While Lowering Quality Of Life More Americans Living Longer With Cardiovascular Disease Will Increase Costs

In the past several decades, some risk factors for cardiovascular disease have improved, while others have worsened. For example, smoking rates have dropped and treatment rates for cardiovascular disease have increased—factors that have made the disease less fatal. At the same time, Americans’ average body mass index and incidence of diabetes have increased as the population continues to live longer— factors that have made cardiovascular disease more prevalent. To assess the aggregate impact of these opposing trends, we used the nine National Health and Nutrition Examination Survey waves from 1973 to 2010 to forecast total cardiovascular disease risk and prevalence from 2015 to 2030. We found that continued improvements in cardiovascular disease treatment and declining smoking rates will not outweigh the influence of increasing population age and obesity on cardiovascular disease risk. Given an aging population, an obesity epidemic, and declining mortality from the disease, the United States should expect to see a sharp rise in the health care costs, disability, and reductions in quality of life associated with increased prevalence of cardiovascular disease. Policies that target the treatment of high blood pressure and cholesterol and the reduction of obesity will be necessary to curb the imminent spike in cardiovascular disease prevalence. U S trends in cardiovasculardisease over the past several decades tell two stories. One is encouraging: Age-adjusted rates for cardiovascular disease mortality declined from 517 per 100,000 in 1981 to 244 per 100,000 in 2008. The second story, however, is sobering: Cardiovascular disease remains the leading cause of death and of health care costs in theUnited States.Over the past twenty years the incidence and prevalence of cardiovascular disease appear to be steady or rising, based on events observed in large cohort studies and estimates from nationally representative surveys. These opposing trends inmortality and nonfatal burden of cardiovascular disease can be at least partially explained by the improvements in treatment that have made cardiovascular disease less fatal but more prevalent. To reduce the incidence and prevalence of cardiovascular disease, prevention efforts shouldbe intensified. Intervening before initial or subsequent cardiovascular disease events occur could avoid substantial mortality, morbidity, and health care costs attributable to cardiovascular disease. With these prevention-related goals in mind, the use of lipid-lowering and antihypertensive medication has increased over the past forty years, and blood pressure and cholesterol levels have declined as a result. Smoking has also steadily decreased over the past forty years, doi: 10.1377/hlthaff.2013.0449