Study Warns of Significant Increases in Diabetes and Cardiovascular Disease by 2060

James Januzzi, MD

An analysis leveraging data from the 2020 US Census Bureau report paints a grim picture related to projected rates of cardiovascular risk factors and disease among the US population by 2060.

Led by a team at Massachusetts General Hospital, results of the study detail projected increases of 18% or more in prevalence of diabetes, cholesterol disorders, hypertension, and obesity as well as 33% increases in the rates of both heart failure and stroke among the US population from 2025 to 2060.

“Our analysis projects that that the prevalence of cardiovascular risk factors and diseases will continue to rise with worrisome trends,” said senior investigator James Januzzi Jr, MD, cardiologist at Massachusetts General Hospital and Hutter Family Professor of Medicine at Harvard Medical School, in a statement. “These striking projections will disproportionately affect racial and ethnic minority populations in the U.S. Understanding these results will hopefully inform future public health policy efforts and allow us to implement prevention and treatment measures in an equitable manner.”

As the US population ages and becomes more diverse, concern has grown over the implications for health systems on a societal level. With an interest in understanding these trends to improve policy planning and public health interventions, Januzzi and a team of colleagues from Massachusetts General Hospital designed the current study with the intent of estimating the prevalence of cardiovascular risk factors and cardiovascular disease according to age, sex, race, and ethnicity using logistic regression models based on NHANES survey data from the 2013-2018 survey cycles and the 2020 US Census report projections for 2025-2060.

The specific risk factors of interest for the investigators’ analyses were diabetes, hypertension, dyslipidemia, and obesity. For the purpose of analysis, cardiovascular disease included ischemic heart disease, myocardial infarction, stroke, and heart failure, all of which were based on self-reported patient data.

In their analyses, investigators found the prevalence of all 4 risk factors was expected to rise among the overall US population from 2025 to 2060. The greatest estimated increase was observed for diabetes mellitus at 39.3% with an estimated 54.6 million individuals impacted by 2060. The rates of hypertension were expected to increase by 27.1% to 162.5 million individuals, the rate of dyslipidemia was expected to increase by 27.6% to 125.7 million individuals, and obesity was expected to increase nay 18.3% to 125.7 million individuals. Investigators pointed out that although the absolute number of individuals with obesity is expected to rise, the overall prevalence is projected to decrease from 39.4% in 2025 to 38.8% in 2060.

Notable increases were observed for cardiovascular disease. Results indicated the estimated prevalence of ischemic heart disease was expected to rise 30.7% from 2025 to 2060 to an estimated 8.8% of the population. Prevalence of heart failure was expected to increase by 33.4% to an estimated 4.0% of the population, stroke was expected to increase by 33.8% to 4.5% of the population, and myocardial infarction was expected to increase by 16.9% to 4.9% of the population.

Investigators called attention to differences in projected change observed in the current study according to race and ethnicity. Specifically, the greatest overall prevalence of risk factors remission was expected to remain among the White population due to overall size, but the White population was expected to experience a gradual decrease in risk factors from 2025 to 2060. Among minority populations, the project prevalence of all risk factors was expected to rise.

“Ultimately, as prevention is imperative to tackle the future burden of cardiovascular disease, the results from this study pose an important challenge,” said lead investigator Reza Mohebi, MD, the Dennis and Marilyn Barry Fellow in Cardiology at Massachusetts General Hospital, in the aforementioned statement. “In order to reduce the burden of cardiovascular disease in the U.S. population, health care policymakers will need to allocate preventive measures and health care resources to the more vulnerable populations we projected to have higher percentage rise in disease.”

In an accompanying editorial published in JACC, Andreas P. Kalogeropoulos, MD, MPH, PHD, and Javed Butler, MD, MPH, MBA, applauded the efforts of investigators and underlined the importance of the implications brought forth by their analyses.

“Despite that several assumptions underlie these projections, the importance of this work cannot be overestimated,” said Kalogeropoulos, a clinical and outcomes researcher at Stony Brook University Medical Center. “The absolute numbers are staggering and suggest that by year 2060, compared to 2025, the numbers of people, particularly minorities, with CV risk factors are expected to increase dramatically. Unless targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time.”

This study, “Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates,” was published in the Journal of the American College of Cardiology.