The Future of Cardiovascular Epidemiology

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide, with the lifetime risk exceeding 60%.1 More than 2200 Americans die of CVD daily, 1 death every 40 seconds. A third of CVD deaths occur before 75 years of age, which is less than the average life expectancy of 78.8 years.1 Thus, prevention of CVD is a public health priority. Major advances in cardiovascular epidemiology over the last 4 decades have improved our understanding of the pathogenesis of CVD, with the identification and treatment of several major risk factors.2 However, several factors are worth highlighting to place these past achievements in appropriate perspective. 1. There remains a substantial societal burden of risk factors. Data indicate that 1 in 3 Americans reports no leisure-time physical activity and is likely to have high blood pressure, prediabetes, or high blood levels of low-density lipoprotein cholesterol.1 A majority of adults in the United States are overweight or obese; about one fifth have low levels of high-density lipoprotein cholesterol; one sixth smoke; and about 1/10th have diabetes mellitus.1 2. Projections indicate that the prevalence of CVD in the United States may escalate by 10% between 2010 and 2030.3 The estimated increase stems in part from the aging of the population and is fueled by the recent trends for increasing obesity rates and the concomitant rising rates of hypertension (8% increase over the next decade) and diabetes mellitus (100% increase over next 3 decades).1 These projections indicate that past achievements potentially may be challenged by some of the recent adverse trends in some risk factors. 3. There is a glaring 14-year difference in life expectancy between select population groups in the United States, as identified in the Eight Americas Study,4 with CVD emerging as the greatest source of difference …