Heart disease and stroke projected to rise significantly in women in the next 25 years

Obesity, diabetes and high blood pressure are fueling increases in cardiovascular disease, even among much younger women, the American Heart Association said.

A patient’s blood pressure is monitored.andreswd / Getty Images

Without better prevention and early detection, the number of women living with cardiovascular disease will increase substantially in the coming decades, the American Heart Association said Wednesday.

Using historical trends from two national health surveys and census estimates of population growth, the heart association forecast that the percentage of women with at least one type of cardiovascular disease will climb by more than a third, from 10.7% in 2020 to 14.4% in 2050.

Cardiovascular disease is already the leading cause of death for women in the U.S.

The most common form is coronary heart disease, which occurs when fatty deposits called plaque build up in the heart’s arteries, preventing them from delivering oxygen-rich blood to the heart muscle. Other types included in the new report are heart failure, when the heart struggles to fill with and pump blood; atrial fibrillation, a type of abnormal heart rhythm; and stroke.

The scientific statement’s findings are “a call to action,” said Dr. Stacey Rosen, volunteer president of the American Heart Association and executive director of the Katz Institute for Women’s Health at Northwell Health in New York City. Each year, the association produces scientific statements and guidelines based on expert consensus to promote longer, healthier lives.

There have been major advances in lifesaving treatments for heart disease. But this is an opportunity to rethink how to improve prevention and early detection, Rosen said.

The statement’s authors looked at several years’ worth of data from two national surveys. One was the National Health and Nutrition Examination Survey, from 2015 to 2020, which asks adults and children about their health and diet.

The other was the 2015-19 Medical Expenditure Panel Surve, an annual government survey that asks a large sample of people and families, their medical providers and employers about the cost and use of health care and health insurance coverage.

The authors used census forecasts for population growth to extend those historical trends into the future.

Among adult women, the rate of cardiovascular disease is projected to increase from:

6.9% in 2020 to 8.2% in 2050 for coronary heart disease.
2.5% to 3.6% for heart failure.
4.1% to 6.7% for stroke.
1.6% to 2.3% for atrial fibrillation.

The aging of the population is partly driving the increases, said Dr. Karen Joynt Maddox, a cardiologist, chair of the group that wrote the paper. Joynt Maddox is professor of medicine and public health at the Washington University School of Medicine in St. Louis.

Risk factors among younger women

Rising rates of diabetes, obesity and high blood pressure are also factors, all of which together and independently raise the risk for heart conditions.

If current trends hold, the prevalence of high blood pressure among adult women is expected to increase from 48.6% in 2020 to 59.1% in 2050.

Diabetes rates could climb from 14.9% to 25.3% and obesity from 43.9% to 61.2%, according to the statement.

Those cardiovascular risk factors are increasing across all age groups, including young women ages 20 to 40. The rate of obesity is also projected to rise among girls, from 19.6% to 32.0%.

“That’s setting up an entire generation of girls and young women to develop these cardiovascular diseases at a much younger age,” Joynt Maddox said.

Based on questions in one of the surveys, the percentage of women who eat poorly or don’t get enough exercise is expected to decline slightly, and smoking will continue to drop. However, the share of women with sleep problems will rise.

Most of the adverse trends are expected to be more pronounced among girls and women who identify as Black, Hispanic, Indigenous or multiracial.

Impact of weight-loss drugs

The study didn’t take into account the growing use of GLP-1 drugs, the powerful weight-loss and Type 2 diabetes medications. Research has also shown that the drugs can help lower the risk of recurring heart attacks and recurring episodes of heart failure, Rosen said.

Their impact 30 years from now on cardiovascular diseases and its risk factors, like obesity and diabetes, is uncertain, Rosen said, adding that “the long-term safety is something that has to continue to be studied.”

Research has also shown that many people stop using the drugs because of unpleasant side effects and then regain much of the weight they lost.

There are other hurdles to the weight-loss medications.

“Not all communities can afford the out-of-pocket expenses for GLP-1s, and unfortunately, we may see a widening of disparities in cardiovascular risk factors and outcomes,” said Norrina Bai Allen, an epidemiologist specializing in cardiovascular disease who is director of the Institute for Public Health and Medicine at Northwestern University’s Feinberg School of Medicine.

In the meantime, women can work now to lower their lifetime risk of developing heart problems, Joynt Maddox said.

Getting regular checkups, taking prescribed medications and building healthy habits around diet and exercise are key, she said, especially around pregnancy, when diabetes and high blood pressure may first appear, and during menopause, when cholesterol, blood pressure and sleep change.

It’s never too late or too early to begin. “Eighty percent of each of our risks for heart disease is preventable, and it starts with awareness,” Rosen said.