Most major cardiovascular disease risk factors and conditions will increase by 2050 in the U.S., with disparities remaining most pronounced among lower-income populations, people with less education, and Medicare and Medicaid beneficiaries, according to a Social Drivers of Health (SDOH) Advisory published in JACC: Advances.

For the study, Khadijah Breathett, MD, MS, FACC; Olga Khavjou, MD; Karen E. Joynt Maddox, MD, FACC, et al., used data from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and U.S. Census to estimate future projections for cardiovascular disease between 2020 and 2050.

Overall results found most risk factors, individual cardiovascular disease conditions (i.e., heart failure) and total cardiovascular disease prevalence are estimated to worsen by 2050. Broken down by specific SDOH, the total prevalence of cardiovascular disease is expected to increase across education, income and insurance categories by 2050, especially among college graduates. According to the authors, Medicare beneficiaries are expected to have the highest prevalence of total cardiovascular disease, reaching 86% over the three decades.

"These projected trends underscore both the persistent, entrenched socioeconomic inequities in cardiovascular health and the emerging burden of disease in groups that have historically been considered lower risk," write Breathett, et al. "Together, these patterns highlight the urgent need for multilevel strategies – including at the clinician, health system, community and policy levels – that address the underlying SDOH while anticipating rising risk in more advantaged populations."

Addressing SDOH in early childhood may also help to alter cardiovascular disease prevalence, according to the authors. Additionally, they highlight how implementation science through "the use of frameworks, theories and metrics based upon psychological evidence, policy and business models" may help improve dissemination and implementation of effective strategies."

The broader challenge of addressing cardiovascular disparities is also the focus of a separate JACC: Advances article, which proposes new, outcomes-driven strategies for advancing equity while aligning with current regulatory requirements.

Ritu Thamman, MD, FACC, and Celina M. Yong, MD. FACC, et al., highlight how "the shifting regulatory landscape requires cardiology to rethink equity strategies through a compliant, outcomes-focused lens while the clinical goal of reducing cardiovascular disparities remains unchanged. They offer a new, legally compliant framework through which workforce diversity, environmental exposures and risk factor access are reclassified as "clinical interventions with measurable outcomes," effectively "reframing cardiovascular equity with upstream drivers."

"Contemporary scientific approaches proteomics, metabolomics, [single nucleotide polymorphisms-based] genetic ancestry, geospatial mapping, digital health and community-based care models advance health equity by identifying and addressing disparities without treating race as a biological category," they write. "... Together, these evidence-based interventions shift the emphasis from identity categories to modifiable clinical, structural and biological determinants, preserving the goal of reducing cardiovascular disparities while remaining consistent with the current regulatory environment."