Coronary heart disease (CHD), also known as coronary artery disease (CAD), inflicts a sizeable disease burden on the US and remains the country’s leading cause of death. Medical advances and advocacy for preventive lifestyle practices have contributed to steadily declining rates of heart disease since the 1960s, giving hope that it would have a diminished role in the twenty-first century. A recent study published in JAMA Cardiology by Lee and colleagues, however, tempers these aspirations; the study data indicate that the prevalence of CAD has fallen by only a very small amount in the past decade. GlobalData epidemiologists expect that the results of this study may indicate a potential reversal in CAD prevalence trends over the next ten years.

In the study by Lee and colleagues, trends in coronary heart disease between 2011 and 2018 were analysed by the US Centres for Disease Control and Prevention’s (CDC) Behavioural Risk Factor Surveillance System. The survey of nearly 3.5 million Americans inquired into various health and lifestyle indicators, including self-reported histories of heart disease. Based on the number of individuals who answered ‘Yes’ to having been diagnosed with CHD or a heart attack, analysts estimated a 6.0% national heart disease prevalence, a statistically insignificant 0.11% decline between 2011 and 2018. By contrast, disease prevalence shrank by 10.4% from 2006 to 2010.

While the survey’s study design may partially influence these findings, related trends in chronic disease offer insight into the surprising shift. Heart disease has been on the decline, but some of its major contributing comorbidities, namely obesity and type 2 diabetes (T2D), have seen increases nationwide. According to the CDC, obesity prevalence has risen from 30.5% to 42.4% among the American population over the past two decades, while the prevalence of T2D grew from 9.5% to 12.0% between 1999 and 2016. In both cases, experts believe that sedentary lifestyles and unhealthy diets bear much of the blame. The disease burden imposed by these conditions, in conjunction with other risk factors such as smoking, hypertension and stress, has likely offset some of the gains made in the effort against heart disease.

In the US, GlobalData epidemiologists forecast that diagnosed prevalent cases of CAD will increase from 13 million this year to 13.7 million in 2027, primarily driven by changes in the underlying population (as shown in Figure 1). But until the contributing risk factors of obesity and diabetes—arguably epidemics in their own rights—are more comprehensively managed, GlobalData’s current forecast estimates will likely be surpassed. While it is premature to predict a rise in heart disease prevalence, a continued slowdown is likely as these risk factors become increasingly prominent in the developed world. As public health and medical authorities further decipher the recent data, it will likely indicate the need for a change in strategy, as the modest gains in heart disease may face a gradual reversal in the coming decade.