Cardiovascular disease (CVD) remains the leading cause of death and disability among women in the United States and worldwide, approximately 157 million adult women in the United States, more than 62 million are living with some form of CVD, including coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke, or hypertension representing nearly 45% of the female population. The economic burden is substantial, with total direct and indirect costs estimated at $417.9 billion in 2020–2021.
Because women account for almost half of all CVD cases and have a longer life expectancy than men, their lifetime healthcare costs may exceed $200 billion annually. Even though the mortality rate of heart disease has reduced drastically between the 1970s and early 2000s, the situation has not improved further.
Recent statistics indicate the deterioration of premature cardiac deaths and the health behaviours and risk factors that perpetuate the disease. Based on data from a national survey and the projections of the U.S. census, researchers have estimated the prevalence of cardiovascular risk factors and clinical disease in women and girls from 2020 to 2050, stratified by age and race/ethnicity.
The predictions are concerning. The prevalence of hypertension among adult women is expected to increase to 59.1% in 2050, as compared to 48.6% in 2020. Diabetes prevalence is projected to rise to 25.3%, and obesity to 61.2%. In contrast, hypercholesterolemia is expected to decline from 42.1% in 2015 to 22.3%, likely due to improved screening and treatment.
Health behavior trends are mixed. Smoking rates are projected to decrease to 7.2%, while inadequate physical activity will remain high at 28.6%. The quality of diet is improving only slightly, whereas insufficient sleep is supposed to deteriorate. Regardless of the fact that there are some behavioral improvements, the overall burden of clinical CVD is projected to rise: CHD from 6.85% to 8.21%, HF from 2.45% to 3.60%, stroke from 4.14% to 6.74%, AF from 1.58% to 2.31%, and total CVD from 10.7% to 14.4%.
Significant disparities persist. Currently, Black women are the most affected by the highest prevalence of hypertension, diabetes, and obesity, along with HF and stroke. CVD burdens are also high among the American Indian/Alaska Native and multiracial women. The women of Hispanic and Asian descent are expected to increase some of the risk factors, specifically at a rapid rate over time. Relatively high rates of hypertension, stroke, and total CVD in young women (20-44) are likely to be the most alarming, as they start their diseases earlier.
Among girls, obesity prevalence is projected to increase dramatically to 32.0% by 2050, compared to 19.6% in 1990. As far as hypertension and diabetes are concerned, they will not be as high as this one. Unhealthy nutrition and lack of physical exercise are very common among all races and ethnic groups. The highest rates of hypertension and diabetes are attributed to black girls, the highest rates of obesity to Hispanic girls, and the highest rates of tobacco use to American Indian/Alaska Native and multiracial girls.
Preventive approaches to diet, exercise, and sleep habits at early stages in school, pediatric clinics, and the community could improve the diet, exercise, and sleep patterns prior to the onset of chronic diseases. Digitally assisted and team-based care models could be used to improve the management of hypertension and diabetes, especially given that these conditions place women at disproportionate risk of stroke and HF.
There are also critical opportunities for intervention during reproductive life stages. Early menarche, pregnancy-induced hypertensive disorders, and long-term cardiovascular risk are affected by menopause-affected metabolic changes. Coordinated care among obstetricians, primary care physicians, and specialists is essential to enhance screening and management during these pivotal periods.
The report further emphasizes the impact of social determinants of health, such as poverty, limited access to care, and structural inequities, which disproportionately affect women, especially Black women. Without targeted public health strategies, sex-specific research, equitable healthcare delivery, and innovation in screening and treatment across the lifespan, CVD prevalence in women is projected to rise substantially over the next 25 years. Researchers conclude that reversing these trends will require sustained investment in prevention, early treatment, and equitable care throughout a woman’s life.
Reference: Joynt Maddox KE, Reynolds HR, Adedinsewo D, et al. Forecasting the burden of cardiovascular disease and stroke in women in the United States through 2050: a scientific statement from the American Heart Association. Circulation. 2026. doi:10.1161/CIR.0000000000001406
