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Population shifts, risk factors may triple U.S. cardiovascular disease costs by 2050
Driven by an older, more diverse population, along with a significant increase in risk factors including high blood pressure and obesity, total costs related to cardiovascular disease (CVD) conditions are likely to triple by 2050, according to projections from the American Heart Association, observing 100 years of lifesaving service as the world’s leading nonprofit organization focused on heart and brain health for all. At least 6 in 10 U.S. adults (61%), more than 184 million people, are expected to have some type of CVD within the next 30 years, reflecting a disease prevalence that will have a $1.8 trillion price tag in direct and indirect costs.
“As we mark the American Heart Association’s centennial, we recognize monumental accomplishments in the fight against cardiovascular disease which includes all types of heart and vascular disease, along with stroke. Supported by efforts led by the Association, death rates from heart disease have been cut in half in the past 100 years. Deaths from stroke have been cut by a third since the creation of the American Stroke Association in 1998,” said the volunteer chair of the advisories’ writing groups, Karen E. Joynt Maddox, M.D., M.P.H., FAHA. “Yet, these are still leading causes of death and disability in the U.S. So, in analyzing the data for these advisories, we set out to learn just what we may expect over the next 30 years, and to identify specific issues that need to be addressed to ensure that we continue our forward progress. Armed with these findings, we can take steps to turn the tide on this dire forecast.”
Heart disease has been the leading cause of death in the U.S. since the inception of the American Heart Association in 1924. Stroke is currently the fifth leading cause of death in the U.S. Together, they kill more people than all forms of cancers and chronic respiratory illnesses combined, with annual deaths from cardiovascular disease now approaching 1 million nationwide.
“As the American Heart Association enters its second century, our future is about improving yours,” said American Heart Association Chief Executive Officer Nancy Brown. “It is crucial to quantify the full burden of cardiovascular disease so we can better inform the policies and community-level and health system interventions needed to change this current path. We recognize that the landscape of cardiovascular health will change over the next three decades because of the coming tsunami of rising health care costs, an older population living longer and increasing numbers of people from under-resourced populations. The findings of these important advisories predict a dire human and economic toll from heart disease and stroke if changes are not made. However, this does not have to be the reality of our future.”
Increases in high blood pressure, diabetes and obesity will drive CVD prevalence.
Clinically, cardiovascular disease refers to a number of specific conditions, including coronary heart disease (including heart attack), heart failure, heart arrhythmias (including atrial fibrillation), vascular disease, congenital heart defects, stroke and hypertension (high blood pressure). However, while high blood pressure is considered a type of cardiovascular disease, it is also a major risk factor contributing to nearly all types of heart disease and stroke, so for the purposes of these analyses, high blood pressure was predicted separately from all CVD. This aligns with the American Heart Association’s Life’s Essential 8™ — key measures of health factors and health behaviors identified for improving and maintaining cardiovascular health.
From 2020 (the most recent data available) to 2050, projected increases of CVD and risk factors contributing to it in the U.S. include:
- High blood pressure will increase from 51.2% to 61.0%, and since high blood pressure is a type of CVD, that means more than 184 million people will have a clinical diagnosis of CVD by 2050, compared to 128 million in 2020.
- Cardiovascular disease, including stroke, (but not including high blood pressure) will increase from 11.3% to 15.0%, from 28 million to 45 million adults.
- Stroke prevalence will nearly double from 10 million to almost 20 million adults.
- Obesity will increase from 43.1% to 60.6%, impacting more than 180 million people.
- Diabetes will increase from 16.3% to 26.8%, impacting more than 80 million people.
- High blood pressure will be most prevalent in individuals 80 years and older, however, the number of people with hypertension will be highest — and rising — in younger and middle-aged adults (20-64 years of age).
- People aged 20-64 years also will have the highest prevalence and highest growth for obesity, with more than 70 million young adults having a poor diet.
Good news: People are choosing to live healthier.
Despite the predicted increase for cardiovascular disease prevalence and costs, there are some positive trends to report. More adults in the U.S. are embracing the healthy behaviors of the American Heart Association’s Life’s Essential 8, as prevalence rates for most are expected to improve:
- Inadequate physical inactivity rates will improve from 33.5% to 24.2%.
- Cigarette smoking rates will drop nearly by half, from 15.8% to 8.4%.
- While more than 150 million people will have a poor diet, that is at least a slight improvement from 52.5% to 51.1%.
“It is extremely promising to see these health behaviors improve, as it indicates a movement by individuals taking control of their health and making positive change. I’m especially pleased to see smoking rates drop substantially, as tobacco addiction is one of the deadliest factors impacting cardiovascular disease over the past century,” said Joseph C. Wu, M.D., Ph.D., FAHA, the current volunteer president of the American Heart Association, director of the Stanford Cardiovascular Institute and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. “Yet, even as we can celebrate these wins, we must realize that new challenges continue to threaten many decades of progress. Findings from these advisories identify a disturbing trend that many of these increases are projected to occur among our younger population — setting up a formidable future.”
Future generation at risk: Concerns CVD risk factor trends in kids
The analysis also looked at projections for children, with concerning trends among key risk factors that were also notable in the adult population.
- Obesity among children (age 2-19 years of age) is estimated to rise from 20.6% in 2020 to 33.0% in 2050, increasing from 15 million to 26 million children with obesity; highest increases will be seen among children 2 to 5 years of age and 12 to 19 years of age.
- The prevalence of inadequate physical activity and poor diet among children is projected to remain high at nearly 60% each, exceeding 45 million children by 2050.
Racial and ethnic disparities persist
“We found larger increases in the prevalence of CVD and risk factors, and in the number of people with these conditions, among people from racially and ethnically diverse backgrounds,” said Joynt Maddox, who is an associate professor of medicine at Washington University School of Medicine in St. Louis. “Some of this is due to demographic shifts in the U.S., with projections suggesting that Asian and Hispanic populations will nearly double by 2060. However, much of the inequity we see in CVD and risk factors remains attributed to systemic racism, as well as socioeconomic factors and access to care.”
Among adults aged 20 and older, projections note:
- Black adults have the highest prevalence of hypertension, diabetes, and obesity, along with the highest projected prevalence of inadequate sleep and poor diet.
- The total numbers of people with CVD will rise most among Hispanic adults with higher numbers also seen among Asian populations.
- Asian adults have the highest projected prevalence of inadequate physical activity.
- The aggregated group of American Indians/Alaskan Natives (AI/AN)/multiracial adults will have the highest projected prevalence of smoking.
Among children, the projections found:
- Black children will have the highest prevalence of hypertension and diabetes.
- Hispanic children will have the highest prevalence of obesity and the greatest projected growth in hypertension, diabetes, and obesity.
- Asian children and Hispanic children had the highest prevalence of inadequate physical activity.
- AI/AN/multiracial children will have the highest prevalence of smoking.
- Black children and white children will have the highest prevalence of poor diet.
- The absolute increase in each risk factor will be greatest for Hispanic children, reflecting broader trends in population growth.
Cardiovascular disease carries a high price tag
“It is not surprising that an enormous increase in cardiovascular risk factors and diseases will produce a substantial economic burden — to the tune of a $1.8 trillion price tag for cardiovascular disease projected by 2050,” said volunteer vice-chair of the advisory writing groups Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA. “This is a near tripling of the total direct and indirect costs of cardiovascular disease over the coming three decades, and almost doubles the economic impact of CVD as a proportion of the U.S. gross domestic product, increasing from 2.7% in 2020 to 4.6% in 2050.”
Total CVD costs include “direct costs,” which include the actual cost of health care, as well as “indirect costs,” including premature death and lost economic productivity that may include time taken off work to seek care or the inability to work due to a disability. The writing committee analyzed these costs in relation to individual health conditions and risk factors, paired with projected inflation and the rising cost of overall health and medical care.
Key economic projections include:
- The increase in total costs for CVD is primarily driven by a projected near quadrupling of direct health care costs, expected to increase from $393 billion in 2020 to $1.4 trillion in 2050.
- Because health care costs are projected to rise much faster than productivity losses, health care costs will constitute a larger proportion of total cost of CVD in the future, from 63% in 2020 to 80% in 2050.
- Stroke will be a major driver in the increased health costs, jumping to 535%, from $67 billion to $423 billion. This is due to the aging of the population, since strokes tend to occur on average ten years later than coronary events, and increases in hypertension, which is a major risk factor for stroke.
Aging population and changing demographics driving CVD burden
“The landscape of cardiovascular disease in the U.S. is seeing the arrival of a near-perfect storm. The last decade has seen a surge of cardiovascular risk factors such as uncontrolled high blood pressure, diabetes and obesity, each of which raises the risks of developing heart disease and stroke,” said Kazi, who is head of health economics and associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and director of the cardiac critical care unit at Beth Israel Deaconess Medical Center in Boston.
Kazi notes that these risk factors are rising even among children and young adults. And this is happening at a time of pivotal demographic shifts.
“The last of the Baby Boomers will hit 65 in 2030, so about 1 in 5 people in the U.S. will be over 65, outnumbering children for the first time in U.S. history. Since cardiovascular risk increases with age, the aging population increases the total burden of cardiovascular disease in the country. And finally, we anticipate that Hispanic, Asian and multiracial populations will more than double in the coming decades,” Kazi said. “By 2060, more than two-thirds of children will belong to underserved, disenfranchised populations which traditionally have higher rates of cardiovascular disease and risk factors. Even after adjusting out the effect of inflation, we project a quadrupling specific to the health care costs related to cardiovascular disease, along with an extensive cost of lost productivity due to early death and disability.”
As with prevalence, the projected increases in CVD costs vary across demographics:
- The greatest increases are seen in the youngest and oldest U.S. adults.
- While women are projected to have lower health spending than men in both 2020 and 2050, the increase in costs over this time frame is greater in women than men.
- Spending for the Asian and Hispanic populations is projected to increase by nearly 500% for each group.
- Costs for people with Medicare will increase the most, from $384 billion to $1.2 trillion, a 214% increase.
Health and hope for all: It’s not too late for change
In presenting the 30-year projected increases in prevalence and costs related to CVD, the writing group noted that these estimates are not set in stone. Appropriate interventions and aggressive approaches to reducing risk factors could change the course, and the group offered two scenarios in which this could happen:
- The first scenario anticipated that reducing the prevalence of high blood pressure, high cholesterol, diabetes and obesity by about 10% and improving the control of blood pressure, blood sugar and cholesterol by about 20%, would result in a 17% to 23% reduction in cases of heart disease and stroke and in cardiovascular deaths. These interventions could equate to 1.2 million fewer CVD and stroke events and 240,000 fewer CVD and stroke deaths annually by 2050.
- A second scenario predicted that further reductions in risk factors, in particular reducing obesity by half and doubling risk factor control, could achieve even greater reductions of up to 30% to 40% in event and death rates in 2050. These reductions could result in 2.3 million fewer CVD and stroke events and more than 450,000 lives saved annually by 2050.
- Both scenarios assumed that interventions began in 2025 and took 5 years to reach full implementation.
“We can bend the cost curve on cardiovascular disease, but this will require strategic investments in cardiovascular prevention and treatment,” Kazi said. “Some of this work is in the health care system — ensuring effective therapies reach patients most likely to benefit from them — but some of the work is upstream of the health system: ensuring that people have access to the resources they need to live healthful lives, to achieve the Life’s Essential 8 factors that are the core of cardiovascular health. It will take all of us working together to make this happen.”
Wu noted that many of these adverse trends can be reversed, as the American Heart Association has helped pioneer breakthroughs in science, policy and health care over the past century, making significant impacts to prevent CVD events and deaths and help people live longer, healthier lives even after having a heart attack or stroke.
“Scientific discovery is paramount to our success. While our forecast analysis was not able to take it into account, the recent approval of glucagon-like peptide 1 agonists and related drugs to treat diabetes and obesity may lead to a sea change in our medical approach to these conditions,” he said. “The next life-changing, life-saving treatment may be developing in a petri dish right now. We must redouble our efforts and support for funding cutting-edge research that may lead to approaches so innovative they don’t yet exist even in our imagination.”
“We must also ensure these approaches are available to all. If poverty, structural racism or negative social factors keep even one person from living their healthiest life, we haven’t fulfilled our mission. Broader public policy and systems changes are needed to address the root causes of these persistent inequities,” Brown said. “Our aging population calls for an enhanced cardiovascular workforce and infrastructure, including access to long-term care facilities and resources. We must better support our children and their families to recognize the impact that health choices made today will influence our health for years to come. Most importantly, we must ensure every person in the U.S. has access to quality, affordable health care.”
She said the clinical and public health interventions urgently need to reverse the trends identified in the presidential advisories must be among the highest priority with major investments on a national level.
“As we enter our second century of saving lives, the American Heart Association is encouraging every individual, company, school and community to unite to change the future of health — for ourselves, our loved ones and the many places in which we live, work and play,” Brown said. “At nearly 40 million-strong, our volunteers, donors, advocates, staff and other supporters will lead the charge to identify and implement real solutions to these very real problems, as we advance health and hope for everyone, everywhere.”
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Early dark energy could resolve cosmology’s two biggest puzzles
A new study by MIT physicists proposes that a mysterious force known as early dark energy could solve two of the biggest puzzles in cosmology and fill in some major gaps in our understanding of how the early universe evolved.
Now, the MIT team has found that both puzzles could be resolved if the early universe had one extra, fleeting ingredient: early dark energy. Dark energy is an unknown form of energy that physicists suspect is driving the expansion of the universe today. Early dark energy is a similar, hypothetical phenomenon that may have made only a brief appearance, influencing the expansion of the universe in its first moments before disappearing entirely.
Some physicists have suspected that early dark energy could be the key to solving the Hubble tension, as the mysterious force could accelerate the early expansion of the universe by an amount that would resolve the measurement mismatch.
The MIT researchers have now found that early dark energy could also explain the baffling number of bright galaxies that astronomers have observed in the early universe. In their new study, reported in the Monthly Notices of the Royal Astronomical Society, the team modeled the formation of galaxies in the universe’s first few hundred million years. When they incorporated a dark energy component only in that earliest sliver of time, they found the number of galaxies that arose from the primordial environment bloomed to fit astronomers’ observations.
“You have these two looming open-ended puzzles,” says study co-author Rohan Naidu, a postdoc in MIT’s Kavli Institute for Astrophysics and Space Research. “We find that in fact, early dark energy is a very elegant and sparse solution to two of the most pressing problems in cosmology.”
The study’s co-authors include lead author and Kavli postdoc Xuejian (Jacob) Shen, and MIT professor of physics Mark Vogelsberger, along with Michael Boylan-Kolchin at the University of Texas at Austin, and Sandro Tacchella at the University of Cambridge.
Big city lights
Based on standard cosmological and galaxy formation models, the universe should have taken its time spinning up the first galaxies. It would have taken billions of years for primordial gas to coalesce into galaxies as large and bright as the Milky Way.
But in 2023, NASA’s James Webb Space Telescope (JWST) made a startling observation. With an ability to peer farther back in time than any observatory to date, the telescope uncovered a surprising number of bright galaxies as large as the modern Milky Way within the first 500 million years, when the universe was just 3 percent of its current age.
“The bright galaxies that JWST saw would be like seeing a clustering of lights around big cities, whereas theory predicts something like the light around more rural settings like Yellowstone National Park,” Shen says. “And we don’t expect that clustering of light so early on.”
For physicists, the observations imply that there is either something fundamentally wrong with the physics underlying the models or a missing ingredient in the early universe that scientists have not accounted for. The MIT team explored the possibility of the latter, and whether the missing ingredient might be early dark energy.
Physicists have proposed that early dark energy is a sort of antigravitational force that is turned on only at very early times. This force would counteract gravity’s inward pull and accelerate the early expansion of the universe, in a way that would resolve the mismatch in measurements. Early dark energy, therefore, is considered the most likely solution to the Hubble tension.
Galaxy skeleton
The MIT team explored whether early dark energy could also be the key to explaining the unexpected population of large, bright galaxies detected by JWST. In their new study, the physicists considered how early dark energy might affect the early structure of the universe that gave rise to the first galaxies. They focused on the formation of dark matter halos — regions of space where gravity happens to be stronger, and where matter begins to accumulate.
“We believe that dark matter halos are the invisible skeleton of the universe,” Shen explains. “Dark matter structures form first, and then galaxies form within these structures. So, we expect the number of bright galaxies should be proportional to the number of big dark matter halos.”
The team developed an empirical framework for early galaxy formation, which predicts the number, luminosity, and size of galaxies that should form in the early universe, given some measures of “cosmological parameters.” Cosmological parameters are the basic ingredients, or mathematical terms, that describe the evolution of the universe.
Physicists have determined that there are at least six main cosmological parameters, one of which is the Hubble constant — a term that describes the universe’s rate of expansion. Other parameters describe density fluctuations in the primordial soup, immediately after the Big Bang, from which dark matter halos eventually form.
The MIT team reasoned that if early dark energy affects the universe’s early expansion rate, in a way that resolves the Hubble tension, then it could affect the balance of the other cosmological parameters, in a way that might increase the number of bright galaxies that appear at early times. To test their theory, they incorporated a model of early dark energy (the same one that happens to resolve the Hubble tension) into an empirical galaxy formation framework to see how the earliest dark matter structures evolve and give rise to the first galaxies.
“What we show is, the skeletal structure of the early universe is altered in a subtle way where the amplitude of fluctuations goes up, and you get bigger halos, and brighter galaxies that are in place at earlier times, more so than in our more vanilla models,” Naidu says. “It means things were more abundant, and more clustered in the early universe.”
“A priori, I would not have expected the abundance of JWST’s early bright galaxies to have anything to do with early dark energy, but their observation that EDE pushes cosmological parameters in a direction that boosts the early-galaxy abundance is interesting,” says Marc Kamionkowski, professor of theoretical physics at Johns Hopkins University, who was not involved with the study. “I think more work will need to be done to establish a link between early galaxies and EDE, but regardless of how things turn out, it’s a clever — and hopefully ultimately fruitful — thing to try.”
“We demonstrated the potential of early dark energy as a unified solution to the two major issues faced by cosmology. This might be an evidence for its existence if the observational findings of JWST get further consolidated,” Vogelsberger concludes. “In the future, we can incorporate this into large cosmological simulations to see what detailed predictions we get.”
This research was supported, in part, by NASA and the National Science Foundation.
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Plant-derived secondary organic aerosols can act as mediators of plant-plant interactions
A new study published in Science reveals that plant-derived secondary organic aerosols (SOAs) can act as mediators of plant-plant interactions. This research was conducted through the cooperation of chemical ecologists, plant ecophysiologists and atmospheric physicists at the University of Eastern Finland.
The study showed that Scots pine seedlings, when damaged by large pine weevils, release VOCs that activate defences in nearby plants of the same species. Interestingly, the biological activity persisted after VOCs were oxidized to form SOAs. The results indicated that the elemental composition and quantity of SOAs likely determines their biological functions.
“A key novelty of the study is the finding that plants adopt subtly different defence strategies when receiving signals as VOCs or as SOAs, yet they exhibit similar degrees of resistance to herbivore feeding,” said Professor James Blande, head of the Environmental Ecology Research Group. This observation opens up the possibility that plants have sophisticated sensing systems that enable them to tailor their defences to information derived from different types of chemical cue.
“Considering the formation rate of SOAs from their precursor VOCs, their longer lifetime compared to VOCs, and the atmospheric air mass transport, we expect that the ecologically effective distance for interactions mediated by SOAs is longer than that for plant interactions mediated by VOCs,” said Professor Annele Virtanen, head of the Aerosol Physics Research Group. This could be interpreted as plants being able to detect cues representing close versus distant threats from herbivores.
The study is expected to open up a whole new complex research area to environmental ecologists and their collaborators, which could lead to new insights on the chemical cues structuring interactions between plants.
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Folded or cut, this lithium-sulfur battery keeps going
Most rechargeable batteries that power portable devices, such as toys, handheld vacuums and e-bikes, use lithium-ion technology. But these batteries can have short lifetimes and may catch fire when damaged. To address stability and safety issues, researchers reporting in ACS Energy Letters have designed a lithium-sulfur (Li-S) battery that features an improved iron sulfide cathode. One prototype remains highly stable over 300 charge-discharge cycles, and another provides power even after being folded or cut.
The team coated iron sulfide cathodes in different polymers and found in initial electrochemical performance tests that polyacrylic acid (PAA) performed best, retaining the electrode’s discharge capacity after 300 charge-discharge cycles. Next, the researchers incorporated a PAA-coated iron sulfide cathode into a prototype battery design, which also included a carbonate-based electrolyte, a lithium metal foil as an ion source, and a graphite-based anode. They produced and then tested both pouch cell and coin cell battery prototypes.
After more than 100 charge-discharge cycles, Wang and colleagues observed no substantial capacity decay in the pouch cell. Additional experiments showed that the pouch cell still worked after being folded and cut in half. The coin cell retained 72% of its capacity after 300 charge-discharge cycles. They next applied the polymer coating to cathodes made from other metals, creating lithium-molybdenum and lithium-vanadium batteries. These cells also had stable capacity over 300 charge-discharge cycles. Overall, the results indicate that coated cathodes could produce not only safer Li-S batteries with long lifespans, but also efficient batteries with other metal sulfides, according to Wang’s team.
The authors acknowledge funding from the National Natural Science Foundation of China; the Natural Science Foundation of Sichuan, China; and the Beijing National Laboratory for Condensed Matter Physics.
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