, January 27, 2011, by Michael O’Riordan  —  (Dallas, Texas) — In the next 20 years, more than 40% of the US population is expected to have some form of cardiovascular disease, and this will triple the total direct medical costs of caring for hypertension, coronary heart disease, heart failure, stroke, and other forms of cardiovascular disease from the current $273 billion to more than $800 billion, according to a new policy statement from the American Heart Association (AHA) [1].

In addition, the AHA estimates that the prevalence of cardiovascular disease will increase by approximately 10% over the next 20 years given no changes to prevention and treatment trends. If some risk factors, such as diabetes and obesity, continue to increase rapidly, cardiovascular disease prevalence and associated costs might increase even more, write Dr Paul Heidenreich (Veteran Affairs Palo Alto Health Care System, CA) and colleagues in the report, published online January 24, 2011 in Circulation.

At present, cardiovascular disease is the leading cause of death in the US and accounts for 17% of overall healthcare expenditures. In the past, the medical costs of cardiovascular disease increased at an average annual rate of 6%, and this growth in costs has been associated with an increase in life expectancy. That said, there are “many opportunities to further improve cardiovascular health while controlling costs,” according to the AHA.

Cardiovascular Disease Is Largely Preventable

The latest 2030 prevalence estimates for hypertension, coronary heart disease, heart failure, and stroke are derived from the 1999–2006 National Health and Nutrition Examination Survey (NHANES) and Census Bureau population estimates for the years 2010 to 2030. Projections of the medical costs associated with cardiovascular disease used the 2001–2005 Medical Expenditure Panel Survey (MEPS) and did not double count expenditures resulting from individuals with multiple conditions.

By 2030, the prevalence of cardiovascular disease is expected to increase 9.9%, with the prevalence of heart failure and stroke increasing approximately 25%. Total direct costs will increase to $818 billion by 2030, according to the AHA estimates, and the total indirect cost to the US in terms of lost productivity is close to $275 billion.

Projections of Crude Cardiovascular Disease Prevalence (%)

Year All cardiovascular disease Hypertension Coronary heart disease Heart failure Stroke
2010 36.9 33.9 8.0 2.8 3.2
2015 37.8 34.8 8.3 3.0 3.4
2020 38.7 35.7 8.6 3.1 3.6
2025 39.7 36.5 8.9 3.3 3.8
2030 40.5 37.3 9.3 3.5 4.0
% change 9.9 9.9 16.6 25.0 24.9

Projected Direct Medical Costs of Cardiovascular Disease ($B)

Year All cardiovascular disease Hypertension Coronary heart disease Heart failure Stroke
2010 272.5 69.9 35.7 24.7 28.3
2015 358.0 91.4 46.8 32.4 38.0
2020 470.3 119.1 61.4 42.9 51.3
2025 621.6 155.0 81.1 57.5 70.0
2030 818.1 200.3 106.4 77.7 95.6
% change 200 186 198 215 238

Hypertension, the data show, has the greatest projected medical cost, in part because of the aging population, although the increase in prevalence and cost is not explained fully by age. Rising obesity rates are also contributing to the increasing rates of hypertension. The AHA notes that the downstream medical costs of high blood pressure–including its impact on cardiovascular disease and stroke–approximately double the cost of hypertension, making it a “particularly valuable target to modify the future total costs of cardiovascular disease.”‘

Offering up a glass-half-full take on the data, Heidenreich and colleagues write that it is “fortunate that cardiovascular disease is largely preventable,” and the healthcare system needs to focus on prevention and early intervention. The group highlights data from the Coronary Artery Risk Development in Young Adults (CARDIA) study that suggest cardiovascular disease prevention should begin earlier in life. In CARDIA, risk-factor levels in individuals younger than 30 years old were predictive of subclinical atherosclerosis 15 years later. The data, they write, also show that modest improvements in risk factors earlier in life have a larger impact than more substantial reductions later in life.

“In the public-health arena, more evidence-based effective policy, combined with systems and environmental approaches, should be applied in the prevention, early detection, and management of cardiovascular disease risk factors,” write the authors. “Through a combination of improved prevention of risk factors and treatment of established risk factors, the dire projection of the health and economic impact of cardiovascular disease can be diminished.”

Heidenreich reports no conflicts of interest. Disclosures for the coauthors are listed in the paper.


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