Category: Cardiovascular Disease

Women’s CVD Will Keep Rising by 2050

Posted on by Viktor Zarev

Imagine an America where two out of three women suffer from cardiovascular disease. What would it look like for your mother, sister, or daughter? The American Heart Association says you won’t have to imagine for long, with its latest scientific statement painting a grim picture of women’s cardiovascular health by 2050.

  • This latest statement builds on prior projections of the future CVD prevalence among women and the economic burden it could cause.
  • More than 62M women in the U.S. are already living with some type of cardiovascular disease and that comes with a price tag of at least $200B.

Over the next 25 years, the report found that the number of women living with CVD in the U.S. could rise sharply, with nearly 60% facing high blood pressure by 2050, up from about 50% reported for 2020. That report also found that…

  • Nearly a third of women aged 22-44 will have CVD by 2050, up from 1 in 4 currently.
  • Diabetes rates for that same age group will more than double, from 6% to nearly 16%.
  • More than a third of those women will have high blood pressure, an increase of +11%.
  • More than 1 in 6 women will become obese, an increase of more than 18%.

The report attributes the rising cardiovascular toll on women’s health to surging rates of obesity and diabetes, but that’s like saying it’s going to rain because it’s cloudy. The truth is, it’s not just a bad weather forecast, it’s the climate.

  • Several studies have already tied rising CVD risk, obesity, and diabetes rates in the U.S. to ultraprocessed foods, sedentary lifestyles, food deserts, and lacking nutrition education.
  • Beyond this, other studies have already outlined the disproportionately worse outcomes that women face from diseases like CAD, AS, and ASCVD.

What the report does remind us of is the severity of the situation, because women’s health is about more than any one person, it’s the health of humanity’s future.

  • Mothers struggling with diabetes, obesity, and ultimately CVD will have a harder time giving birth to healthy children and healthily raising those children.

The Takeaway

The AHA’s report is a sobering reminder of the population level burden of CVD in women and where we’re headed as a species. If we don’t reverse the current trend, it will echo through the future generations of mothers and children in America and abroad.

Genetic Risk Scores Improve CAD Detection

Posted on by Viktor Zarev

Coronary artery disease risk assessment might soon rely on genetic testing, following a UK Biobank analysis that suggests adding a CAD multi-gene risk score to conventional biomarkers significantly improves disease prediction and patient identification.

  • Traditional CAD risk assessment uses biomarkers that fluctuate over time, while genetic scores capture inherited disease risk since birth.
  • Currently, there are over one million genetic mutations that can lead to inherited CAD risk.

Examining genetic profiles, researchers followed 353k UK Biobank participants without baseline CAD for 11 years on average, and compared the predictive effects of adding a polygenic risk score (PRS) to a combo of three CV biomarkers (LDL-C, Lp(a), hs-CRP), finding substantial improvements…

  • The predictive model’s discrimination significantly improved when CAD PRS was added to biomarkers (C-index: 0.739 vs. 0.754).
  • The improvement was also similar when apoB replaced LDL-C (C-index: 0.740 vs. 0.754).
  • Patients in the highest category for all three biomarkers showed 2x CAD risk (aHR: 2.15), but those also in the highest CAD PRS category faced nearly 4x higher risk (aHR: 3.71).
  • CAD PRS alone showed stronger association than any single biomarker, with the highest PRS group facing 78% higher risk.
  • Risk stratification also remained consistent across patient sex, suggesting universal applicability.

Since genetic risk is determined at birth and remains constant, using polygenic risk scores for CAD could enable early identification of high-risk patients before biomarker abnormalities even develop.

  • Some institutions already use PRS in clinical risk assessment, but insurance coverage remains limited with tests costing $200-$250.
  • It’s also worth noting that high genetic risk doesn’t doom a patient, since knowing earlier can enable preventive interventions before disease manifests.

The Takeaway

This study, like other genetic cardiology studies, reminds us that some people are at higher risk of heart disease no matter how they live their lives. The good news is, we have the technology to find out who these people are and with a disease like CAD, catching it sooner always leads to better outcomes.

OCTOPUS: What Really Causes MI in Younger Patients

Posted on by Viktor Zarev

Young heart attack patients might actually be a completely different disease population than previously understood, after the OCTOPUS registry analysis revealed that the causes of early MI and the people who get them aren’t what’s expected.

  • Currently the accepted most common cause of heart attacks in young people is typically coronary artery disease due to plaque buildup.
  • Other accepted major factors include genetics, substance abuse, hypertension, obesity, and less commonly, spontaneous coronary artery dissection (SCAD).

The OCTOPUS registry analyzed 4k cardiac events between 2003-2018, using medical record linkage to classify MI etiologies in patients 18-65 years old, but what researchers found could challenge our usual assumptions about young MI patients…

  • Atherothrombosis caused 67% of MIs overall, but supply-demand mismatch (when the heart’s oxygen demand exceeds its oxygen supply) accounted for 23%.
  • Meanwhile, SCAD accounted for 4%, MINOCA-U for 3%, embolism for 2%, and vasospasm for 1% of young MIs.
  • Angiographic review led to MI cause reclassification in 4% of cases, most commonly changing MINOCA-U diagnoses to SCAD and atherothrombosis to coronary embolism.

Given these distinct etiological patterns, the findings suggest young MI patients require fundamentally different diagnostic and therapeutic approaches compared to older populations with predominantly atherosclerotic disease.

  • For example, takotsubo syndrome (temporary LV weakening) showed concerning long-term outcomes with 26% noncardiovascular mortality at 5 years in patients with a median age of just 54.
  • Many supply-demand mismatch patients (64%) didn’t undergo angiography, meaning there could be potential for reclassification with better evaluation.

The Takeaway

The OCTOPUS analysis reveals that young MI patients represent a much more uniform population where nonatherosclerotic causes predominate. This challenges the traditional atherosclerosis-focused approach to MI management and highlights the critical importance of accurate initial diagnosis, especially for conditions like SCAD where inappropriate intervention can cause harm.

The Impact of Physical Activity Before and After CV Events

Posted on by Viktor Zarev

A long-term analysis of the CARDIA study revealed that moderate-to-vigorous physical activity steadily declines from young adulthood through midlife, but patients destined to develop cardiovascular disease experience rapid activity decreases more than a decade before their first event.

  • Studies have shown that moderate-to-vigorous physical activity (MVPA) is critical for both preventing and managing cardiovascular disease.
  • To help stave off CVD, guidelines recommend 150 minutes per week of MVPA.
  • However, previous research focused on short-term activity patterns rather than lifelong impact on cardiac events.

Collecting data over 37 years, researchers tracked ~3k participants from young adulthood to middle age and paired each individual with a matched control partner, finding that…

  • Patients who eventually developed CVD, began decreasing their physical activity levels roughly 12 years before their cardiac events.
  • Activity decline accelerated sharply within 2 years before their first cardiovascular event.
  • Post-CVD, patients remained 78% more likely to maintain low activity levels compared to matched controls.
  • Heart failure patients showed the steepest pre-event declines and consistently low post-event activity.

Researchers also identified striking demographic disparities that persisted throughout the entire study, even after adjusting for pre-CVD activity levels…

  • Black women consistently reported the lowest MVPA levels across all age groups.
  • Black women also faced the highest risk of low post-CVD activity (OR: 4.52).
  • Black men experienced more sustained activity decline compared to other groups.

The Takeaway

This 37-year study reveals that CVD casts a long shadow, with physical activity decline beginning more than a decade before clinical events manifest. Even more sobering is the fact that post-CV-event activity gaps suggest traditional cardiac rehabilitation may not be enough for long-term recovery. In other words, don’t wait till it’s broken to fix it.

CV Polypills Could Prevent Millions of Deaths by 2050

Posted on by Viktor Zarev

A new JACC study revealed that broader adoption of single-pill combination therapies (aka polypills) containing multiple cardiovascular medications could significantly transform global health trends by 2050 and potentially lower the burden of future CVD.

  • It’s already well established that polypill therapies consisting of a statin and one or more antihypertensive drugs can reduce rates of CVD.
  • However, the use of polypills for preventing cardiovascular disease is low in many countries, both due to a lack of coordinated initiatives and resources.

To predict the benefits of polypills, researchers modeled two different implementation strategies, a targeted and a population level approach.

  • The targeted approach focused on high-risk patients already receiving care but not optimized therapy, leading to 15% coverage by 2050.
  • Meanwhile the population approach expanded potential patients to people over 55 with intermediate-high cardiovascular risk not yet receiving care, resulting in 35% coverage.

For the targeted approach, researchers found that it would translate into 29 million fewer deaths and 72 million fewer nonfatal cardiovascular events cumulatively over 2023-2050.

On the other hand, the broader population approach could lead to 51 million fewer deaths and 130 million fewer events over the same time.

  • That’s an impact similar to eliminating tobacco smoking completely or achieving 80% antihypertensive therapy coverage
  • Researchers also expect the greatest benefits to occur in South and East Asia Pacific regions due to their large populations and high CVD rate.

However, both approaches face serious barriers to implementation such as…

  • Pharmaceutical industry reluctance due to questionable profitability with generic medications.
  • Low manufacturer interest and a lack of government demand.
  • Clinician resistance to simplified treatment approaches.

The Takeaway

It’s becoming pretty clear that polypills have serious potential to improve long-term CVD patient outcomes, and this study gives us a glimpse into a better future where they’re more widely implemented. What’s uncertain is whether or not the border pharmaceutical and public health decision-makers are willing to trade profits for better outcomes.

Good News and Bad News – CV Deaths Are Changing

Posted on by Viktor Zarev

Good news – overall heart disease deaths in the U.S. have declined significantly since 1970. The bad news? According to a recent AHA study, several complex heart conditions are becoming increasingly responsible for cardiovascular deaths.

  • The number one cause of death in the U.S. has been heart disease for decades, but its share of deaths has decreased by almost half (41% in 1970 vs. 21.4% in 2022).
  • Much of this improvement stems from the development of new ways to treat heart attacks and ischemic heart disease, but cardio-metabolic health is on the decline.

Searching for trends in CV mortality, Stanford researchers analyzed over 50 years of CDC data, revealing dramatic changes in cardiac mortality patterns among American adults. 

  • On one hand, acute myocardial infarction deaths decreased by 89%.
  • On the other, heart failure mortality rose 146%.
  • Hypertensive heart disease mortality rose 106%. 
  • And arrhythmia mortality rose by a whopping 450%.

So what does this mean? It’s mostly good news, since it shows the U.S. cardiovascular care community has gotten really good at ischemic heart disease management, but there are emerging challenges stemming from more complex conditions like HF and rhythm disorders.

However, there’s one critical factor to keep in mind – obesity. 

  • Conditions like arrhythmias, hypertension, and heart failure are rising in parallel to the U.S. adult obesity rate which reached 40% in 2025 compared to 15% in 1970.
  • While this study itself wasn’t designed to explore causality between the two, many other studies have shown the devastating effects of obesity on heart health.

Where do we go from here? The AHA’s 2025 Heart Disease and Stroke Report earlier this year already gave us insights into the solution to these emerging cardiovascular conditions and it isn’t a treatment.

  • With obesity and obesity-related CV deaths on the rise in the U.S., the number one cure for conditions like arrhythmias, hypertension, and heart failure is prevention.

The Takeaway

This AHA study comfortingly confirms we’ve gotten really good at treating heart attacks and managing ischemic heart disease. Unfortunately, with the rising obesity rates in the U.S., the challenges of complex CVD might need to be addressed on the population level before the patient ever gets to a cardiologist.

Cardiovascular Disease and Deaths On the Rise

Posted on by Viktor Zarev

Another year, another AHA report reasserting heart disease’s dominance as the number one killer in the United States, and the latest data shows that this trend is still gaining momentum.

  • Every year, the AHA reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors.
  • In 2010, the AHA released a 2020 goal to improve the CV health of all Americans by 20%, while reducing CVD and stroke deaths by 20%.

Four years after that goal’s due date, the burden of CVD in the U.S. is at an all time high, with 942k cardiovascular disease-related deaths in 2022, up by 10k from 2021.

  • Nearly half of all Americans over 20 (48.6% as of 2020) have some form of CVD (comprising CHD, HF, stroke, and hypertension).
  • Excluding hypertension (CHD, HF, and stroke only), just 9.9% of U.S. adults have CVD.

What’s causing this high CVD prevalence? While there’s no one answer for a specific patient group, the AHA’s biggest CVD risk culprits should be pretty familiar – obesity, smoking/tobacco use, and sedentary behavior.

  • From 2017 to 2020, adult obesity prevalence in the U.S. was 41.8%, while obesity-related CV deaths tripled from 1999 to 2020 (2.2 to 6.6 deaths per 100k people).
  • Sedentary behavior is also on the rise in America, with self-reported daily sitting times increasing from 332 min/day in 2007 to 351 min/day in 2017.
  • The percentage of U.S. adult smokers is now down to 11.5% (it was 51% of men in 1965), although smokers still face a nearly three-fold higher all-cause mortality risk (HR: 2.80).

However, there’s light at the end of the cardiovascular tunnel thanks to advancements in drugs like GLP-1s and new cholesterol controls, which mean heart disease isn’t a death sentence like it used to be.

The Takeaway

The AHA’s latest report reads more like a public health problem than a cardiology one, suggesting that prevention could have a greater impact than any drug, device, or treatment.

America’s Growing CVD Problem

Posted on by Jason Barry

It’s well known that heart disease is the U.S.’s top cause of death, and our rising CVD rates have been widely covered, but a look back on some of the biggest stories of 2024 suggests that cardiovascular disease is about to become a much bigger problem.

  • Heart Disease in 2050 – The AHA warned of massive heart disease increases by 2050, spanning CVD (+60%), diabetes (+100%), obesity (+70%), hypertension (+44%), heart failure (+66%), and stroke (+100%). Add all that up and the cost of treating adult CVD and stroke patients will increase by 195% to $1.85 trillion, representing 4.6% of US GDP.
  • America Has CKM Syndrome – The vast majority of Americans are at risk of developing cardiovascular-kidney-metabolic (CKM) syndrome. A JAMA analysis of 11k adults revealed that only 10.6% had no CKM syndrome risk factors, while 26% were at Stage 1 (overweight, prediabetes), 49% were Stage 2 (hypertension, diabetes, CKD), 5% had Stage 3 (kidney disease or high CVD risks), and 9% were Stage 4 (heart disease, with or without kidney disease).
  • U.S. Hypertension Problems: Another JAMA study highlighted the U.S.’s massive hypertension diagnosis and treatment problems. A survey of 7.3k U.S. adults (4k with hypertension) revealed that 79% of participants with hypertension didn’t have their BP under control, and 57.6% didn’t even know they had the disease. Meanwhile, only 30% of the participants who were actually aware of their hypertension had their BP under control. 
  • AFib Wakeup Call – A JACC study suggested that atrial fibrillation is far more prevalent than many thought. Analysis of 29M Californian’s records revealed that a whopping 2M (6.8%) of them had been diagnosed with AFib, with rates increased dramatically during the study period (4.49% in 2005-2009 >>> 6.82% in 2015-2019). If applied across the U.S., at least 10.55M Americans are currently diagnosed with AFib, representing 4.48% the U.S. adult population. 

The Takeaway

These truly frightening statistics suggest that the U.S. is due for a wave of new CVD cases unless we make some major changes to how we live and deliver care. And we better get working on both fast, considering that another 2024 study revealed that 46.3% of U.S. counties don’t have a single cardiologist.

Lipoprotein(a)’s Outsized Per-Particle Risks

Posted on by Jake Fishman

A pair of JACC studies laid what might be a new scientific foundation for all that research showing that people with high lipoprotein(a) have elevated cardiovascular risks.

The first study analyzed 502k UK Biobank participants, identifying two clusters of genetic variants that either raise apoB by increasing Lp(a) or LDL, showing that the Lp(a) cluster faced far greater cardiovascular risks:

  • Each 50 nmol/L higher Lp(a)-apoB brought a 28% greater risk for coronary heart disease, versus 4% with LDL-apoB.
  • Based on polygenic scores, subjects in the Lp(a) cluster had a 47% higher risk of  coronary heart disease per 50 nmol/L apoB, versus 4% again in the LDL cluster.
  • With that, the researchers estimated that Lp(a)’s per-particle atherogenicity is 6.6-times greater than LDL.

A second study analyzed data from 356k UK Biobank participants, finding that apoB-containing Lp(a) particles have far greater cardiovascular event risks:

  • Lp(a) particles carry 5-times greater risks than non-Lp(a) apoB particles (e.g LDL-C apoB particles).
  • Each 100 nmol/L increase in Lp(a) brought a 24% greater risk, while 100 nmol/L increases in non-Lp(a) apoB came with just a 5% higher risk.

These results underscore the need to develop effective LP(a)-lowering therapies, and there appears to be some promising options on the horizon:

  • Amgen’s injectable siRNA olpasiran slashed Lp(a) by as much as 100% in its Phase II trial, and has moved on to Phase III.
  • Lilly’s injectable siRNA lepodisiran’s Phase II is underway, its other injectable siRNA LY3819469 is in Phase II trials, and its oral small molecule inhibitor muvalaplin performed well in its Phase I trial.
  • Silence Therapeutics’ injectable siRNA zerlasiran cut Lp(a) levels by 90% in a Phase 1 trial, and has progressed to Phase II.

More candidates are surely on the way, noting that Lilly has entered into a Lp(a)-targeted gene editing alliance with Verve Therapeutics, and Novartis and Ionis Pharmaceuticals recently expanded their antisense-based Lp(a) therapy alliance.

The Takeaway

Years of studies have shown that people with high Lp(a) have worse cardiovascular outcomes, and this new research adds solid particle-level evidence showing why this is the case, while further supporting the need for Lp(a)-lowering therapies. In fact, these studies suggest that it might be more beneficial to target Lp(a) reduction rather than prescribing a second or third LDL therapy, even if cutting LDL remains the primary focus.

Inflammation’s ASCVD Risks and Potential

Posted on by Jake Fishman

New data reveals that inflammation is a stronger predictor of future cardiovascular events and death than cholesterol among patients who take statins, suggesting that treatment regimens that target both LDL and vascular inflammation are more likely to reduce atherosclerotic risk compared to treatments that only target LDL.

The Lancet meta-analysis used 32k patients’ data from the PROMINENT, REDUCE-IT, and STRENGTH trials, all of whom had or were at high risk of ASCVD and were already taking statins. Across the three trial groups, baseline levels of high-sensitivity CRP (hsCRP) and LDL-C were “almost identical.” The study was also authored by leaders of the three original trials.

After adjustments, comparisons of patients in the highest and lowest hsCRP quartiles seemed to solidify residual inflammatory risk’s association with: 

  • Major adverse cardiovascular events (HR: 1.31)
  • Cardiovascular mortality (HR: 2.68)
  • All-cause mortality (HR: 2.42)

Meanwhile, patients in the highest and lowest LDL-C quartiles revealed that residual cholesterol risk had a “neutral”  association with MACE and a “low magnitude” associated with mortality: 

  • Major adverse cardiovascular events (HR: 1.07)
  • Cardiovascular mortality (HR: 1.27)
  • All-cause mortality (HR: 1.16)

The Takeaway

We’ve seen growing evidence that patients on statins can benefit from adjunctive LDL-lowering therapies, but this study gives a strong argument for combining LDL-reducing and inflammation-reducing therapies. If proven through future trials, that could have a major impact on ASCVD care.

Get twice-weekly insights on the biggest stories shaping cardiology.