Although mortality related to cardiovascular disease has been decreasing in the United States, the incidence and prevalence of cardiovascular disease are increasing; more people are getting sick, but better treatments allow them to live longer. Over time, this increased longevity will lead to significant increases in morbidity and health care costs. To examine the potential impact of these trends, researchers evaluated nine data sets from the National Health and Nutrition Examination Surveys (from 1971 through 2010) to project cardiovascular disease incidence and mortality through 2030. They also estimated the impact of different scenarios involving trends in risk factors (such as obesity, smoking, high cholesterol levels, and diabetes) and in factors that can mitigate those risk factors (such as cholesterol and blood pressure medications and decreasing saturated fat intake).

In 1991 the average 10-year risk of cardiovascular disease was 13% in men and 7% in women. According to their analyses, the authors estimate risks of 15% and 9%, respectively, by 2030 (however, age-adjusted projections showed a decline). They also estimate that if cardiovascular disease mortality rates were to remain at 2010 levels, prevalence would decrease-but the rising age of the U.S. population should contribute to an increased prevalence of cardiovascular disease.

Whether projected trends in risk factors-such as, say, body mass index (BMI), which is projected to rise, and smoking, which is projected to fall-hold true will have tremendous effects on cardiovascular disease morbidity and mortality. For instance, if 2010 rates of smoking and treatment of cholesterol were to hold steady, cardiovascular disease risk and prevalence rates would increase through 2030. In contrast, were the average 2010 BMI to hold steady, risk and prevalence would decrease. The authors calculate that stalling the projected rise in obesity could result in 1.6 million fewer people with cardiovascular disease in 2030.

The authors noted several study limitations, including the exclusion of other important factors from their calculations, such as physical activity, socioeconomic status, and race. However, their data imply that improvements in treatment and reductions in smoking rates cannot totally forestall an increase in cardiovascular disease risk, which will be influenced significantly by increases in longevity and obesity in the U.S. population and will result in significant increases in health care costs and disability, as well as decreases in quality of life. The authors conclude that substantial reductions in cardiovascular disease incidence-by decreasing obesity and improving cholesterol and blood pressure treatment-are crucial and that policies should be developed to address these areas.

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