should serve as a warning sign.

“Every woman, at any age, should understand her risk of heart disease and stroke and feel motivated to take steps to reduce it,” she said. “Know your health indicators, listen to your body, and take an active role in your health care. Also, encourage the girls and women in your life to do the same. We can make a difference: we can be the difference.”

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association’s Committee on Women’s Health Science, which is part of the Council on Clinical Cardiology and Stroke; the Council on Basic Cardiovascular Sciences; the Council on Cardiovascular and Stroke Nursing; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and the Council on Peripheral Vascular Disease. American Heart Association scientific statements promote greater awareness of the problems caused by cardiovascular disease and stroke and help facilitate informed health care decisions. Scientific statements describe what is currently known about a topic and areas that need further research. While scientific statements inform the development of guidelines, they are not treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice President Harmony R. Reynolds, MD, FAHA; Demilade Adedinsewo, MD, MPH; Cheryl Bushnell, MD, MHS, FAHA; Holli A. DeVon, Ph.D., FAHA; Holly C. Gooding, MD, MS; Virginia J. Howard, Ph.D., FAHA; Rina Mauricio, MD; Eliza C. Miller, MD, MS; Garima Sharma, MD, FAHA; and RJ Waken, Ph.D. The authors’ statements are found in the article.

Source https://www.heart.org/