In a sobering look at risk factors for heart disease and stroke, new projections estimate that 6 out of 10 women will develop at least one type of cardiovascular disease over the next 25 years. Moreover, disease will show up at younger ages.
By 2050, nearly one-third of girls from ages 2 to 19 will have obesity, one of the three main drivers of cardiovascular disease, the new American Heart Association scientific statement published Wednesday in Circulation said.
The work is based on the organization’s previous research estimating future cardiovascular disease prevalence. High blood pressure, the leading risk factor for cardiovascular disease, becomes more common in older age, but obesity is a relatively new concern for children. Diabetes is the third risk factor.
“That should be a wake-up call for us,” C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center, told STAT. She was not involved in the paper. “It’s alarming and it’s all preventable. That’s the sad reality.”
Increasing levels of obesity in children are alarming to Karen Joynt Maddox, a cardiologist and professor at Washington University School of Medicine. She is the lead author of the AHA statement.
“We’re just setting up a generation of people to move through life, having their cardiovascular events earlier and more severe,” she told STAT. “The biggest call to action that comes out of this is recognizing that among young people, the health of the country is just really heading in the wrong direction and we certainly see that in women.”
Overall, high blood pressure will affect 6 out of 10 women by 2050, according to the estimates. But one-third of younger women, from 22 to 44 years old, will be living with some form of cardiovascular disease other than high blood pressure, compared to less than a quarter of that age group who currently face those conditions. Their risk of diabetes is predicted to jump from 6% to nearly 16% and obesity will go up by 18%, affecting 1 in 6 women in that age range.
The analysis did not consider the impact of obesity drugs since it focused on 2015 to 2020, mostly before the medications became increasingly common.
“They were not out in broad use by the time that any of our data were calculated, so what our calculations assume is that there’s no change to what has been happening,” Joynt Maddox said. “I think we’re just at just the infancy of knowing how to use these weight loss drugs, and I’m actually optimistic that we will see a change in the obesity rates as we start to have data come in over the next decade.”
Men are unlikely to escape what has been a reversal of progress for all Americans since about 2011, when decades-long improvements in cardiovascular health, spurred by lower smoking rates and improved health care, began to stall. Heart failure deaths dropped and then plateaued in 2012, before beginning to rise steadily. Cardiovascular deaths ticked up during the coronavirus pandemic’s early years before returning to 2019 levels.
“This is a public health problem,” Nicole Bhave, cardiologist and echocardiographer at the University of Michigan Health Frankel Cardiovascular Center, said. She was not involved in preparing the AHA projections. “Before people develop disease, it’s not just what’s happening in the home, but what’s happening in school, what’s happening in the community. And we need public health interventions to address this. We need better green spaces and better safety so people will feel comfortable exercising outside.”
Joynt Maddox pointed to heart disease in younger people to explain why cardiovascular mortality seems stuck.
“We’re continuing to do well with the older people,” she said. “We’re taking care of heart attacks quite well, but we’re really not preventing any. And so we’re seeing more disease in younger people, which I think is a terrible trend. We can’t treat our way out of this; we have to prevent our way out of this.”
Most girls — more than 6 out of 10 — are not physically active enough and half of them have poor diets, the AHA forecast found. Risk factor rates were higher among different groups: 4 out of 10 Black girls were projected to have obesity.
Women do not do as well as men in several specific cardiovascular conditions. Some differences may reflect different biology, treatment, awareness, or some combination. Then there’s poverty, a burden disproportionately borne by women, making them more likely to delay or skip health care because of its costs.
Understanding heart disease as it relates to reproductive health is still evolving. More is being learned about the onset of menstruation, preeclampsia in pregnancy, and the impact of menopause than what was taught in medical school 25 years ago, Joynt Maddox said.
In another example cited in the forecast, men tend to have the kind of heart failure following blockages in the coronary artery that mean their hearts can’t pump blood as well. Women are more likely to have a stiffening of the heart, leading to issues with fluid backup and kidney problems. Most of the new drug developments have been for the kind of heart failure more men have, in which the heart doesn’t pump as strongly.
Women have a higher burden of stroke than men, are less likely to receive clot-busting treatments, and are more likely to have poor outcomes than men. Women are at higher risk of stroke with the rhythm disorder atrial fibrillation than men, but women receive less blood-thinning and rhythm-control treatment than men.
“A lot of these things share common risk factors,” Joynt Maddox said, citing high blood pressure as a danger for heart attacks, strokes, arrhythmias, and both kinds of heart failure. “If we focus on some of those conditions, we’d be helping women and men across the board for all different kinds of conditions. I think that the biological differences are more about how we monitor and treat people. Everyone needs better health.”
Bairey Merz said “we’re kind of all in this together” about men and women, noting that while men are more likely to be overweight, women are slightly higher in obesity.
Bhave is concerned about the way different genders access medical care over their lifespans. Many of the young Black men she sees in a kidney and liver transplantation program have untreated high blood pressure and uncontrolled diabetes. Their kidneys fail when they’re in their 30s or 40s.
“Men can go from their pediatrician for 20, 30 years and never see a doctor until they have a symptom, whereas women often are more of a captive population during those reproductive years. Then they fall off the map, too,” she said.
That’s not to say the playing field is even for women. Even before Congress enacted a law in 1993 to enforce a National Institutes of Health policy requiring the studies it funded to include women, Bairey Merz was involved in an NIH study of heart disease in women.
“I used to say we’re 50 years behind the knowledge that we have in men about bypass surgery, about stents, about heart failure medications, about different kinds of procedures,” she said. “We’ve studied it now 25-plus years, so we have another 25 years to go.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
