Research in Brief: BIDMC Investigators Lead Inaugural Report on State of US Cardiovascular Health

JACC Report Highlights National Trends, Persistent Disparities, and Opportunities To Improve US Heart Health

After decades of progress, cardiovascular health in the United States has been sliding backward, and younger adults are bearing the brunt. A new national effort now aims to provide a clear picture of where the country stands and where action is most urgently needed to reverse course.

The inaugural JACC Cardiovascular Statistics report, published today in the Journal of the American College of Cardiology and co-led by investigator Rishi K. Wadhera, MD, MPP, MPhil, of Beth Israel Deaconess Medical Center (BIDMC) offers a comprehensive, data-driven assessment of cardiovascular risk factors, disease burden, quality of care and outcomes in the United States.

“Progress in cardiovascular health depends on a clear-eyed understanding of where we are, where we’ve made gains, and where we’re falling behind,” said Wadhera, Associate Director of the Richard A. and Susan F. Smith Center for Outcomes Research at BIDMC and Associate Professor at Harvard Medical School. “We can’t improve what we don’t see clearly, and this report is designed to serve as an annual benchmark.”

The report paints a troubling portrait. After decades of medical and public health advances, mortality from heart failure and stroke is rising. Younger adults are experiencing increases in heart attacks and diabetes. And across nearly every measure, Black, low-income and rural Americans fare worse.

Among the key findings:

Risk factors

• More than 40 percent of United States adults are obese, a major driver of cardiovascular disease.
• Hypertension affects nearly one in two adults. However, only about two-thirds of adults with hypertension receive treatment for the condition. Deaths related to high blood pressure have nearly doubled over the past two decades.
• Diabetes prevalence has risen sharply over the past 15 years, particularly among younger adults, those with low incomes and non-Hispanic Black populations.
• While cigarette smoking has declined overall, rates remain twice as high among low-income adults.

Conditions

• Heart attack hospitalizations, after years of decline, are now rising among younger adults.
• Heart failure-related mortality, which fell steadily from 1999 to 2011, is now on the rise, with age-adjusted death rates highest among non-Hispanic Black adults.
• Mortality from coronary heart disease declined by nearly 50 percent between 2000 and 2020, yet only one in two patients currently receives optimal medical therapy.
• Stroke mortality declined substantially from the 1970s through 2013 but has since rebounded, with the sharpest increases among Black and middle-aged adults.

Co-led by Wadhera and Lesley H. Curtis, PhD, of Duke University School of Medicine, the report is a multi-institutional collaboration that draws on national surveys, clinical registries and administrative data. In addition to the persistent disparities by race, geography and socioeconomic status that emerged as a central finding, the report identifies critical areas where data are incomplete and new research is urgently needed. Future editions will expand the report's scope to include additional conditions and international populations.

“Data are most powerful when they lead to action,” Wadhera said. “JACC Cardiovascular Statistics is designed to inform conversations, sharpen decision-making, and help align clinicians, health systems, public health leaders, and policymakers around a common goal - improving cardiovascular health for all.”

Co-authors included ZhaoNian Zheng, MSc, of Beth Israel Deaconess Medical Center; Behnood Bikdeli, MD, MS, and Jason H. Wasfy, MD, MPhil, of Harvard Medical School; Sanket S. Dhruva, MD, of University of California, San Francisco; Marc P. Bonaca, MD, MPH, of University of Colorado School of Medicine; Michelle M. Kittleson, MD, PhD, of Cedars-Sinai Medical Center; Dennis T. Ko, MD, MSc, of Sunnybrook Hospital, University of Toronto: Yuan Lu, ScD, Erica S. Spatz, MD, MHS, and Harlan M. Krumholz, MD, of Yale School of Medicine; Neha J. Pagidipati, MD, MPH, and Lesley H. Curtis, PhD, of Duke University School of Medicine; Mitsuaki Sawano, MD, PhD, of Teikyo University; Muthiah Vaduganathan, MD, MPH, of Brigham and Women's Hospital; Celina M. Yong, MD, MBA, MSc, of Stanford University School of Medicine; Huanhuan Yang, PhD, of Tsinghua University.

For a complete list of funding support and author disclosures, please see the JACC research paper.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.