Nearly 6 in 10 women in the U.S. may have cardiovascular disease in the next 25 years

Driven by rising rates in high blood pressure, nearly 6 in 10 women in the U.S. will have some type of cardiovascular disease (CVD) in the next 25 years, according to a new scientific statement published today in Circulation, the peer-reviewed, flagship journal of the American Heart Association, a global force changing the future of health for all.

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050 in Women: A Scientific Statement From the American Heart Association builds upon prior work by the Association to assess projections of the future cardiovascular disease prevalence among women and the subsequent economic burden based on the current landscape.

"One in every three women will die from cardiovascular disease - maybe it's your grandmother, or your mother or your daughter," said the American Heart Association volunteer chair of the statement writing group, Karen E. Joynt Maddox, M.D., M.P.H., FAHA, a professor of medicine and public health and the co-director of the Center for Advancing Health Services, Policy & Economics Research at the Washington University School of Medicine in St. Louis. "Additionally, more than 62 million women in the U.S. are living with some type of cardiovascular disease and that comes with a price tag of at least $200 billion, annually. Our estimates indicate that if we stay on the current path, these numbers will grow substantially over the next 25 to 30 years."

Findings from the report point to significant increases among women for all types of cardiovascular disease, including heart disease, heart failure, atrial fibrillation and stroke. Surges are also projected among women for many of the major health factors that contribute to cardiovascular disease, including high blood pressure, obesity and diabetes.

Joynt Maddox said it is even more concerning that:

• The prevalence of some health factors is increasing among young girls, ages 2-19, as well.
• The increases are even more prevalent among women and girls identifying as American Indian/Alaska Native, Black, Hispanic or multiracial people.

Cardiovascular disease is the leading cause of death for women and remains their #1 health risk overall. While many people may think these conditions like high blood pressure are only occurring in older women, we know this is not the case. We know the factors that contribute to heart disease and stroke begin early in life, even among young women and girls. The impact is even greater among those experiencing adverse social determinants of health such as poverty, low literacy, rural residence and other psychosocial stressors. Identifying the types of trends outlined in this report is critical to making meaningful changes that can reverse this course."

Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and executive director of the Katz Institute for Women's Health and senior vice president of women's health at Northwell Health, New York City

By the numbers

The report finds that, given current trends, by 2050:

• Nearly 60% of women will have high blood pressure, compared to fewer than half currently.
• More than 25% of women will have diabetes, compared to about 15% currently.
• More than 60% of women will have obesity, compared to about 44% currently.

The projections among women of color indicate some of the largest increases; by 2050:

• High blood pressure will increase the most among Hispanic women, up by more than 15%.
• Obesity will increase the most among Asian women, up by nearly 26%.
• Prevalence rates of health factors for CVD will, for the most part, remain highest among Black women. More than 70% of Black women will have high blood pressure, more than 71% will have obesity and nearly 28% will have diabetes.

While older women will continue to have some of the highest rates of cardiovascular disease and associated risk factors, rates will climb substantially among young women. By 2025:

• Nearly a third of all women 22-44 years of age will have some type of cardiovascular disease, compared to less than 1 in 4 currently.
• Diabetes rates for women age 22-44 will more than double, from 6% to nearly 16%.
• More than a third of women age 22-44 will have high blood pressure, an increase of more than 11%.
• More than 1 in 6 women age 22-44 will have obesity, an increase of more than 18%.

The report also looks at cardiovascular health risk factors among young girls:

• By 2050, nearly 32% of girls 2-19 years of age will have obesity, an increase of more than 12%.
• That's likely driven by more than 60% of these girls having inadequate physical activity and more than half having poor diets, rates that are projected to improve only slightly over the coming decades.
• As with women, these rates are typically higher among girls of color, particularly Black girls - 40% of whom will have obesity by 2050.

"This trend in increased health risks among girls and young women is particularly disturbing, as it indicates they will be facing chronic health issues for most of their lives. Women are already at increased risk for so many of these health conditions due to factors unique to them throughout their lifespan," Rosen said. "Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times."

A positive outlook

There is some good news ahead as rates of high cholesterol are expected to decline among nearly all groups of women. Additionally, there are improvements expected in some of the health behaviors that impact CVD, including healthier eating, more physical activity and less smoking.

"We know that people are living longer as health conditions are being better managed. As a medical community, we have done a great job decreasing deaths from big cardiovascular events like heart attacks and strokes, but these data suggest that we need to really refocus our efforts on health, wellness and prevention," Joynt Maddox said. "We need to keep girls and women from developing cardiovascular risk factors so that they can live long, healthy lives free of cardiovascular disease, and that means being very intentional about focusing on optimal cardiovascular health across the life course."

The American Heart Association defines optimal health through its Life's Essential 8™ - four health behaviors (eat better, be more active, quit tobacco and get healthy sleep) and four health factors (manage weight, control cholesterol, manage blood sugar and manage blood pressure).

"These ideal cardiovascular health metrics are based on extensive scientific research that recognizes the majority - as much as 80% - of heart disease and stroke can be prevented," Rosen said. "I like to call Life's Essential 8 a prescription for health. And one of the most exciting things about it is that we have tailored guidance for these metrics for different times in a woman's life - from childhood through menopause and beyond. This report projects a concerning future, however, it's not too late to take the first steps to healthier outcomes."

A call to action

"The most efficient, effective, and least costly way to reduce the prevalence and impact of cardiovascular disease is through prevention. Yet, these projections signal that our current prevention efforts are inadequate, particularly for women of color and younger women," Joynt Maddox said. "In the report, we've identified several considerations to improve prevention, treatment and sustained care across the life course for all women."

Health behaviors: Preventing health problems before they start is one of the best ways to protect heart health.

• Promote healthy choices in places where people learn, live, and receive care - like schools, community centers, pediatric clinics, and gynecology offices.
• Use digital tools, when helpful, to encourage and reinforce positive lifestyle changes.

Health factor management: Managing chronic conditions like high blood pressure, diabetes, and obesity early can make a big difference - especially for women at higher risk.

• Health care teams and policymakers should prioritize long‑term support for managing chronic conditions in women, including early check-ins, team‑based care and the use of digital tools that make care easier to access.
• Studies should look at how new obesity medications work specifically in women to ensure they're safe and effective.

Clinical cardiovascular disease: Optimal care and high-quality treatments are needed for women experiencing all types of CVD, including heart attacks, heart failure, atrial fibrillation and stroke.

• When women come to the hospital with a heart attack, heart failure or stroke, quality improvement programs, such as the American Heart Association's Get With The Guidelines^®, are needed to ensure they get fast, effective and equitable treatment.
• For long‑term conditions like atrial fibrillation and heart failure, care plans should include factors unique to women so shared treatment decisions are better tailored.
• Brain health, particularly dementia, should be considered an important part of blood pressure control, along with CVD prevention and treatment in women.

Care across every stage of life: Each stage of life offers an opportunity to spot risks early and protect heart health.

• Pediatricians should know that early menstrual periods can signal higher future cardiovascular risk as an adult. Menstrual history should be part of routine evaluations at every age.
• Coordinated care across specialties should be integrated before, during and after pregnancy, ensuring needs are met at every step.
• Research should continue to explore how lifestyle changes and hormone therapy around menopause impact women's heart health.

Understanding the role of social and demographic factors: Social and environmental factors affect women differently.

• Programs tailored for Black women are urgently needed to help address their higher rates of cardiovascular disease.
• Health systems should consider how social challenges - like access to healthy food, transportation or safe housing - combine with medical risks, and design interventions that improve heart health in each setting.

Not set in stone

Joynt Maddox was also the author of the American Heart Association's 2024 presidential advisory Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease. The report included several simulation studies that identified ways to reverse current trends:

• A 10% reduction of health factors such as high blood pressure, high cholesterol, diabetes and obesity and a 20% improvement in the control of blood pressure, blood sugar and cholesterol could reduce CVD and stroke events, including death, by 17% to 23%.
• Reducing obesity by half and doubling risk factor control could reduce CVD events and deaths by 30% to 40%.

"Society has come so far in medical advancements, but the same can't be said for innovation and progress around cardiovascular health, wellness and prevention. These projections emphasize how critical it is that we start focusing on how to help all people stay healthy," Joynt Maddox said. "In this new era of digital health, artificial intelligence and new metabolic medication options, health care professionals increasingly have the tools to do this, but not yet the systems."

Rosen noted that at a time when awareness about cardiovascular disease among women has been declining, the future outlined in this report should be a wake-up call.

"Every woman of every age should understand her risk of heart disease and stroke and be empowered to take action to reduce that risk," she said. "Know your numbers, listen to your body and be an advocate for your health. Additionally, support girls and women in your life to do the same. We can make a difference - we can be the difference."

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association Women's Health Science Committee of the Council on Clinical Cardiology and Stroke Council; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Council on Peripheral Vascular Disease. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association's official clinical practice recommendations.