The state of US cardiovascular health

JACC, the flagship journal of the American College of Cardiology, today published the first JACC Cardiovascular Statistics report. This comprehensive analysis examines five major cardiovascular disease (CVD) risk factors - hypertension, diabetes, obesity, LDL-cholesterol and cigarette smoking - and the five conditions that collectively account for most CVD deaths and disability in America: coronary heart disease (CHD), acute myocardial infarction (AMI), heart failure (HF), peripheral artery disease (PAD) and stroke.

Key findings on risk factors include:

• Hypertension affects 1 in 2 U.S. adults with little change between 2009 and 2023.
• Diabetes prevalence and mortality are increasing, especially among young adults and low-income populations.
• Obesity has reached epidemic levels, affecting more than 40% of U.S. adults.
• LDL-cholesterol control is falling short. Most high-risk adults fail to meet LDL targets and statin use remains limited, underscoring gaps in implementation.
• Smoking rates have declined nationally but remain twice as high among low-income adults, with e-cigarette use rising among younger adults.

Key findings on conditions include:

• CHD affects over 20.5 million U.S. adults. Rates have risen since 2019, with only 1 in 2 adults receiving optimal medical therapy.
• AMI hospitalizations have declined in the U.S. from 2004 to 2010 but have recently risen for younger adults.
• HF affects about 6.7 million U.S. adults. HF-related mortality rates declined from 1999 to 2011 but have reversed in trajectory with sharp increases during the COVID-19 pandemic.
• PAD affects approximately 1 in 14 U.S. adults. Nearly half of PAD patients undergoing peripheral vascular interventions are discharged without full guideline directed medical therapy.
• Stroke is the fifth leading cause of death in the U.S, accounting for nearly 1 in 20 deaths in 2023. Quality of care has improved over the past two decades, but opportunities for improvement remain.

Persistent disparities by race, geography and socioeconomic status emerged as a central finding across all risk factors and conditions, underscoring urgent gaps in prevention and care. The report also highlights critical gaps where data are incomplete, pointing to opportunities for innovation, policy and discovery.