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Population shifts, risk factors may triple U.S. cardiovascular disease costs by 2050

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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.

The new data comes from two new presidential advisories published today in the Association’s flagship peer-reviewed journal, CirculationForecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease and Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States through 2050. The companion papers build upon prior work by the Association to assess projections of the future cardiovascular disease prevalence and subsequent economic burden based on the current landscape.

“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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Prying open the AI black box

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Prying open the AI black box


Artificial intelligence continues to squirm its way into many aspects of our lives. But what about biology, the study of life itself? AI can sift through hundreds of thousands of genome data points to identify potential new therapeutic targets. While these genomic insights may appear helpful, scientists aren’t sure how today’s AI models come to their conclusions in the first place. Now, a new system named SQUID arrives on the scene armed to pry open AI’s black box of murky internal logic.

SQUID, short for Surrogate Quantitative Interpretability for Deepnets, is a computational tool created by Cold Spring Harbor Laboratory (CSHL) scientists. It’s designed to help interpret how AI models analyze the genome. Compared with other analysis tools, SQUID is more consistent, reduces background noise, and can lead to more accurate predictions about the effects of genetic mutations.

How does it work so much better? The key, CSHL Assistant Professor Peter Koo says, lies in SQUID’s specialized training.

“The tools that people use to try to understand these models have been largely coming from other fields like computer vision or natural language processing. While they can be useful, they’re not optimal for genomics. What we did with SQUID was leverage decades of quantitative genetics knowledge to help us understand what these deep neural networks are learning,” explains Koo.

SQUID works by first generating a library of over 100,000 variant DNA sequences. It then analyzes the library of mutations and their effects using a program called MAVE-NN (Multiplex Assays of Variant Effects Neural Network). This tool allows scientists to perform thousands of virtual experiments simultaneously. In effect, they can “fish out” the algorithms behind a given AI’s most accurate predictions. Their computational “catch” could set the stage for experiments that are more grounded in reality.

“In silico [virtual] experiments are no replacement for actual laboratory experiments. Nevertheless, they can be very informative. They can help scientists form hypotheses for how a particular region of the genome works or how a mutation might have a clinically relevant effect,” explains CSHL Associate Professor Justin Kinney, a co-author of the study.

There are tons of AI models in the sea. More enter the waters each day. Koo, Kinney, and colleagues hope that SQUID will help scientists grab hold of those that best meet their specialized needs.

Though mapped, the human genome remains an incredibly challenging terrain. SQUID could help biologists navigate the field more effectively, bringing them closer to their findings’ true medical implications.



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Iron meteorites hint that our infant solar system was more doughnut than dartboard

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Iron meteorites hint that our infant solar system was more doughnut than dartboard


Four and a half billion years ago, our solar system was a cloud of gas and dust swirling around the sun, until gas began to condense and accrete along with dust to form asteroids and planets. What did this cosmic nursery, known as a protoplanetary disk, look like, and how was it structured? Astronomers can use telescopes to “see” protoplanetary disks far away from our much more mature solar system, but it is impossible to observe what ours might have looked like in its infancy — only an alien billions of light years away would be able to see it as it once was.

Fortunately, space has dropped a few clues — fragments of objects that formed early in solar system history and plunged through Earth’s atmosphere, called meteorites. The composition of meteorites tells stories of the solar system’s birth, but these stories often raise more questions than answers.

In a paper published in Proceedings of the National Academy of Sciences, a team of planetary scientists from UCLA and Johns Hopkins University Applied Physics Laboratory reports that refractory metals, which condense at high temperatures, such as iridium and platinum, were more abundant in meteorites formed in the outer disk, which was cold and far away from the sun. These metals should have formed close to the sun, where the temperature was much higher. Was there a pathway that moved these metals from the inner disk to the outer?

Most meteorites formed within the first few million years of solar system history. Some meteorites, called chondrites, are unmelted conglomerations of grains and dust left over from planet formation. Other meteorites experienced enough heat to melt while their parent asteroids were forming. When these asteroids melted, the silicate part and the metallic part separated due to their difference in density, similar to how water and oil don’t mix.

Today, most asteroids are located in a thick belt between Mars and Jupiter. Scientists think that Jupiter’s gravity disrupted the course of these asteroids, causing many of them to smash into each other and break apart. When pieces of these asteroids fall to Earth and are recovered, they are called meteorites.

Iron meteorites are from the metallic cores of the earliest asteroids, older than any other rocks or celestial objects in our solar system. The irons contain molybdenum isotopes that point toward many different locations across the protoplanetary disk in which these meteorites formed. That allows scientists to learn what the chemical composition of the disk was like in its infancy.

Previous research using the Atacama Large Millimeter/submillimeter Array in Chile has found many disks around other stars that resemble concentric rings, like a dartboard. The rings of these planetary disks, such as HL Tau, are separated by physical gaps, so this kind of disk could not provide a route to transport these refractory metals from the inner disk to the outer.

The new paper holds that our solar disk likely didn’t have a ring structure at the very beginning. Instead, our planetary disk looked more like a doughnut, and asteroids with metal grains rich in iridium and platinum metals migrated to the outer disk as it rapidly expanded.

But that confronted the researchers with another puzzle. After the disk expansion, gravity should have pulled these metals back into the sun. But that did not happen.

“Once Jupiter formed, it very likely opened a physical gap that trapped the iridium and platinum metals in the outer disk and prevented them from falling into the sun,” said first author Bidong Zhang, a UCLA planetary scientist. “These metals were later incorporated into asteroids that formed in the outer disk. This explains why meteorites formed in the outer disk — carbonaceous chondrites and carbonaceous-type iron meteorites — have much higher iridium and platinum contents than their inner-disk peers.”

Zhang and his collaborators previously used iron meteorites to reconstruct how water was distributed in the protoplanetary disk.

“Iron meteorites are hidden gems. The more we learn about iron meteorites, the more they unravel the mystery of our solar system’s birth,” Zhang said.



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Supermassive black hole appears to grow like a baby star

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Supermassive black hole appears to grow like a baby star


Supermassive black holes pose unanswered questions for astronomers around the world, not least “How do they grow so big?” Now, an international team of astronomers, including researchers from Chalmers University of Technology in Sweden, has discovered a powerful rotating, magnetic wind that they believe is helping a galaxy’s central supermassive black hole to grow. The swirling wind, revealed with the help of the ALMA telescope in nearby galaxy ESO320-G030, suggests that similar processes are involved both in black hole growth and the birth of stars.

Most galaxies, including our own Milky Way have a supermassive black hole at their centre. How these mind-bogglingly massive objects grow to weigh as much as millions or billions of stars is a long-standing question for astronomers.

In search of clues to this mystery, a team of scientists led by Mark Gorski (Northwestern University and Chalmers) and Susanne Aalto (Chalmers) chose to study the relatively nearby galaxy ESO320-G030, only 120 million light years distant. It’s a very active galaxy, forming stars ten times as fast as in our own galaxy.

“Since this galaxy is very luminous in the infrared, telescopes can resolve striking details in its centre. We wanted to measure light from molecules carried by winds from the galaxy’s core, hoping to trace how the winds are launched by a growing, or soon to be growing, supermassive black hole. By using ALMA, we were able to study light from behind thick layers of dust and gas,” says Susanne Aalto, Professor of Radio Astronomy at Chalmers University of Technology.

To zero in on dense gas from as close as possible to the central black hole, the scientists studied light from molecules of hydrogen cyanide (HCN). Thanks to ALMA’s ability to image fine details and trace movements in the gas — using the Doppler effect — they discovered patterns that suggest the presence of a magnetised, rotating wind.

While other winds and jets in the centre of galaxies push material away from the supermassive black hole, the newly discovered wind adds another process, that can instead feed the black hole and help it grow.

“We can see how the winds form a spiralling structure, billowing out from the galaxy’s centre. When we measured the rotation, mass, and velocity of the material flowing outwards, we were surprised to find that we could rule out many explanations for the power of the wind, star formation for example. Instead, the flow outwards may be powered by the inflow of gas and seems to be held together by magnetic fields,” says Susanne Aalto.

The scientists think that the rotating magnetic wind helps the black hole to grow.

Material travels around the black hole before it can fall in — like water around a drain. Matter that approaches the black hole collects in a chaotic, spinning disk. There, magnetic fields develop and get stronger. The magnetic fields help lift matter away from the galaxy, creating the spiralling wind. Losing matter to this wind also slows the spinning disk — that means that matter can flow more easily into the black hole, turning a trickle into a stream.

For Mark Gorski, the way this happens is strikingly reminiscent of a much smaller-scale environment in space: the swirls of gas and dust that lead up to the birth of new stars and planets.

“It is well-established that stars in the first stages of their evolution grow with the help of rotating winds — accelerated by magnetic fields, just like the wind in this galaxy. Our observations show that supermassive black holes and tiny stars can grow by similar processes, but on very different scales,” says Mark Gorski.

Could this discovery be a clue to solving the mystery of how supermassive black holes grow? In the future, Mark Gorski, Susanne Aalto and their colleagues want to study other galaxies which may harbour hidden spiralling outflows in their centres.

“Far from all questions about this process are answered. In our observations we see clear evidence of a rotating wind that helps regulate the growth of the galaxy’s central black hole. Now that we know what to look for, the next step is to find out how common a phenomenon this is. And if this is a stage which all galaxies with supermassive black holes go through, what happens to them next?,” asks Mark Gorski.



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