American Heart Association report highlights disparities in heart disease, calls for equitable healthcare

In a recent review published in the journal Circulation, researchers provide the most current statistics on heart disease (HD), stroke, and cardiovascular risk factors, wherein they increase focus on health equity and address structural racism in healthcare.

Study: Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Image Credit: sdecoret / Shutterstock.com

Background 

Annually, the American Heart Association (AHA), in collaboration with the National Institutes of Health (NIH), releases comprehensive statistics on HD, stroke, and related risk factors. This includes data on health behaviors like smoking and obesity, as well as various heart and circulatory conditions and their impact on healthcare quality and costs.

Nearly one century later, the AHA continues to update these statistics annually, providing vital information on cardiovascular diseases (CVDs), their prevalence, and impact. The report has evolved into a comprehensive resource that aids various stakeholders, including the public, policymakers, media, clinicians, and researchers. This information not only informs policy development and resource allocation but also guides cardiovascular research priorities.

Nevertheless, continuous research is crucial to updating and enhancing our understanding of CVDs, ultimately improving prevention, diagnosis, and treatment strategies.

Cardiovascular health and risk factors

Since 1921, HD remains the leading cause of death in the United States. However, significant progress has been made throughout the past century to reduce the risk of acquiring CVDs. For example, CVD-related death rates have decreased by 60% since 1950, with the number of people in the U.S. dying from a heart attack declining from one in two to one in eight.

Despite this progress, the prevalence of several CVD risk factors, including diabetes, population aging, and health inequities, continues to rise. To date, about 48.6% of the U.S. population over the age of 20 are estimated to have CVDs, including coronary heart disease, heart failure, stroke, or hypertension. Some of the communities that are most affected by CVDs include non-Hispanic black females and males, 59% of whom are currently living with CVDs.

Likewise, despite overall reductions in youth and adult cigarette use throughout the U.S. over the past twenty years, significant disparities persist. Whereas 1.8% of Hispanic and non-Hispanic white youth currently smoke cigarettes, about 2.3% of non-Hispanic multiracial youth report past 30-day cigarette use. Notably, this declining trend has been in stark contrast to rising electronic cigarette adolescent users, which has risen from 3.3% to 14.1%.

Physical activity, diet, and weight

Upon examination of physical activity levels, a concerning percentage of the population does not meet recommended exercise guidelines. Between 2020 and 2021, about 20.5% of children between six and 17 years of age were reported to be active for 60 minutes or more every day. Similarly, only about 24.2% of adults met aerobic physical activity guidelines for Americans in 2020.

Nutrition is another critical area, with the report highlighting the generally poor dietary patterns in the U.S. and their impact on cardiovascular health. Some of the different social and environmental factors that were found to impact diet quality include education, income, race and ethnicity, neighborhood supermarket availability, and food-related costs.

Taken together, these factors have a significant impact on overweight and obesity rates, both of which are major risk factors for CVD that remain prevalent in a significant portion of the U.S. population. As of March 2020, about 71.2% of U.S. adults 20 years of age and older were considered to be overweight or obese, whereas about 20% of adolescents between two and 19 years of age were considered obese.

Related health conditions and diseases

Congenital heart disease, hypertension, diabetes, obesity, and smoking account for 52% of heart failure cases within the U.S. The prevalence of diabetes throughout the U.S. varies greatly by both sex and ethnicity, with 7.7% of non-Hispanic White females currently diagnosed with diabetes as compared to 14.5% of Hispanic males.

Despite the direct association between diabetes and CVD-related death, less than 20% of U.S. adults with diabetes currently meet their hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol targets. Recently, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have emerged as highly effective diabetes medications that can reduce CVD risk; however, these medications remain highly underused.

The prevalence of metabolic syndrome in U.S. adults has increased significantly since 1999, from 36.2% to 47.3% as of 2018, with the highest prevalence of metabolic syndrome reported among Mexican American adults at 52.2%. Some notable risk factors for metabolic syndrome include lower education and income levels.

The current report also identifies various other health conditions and their impact on CVD risk, some of which include cerebrovascular diseases like stroke, pregnancy, congenital cardiovascular defects, Kawasaki disease, kidney disease, atherosclerosis, valvular diseases, peripheral artery disease, and aortic diseases.

The Role of AHA in advancing cardiovascular health

The AHA continues to drive science and innovation, advocate for patients’ rights, and strive toward healthier communities worldwide. By understanding past and present trends, the report allows researchers throughout the world to develop strategies to effectively combat HD and stroke. The AHA remains committed to being a force for a world of longer, healthier lives, advancing health, and hope for everyone everywhere.