Cardiovascular disease – the number one cause of death among people aged 65 and over – is set to become more prevalent in the coming years, disproportionately affecting black and Hispanic communities and weighing heavily on health and quality life of older Americans.
The estimates are sobering: by 2060, the prevalence of ischemic heart disease (a condition caused by blocked arteries and also known as coronary heart disease) is expected to increase by 31% compared to 2025; heart failure will increase by 33%; heart attacks will increase by 30%; and strokes will increase by 34%, according to a team of researchers from Harvard and other institutions. The biggest increase will occur between 2025 and 2030, they predicted.
The dramatic expansion of the aging population of the United States (cardiovascular disease is much more common in the elderly than in the young) and the growing number of people with conditions that put them at risk for heart disease and heart disease. stroke – high blood pressure, diabetes and obesity foremost among them – should contribute to this alarming scenario.
Because the risk factors are more common among black and Hispanic populations, cardiovascular disease and death will become even more common for these groups, the researchers predicted. (Hispanics can be of any race or combination of races.)
“Disparities in the burden of cardiovascular disease will only be exacerbated” unless targeted efforts are made to strengthen health education, expand prevention and improve access to effective therapies, the authors wrote. authors of an accompanying editorial, from Stony Brook University in New York. and Baylor University Medical Center in Texas.
“Whatever attention we have had before on the management [cardiovascular] disease risk among Black and Hispanic Americans, we need to work harder,” said Clyde Yancy, chief of cardiology and associate dean for diversity and inclusion at Northwestern University’s Feinberg School of Medicine at Chicago, which did not participate in the research.
Of course, medical advances, public health policies, and other developments could change the outlook for cardiovascular disease in the coming decades.
More than 80% of cardiovascular deaths occur in adults 65 years of age or older. For about a dozen years, the total number of cardiovascular deaths in this age group has steadily increased, as the ranks of the elderly have broadened and earlier progress in reducing deaths from to heart disease and stroke have been undermined by Americans’ growing waistlines, poor diets and physical inactivity.
Among people age 65 and older, cardiovascular deaths fell 22% between 1999 and 2010, according to data from the National Heart, Lung, and Blood Institute – a testament to new medical and surgical therapies and treatments and a strong smoking reduction, among other health initiatives. Then between 2011 and 2019, deaths rose by 13%.
The COVID-19 pandemic has also increased the death toll, with coronavirus infections causing serious complications such as blood clots and millions of elderly people avoiding treatment for fear of infection. Those most affected are low-income people and black and Hispanic non-Hispanic seniors, who have died from the virus at disproportionately higher rates than non-Hispanic white people.
“The pandemic has laid bare persistent health inequalities,” and that has fueled a new wave of research into the disparities between various medical conditions and their causes, said Nakela Cook, cardiologist and executive director of Patient-Centered Outcomes. Research Institute, an independent organization. authorized by Congress.
One of the most detailed reviews to date, published in JAMA Cardiology in March, looked at death rates for Hispanic, non-Hispanic black, and non-Hispanic white populations from 1990 to 2019 in all 50 states and the District of Columbia. It showed that black men remain at the highest risk of dying from cardiovascular disease, especially in southern states along the Mississippi River and in the northern Midwest. (The age-adjusted death rate from cardiovascular disease among black men in 2019 was 245 per 100,000, compared to 191 per 100,000 for white men and 135 per 100,000 for Hispanic men. The results for women of each demographic group were lower.)
Progress resulting from cardiovascular disease deaths among Black men slowed significantly between 2010 and 2019. Nationwide, cardiovascular deaths for this group fell 13%, much less than the 28% decline from 2000 to 2010 and the 19% decline from 1990 to 2000. In areas where black men were most at risk, the situation was even worse: in Mississippi, for example, deaths of black men fell only 1% from 2010 to 2019, while in Michigan they were down 4%. In the District of Columbia, they even increased, by almost 5%.
While individual lifestyles are partly responsible for the unequal burden of cardiovascular disease, the American Heart Association’s 2017 Scientific Statement on the Cardiovascular Health of African Americans notes that “perceived racial discrimination” and related stress are associated with hypertension, obesity, persistent inflammation and other clinical processes that increase the risk of cardiovascular disease.
While black people are deeply affected, so are other racial and ethnic minorities who are experiencing adversity in their daily lives, several experts noted. However, recent studies of cardiovascular deaths miss some of these groups, including Asian Americans and Native Americans.
What are the implications for the future? Noting significant variations in cardiovascular health outcomes by geographic location, Alain Bertoni, internist and professor of epidemiology and prevention at Wake Forest University School of Medicine, said, “We may need solutions different in different parts of the country.
Gregory Roth, co-author of the JAMA Cardiology article and associate professor of cardiology at the University of Washington School of Medicine, called for a renewed effort to educate people in at-risk communities about “modifiable risk factors.” – high blood pressure, high cholesterol, obesity, diabetes, smoking, inadequate physical activity, poor diet and lack of sleep. The American Heart Association offers suggestions on its website for promoting cardiovascular health in each of these areas.
Michelle Albert, a cardiologist and current president of the American Heart Association, said more attention needs to be paid in medical education to the “social determinants of health” – including income, education, housing , neighborhood environments and community characteristics – so that health care workers are better prepared to meet the unmet health needs of vulnerable populations.
Natalie Bello, cardiologist and director of hypertension research at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, said: “We really need to get into vulnerable communities and reach people where they are to increase their knowledge. risk factors and how to reduce them. That could mean deploying community health workers more widely or expanding innovative programs like those that bring pharmacists to black-owned barbershops to educate black men about high blood pressure, she suggested.
“Now, more than ever, we have the medical therapies and technologies in place to treat cardiovascular disease,” said Rishi Wadhera, cardiologist and section chief for health policy and equity research at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess. Boston Medical Center. What is needed, he said, are more vigorous efforts to ensure that all elderly patients, including those in disadvantaged communities, are connected with primary care physicians and receive screening. and treatment for cardiovascular risk factors, as well as high-quality, evidence-based care for heart failure, heart attack or stroke.
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