A special JACC spotlight issue supporting the journal’s recent Cardiovascular Statistics 2026 (JACC Stats) report published online earlier this year offers a comprehensive snapshot of cardiovascular health in the U.S. today. The focused issue, which also includes the inaugural report, expands the analysis beyond clinical disease to the broader drivers of cardiovascular health, examining trends in sleep, physical activity and diet as well as health care access, utilization, affordability and financial burden.

“The purpose of JACC Stats and associated publications in this issue is not simply to produce reports, attract attention, or garner citations, but to elicit action,” writes JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, in an accompanying Editor’s Page. “…by placing data at the center of our collective awareness, we hope this report will inform action, sharpen priorities, and help the cardiovascular community move from knowledge to impact.”

Highlights from the issue include:

Sleep Duration and ASCVD: The average sleep duration remained stable at 7.13 hours per night among nearly 92,000 adults from 2020-2024, according to an analysis using data from the National Health Interview Survey (NHIS). A similar duration was seen in individuals with and without atherosclerotic cardiovascular disease (ASCVD) (7.32 and 7.11 hours, respectively). Adith S. Arun, BS, et al., report the persistence of disparities in short sleep (<7 hours) and long sleep (>9 hours) across race/ethnicity, income and age. Notably, the highest prevalence of short sleep was among Black, American Indian/Alaska Native, middle-aged and lower income adults and of long sleep was among older adults. These persistent inequities “highlight an important opportunity to improve cardiovascular health through targeted public health strategies, community-level interventions, and efforts to address stress, environment, and socioeconomic constraints that influence sleep,” write the authors.

Adherence to Physical Activity Guidelines: Using the same NHIS data set, Arun and colleagues found persistently low adherence to physical activity guidelines, with 45% of those without ASCVD and 62% of those with ASCVD not meeting recommendations for aerobic activity and muscle strengthening in 2024. Only 27% and 12% of each group, respectively, met recommendations for both guidelines. Differences were also seen by age, where 55% of those ≥65 years vs. 39% of those ≤40 years met recommendations, and by income level, with 60% of those <100% of the federal poverty level (FPL) not meeting either guideline recommendations vs. 37% for an income ≥500% FPL. The authors note a slight improvement among the lowest income group, writing “expanding access to practical, low-cost activity programs and addressing structural barriers to exercise could help improve national trends in cardiovascular risk.”

Dietary Quality by Sex, Age and Race/Ethnicity: The quality of Americans’ diets remains low, based on data from the 1999-2020 National Health and Nutrition Examination Survey, with only modest improvements in the Alternative Healthy Eating Index-2010 driven by increases in whole grains, nuts/legumes and polyunsaturated fats. These gains were offset by declining intake of vegetables and long chain omega 3 fats. Persistent disparities were observed, particularly among men, younger adults and non-Hispanic Black adults, who had the lowest diet quality scores. To address these disparities, report authors Huanhuan Yang, PhD, et al., write that, “Strengthening nutrition policy, expanding equitable access to healthy foods, and incorporating structured diet-quality assessment into routine cardiovascular care are critical.”

Health Care Access by ASCVD Status: NHIS data revealed that rates of insurance coverage and access to a usual source of care were both higher for adults with vs. without ASCVD, as well as modest improvements in insurance coverage from 2019 to 2024; declines in uninsurance were observed among people with and without ASCVD, and most significantly among Latino/Hispanic and American Indian/Alaska Native adults. However, the share of adults lacking a usual source of care remained essentially unchanged across all groups, indicating that gains in insurance did not translate into improved access to consistent care and highlighting “the need for targeted policies that expand coverage, strengthen primary care infrastructure, and reduce administrative and financial barriers to care,” according to authors Adith S. Arun, BS, et al.

Health Care Utilization by ASCVD Status: Another study using NHIS data among 172,434 adults focused on telehealth and interactions with health care professionals. In 2024, a quarter of all adults reported using telemedicine (video or phone) in the past 12 months, while this was reported by 24.4% of those without ASCVD and 3.2% with ASCVD. Its use decreased for all three groups from 2020-2024. Moreover, its use in 2024 varied from 21.5% to 27.6% across races/ethnicities and from 21.8% to 29.8% across income groups. Notably, 14.9% of all adults reported not interacting with a health professional in the past 12 months, and this was 15.9% for adults without ASCVD and 3.4% of those with ASCVD. This rate in 2024 also varied by race/ethnicity and income level.

CV Spending and Mortality: From 2000 to 2022, the age-adjusted mortality rate for cardiovascular disease fell 34.7%, from 343.1 to 224.3 per 100,000, based on data from the Centers for Disease Control and Prevention WONDER database, while total direct cardiovascular disease spending increased 212.3% from $70.5 billion to $220.2 billion, including a marked jump between 2019 and 2020, based on Medical Expenditure Panel Survey data. “The divergence between rising spending and stagnating mortality raises fundamental questions about how resources are being deployed and what is needed to resume progress in cardiovascular health,” write the authors.

Out-of-Pocket Costs and Financial Burden Among Working-Age Adults With CV Conditions: According to data from the 2007-2022 Medical Expenditure Panel Survey, total annual health care spending among privately insured working-age adults with cardiovascular disease or related risk factors rose from $4,813 to $5,304, driven almost entirely by an increase in insurance premiums from $3,389 to $3,919 – while out-of-pocket spending remained unchanged at roughly $1,400. Over the same period, the share of adults experiencing financial burden, defined as spending >10% of income on health care, remained essentially flat (34.6% to 34.2%), and about one in 10 continued to face catastrophic financial burden (≥40% of income). “In the context of worsening cardiometabolic health among younger working-age adults, rising premiums represent an underrecognized but critical barrier to accessing and receiving guideline-directed [cardiovascular] care,” write report authors Smaraki Dash, MD, MPH, et al. “In addition, policy strategies are needed to mitigate the high prevalence of catastrophic financial burden among working-aged adults with [cardiovascular] conditions.”

Health Care Affordability by ASCVD Status: No meaningful national improvement in medication affordability was found between 2019-2024 in an examination of NHIS data from nearly 173,000 adults. Cost-related medication nonadherence in 2024 was 11.7% of all adults, and 11.6% and 12.6% among those without ASCVD and with ASCVD. This metric declined from 2019 to 2021 for all groups, with a larger reduction among adults without ASCVD (13.5% to 9.4%). Persistent disparities by race (e.g., 7.4% among Asian adults vs. 14.7% among other identifying adults) and income (e.g., 16.1% of those <100% the FPL vs. 5.9% for those ≥500% above it). Delaying or forgoing medical care because of cost also remained stable, ranging from 7.5% to 11.6% annually, with higher burdens among adults with lower income. Adults with ASCVD experienced greater affordability challenges – a pattern that “highlights ongoing financial strain among individuals managing chronic cardiovascular conditions, for whom medication adherence is essential to reducing risk of future adverse cardiovascular events,” write Rishi M. Shah and colleagues.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise

Keywords: Diet, Healthy, Health Expenditures, Patient Acceptance of Health Care, Medication Adherence, Health Services Accessibility, Insurance Coverage, Exercise, Nutrition Policy