Progress on Cardiovascular Disease Care in the U.S. Has Stalled Despite Treatment Advances, New Report Finds

Progress against cardiovascular disease in the United States has slowed — and in some cases reversed — over the past 15 years, despite major advances in treatment, according to a new Harvard-led report published in the Journal of the American College of Cardiology.

The inaugural report, led by Harvard School of Public Health professor Rishi K. Wadhera, synthesized national data on the risk factors and conditions that drive most cardiovascular deaths in the U.S., including hypertension, diabetes, and stroke, among several other factors.

The report found “persistent gaps” between the availability of effective treatments and their actual use, with disparities by race, income, and geography running through every risk factor and condition examined.

“Our goal was to make this report very clear and accessible and actionable to broad and diverse audiences — not just researchers, but patients,” Wadhera said. “The goal was really to make this concise, visually oriented and highly accessible.”

One in two U.S. adults now meets the criteria for hypertension under high blood pressure guidelines, a rate that has barely moved since 2009. But only two in three adults with high blood pressure receive treatment, with no improvement since 2009-2010, the report found. From 2000 to 2019, hypertension-related cardiovascular deaths nearly doubled, from 23 to 43 per 100,000.

Diabetes prevalence among U.S. adults rose from about 12 percent to 14 percent over the study period, with the steepest increase among low-income and Black populations. Only about half of adults with diabetes achieved adequate blood sugar control, and glycemic control worsened from 2021-2023 among young adults aged 20 to 44, the report found.

The report noted some bright spots — coronary heart disease mortality fell roughly 50 percent between 2000 and 2020, and smoking rates declined — though it also found that heart attack hospitalizations among adults 25 to 64 have risen since 2008.

“People will be living longer with chronic cardiovascular disease,” Wadhera said.

Jagmeet P. Singh, a Harvard Medical School professor and clinician-investigator at the Mass General Research Institute, said the current system is built to treat disease at its most acute — not to prevent it upstream.

Though treatment protocols are improving and new technology for therapies are being developed, he said advanced care at institutions like Massachusetts General Hospital does not “necessarily translate into better overall population health.”

“Much of the care that we deliver here is delivered right at the top,” he said. “We’re not really providing a whole lot of wellness care, and we're not as good in chronic disease care.”

Singh argued that the fee-for-service payment model in the U.S. discourages investment in prevention and that shifting toward value-based care could change those incentives.

“I think if we switch that towards value-based care strategies and shared saving strategies — which is something that there’s a movement towards — that there will be incentive for people to devote more attention to primary care and preventative strategies,” Singh said.

Lee Goldman, a cardiology professor at Columbia University, said the report’s conclusions were consistent with longstanding patterns in U.S. public health. The lack of progress on cardiovascular health, he argued, is a result of the lifestyle conditions that precede disease rather than a failure of medical capability.

“Our real problem here is the lifestyles that lead to these problems, and the major one is overweight and obesity,” he said.

Goldman added that while obesity has been rising in many countries globally, the increase in the U.S. has been notably high.

“The U.S. tends to be a leader, and we’re the leader here,” he said.

Wadhera said he and his collaborators plan to release the report annually. He hopes future editions will inform policymakers at agencies like the Centers for Disease Control Prevention and the United States Department of Health and Human Services.

“There’s certainly opportunities to use this as a springboard,” he said. “Part of the goal is to get this into the hands of people that make decisions that ultimately influence cardiovascular health.”

—Staff writer Andrew Park can be reached at [email protected]. Follow him on X @AndrewParkNews.

—Staff writer Mana Tsuruta can be reached at [email protected]. Follow her on X @ManaTsuruta.