Cardiovascular disease trends raise alarms on primary care

Editor's Note

In a series of interviews with STAT, 11 cardiologists and other clinicians, including the FDA commissioner, said a crisis in primary care is dragging back progress in the nation’s cardiovascular health.

Published October 15, the article begins with commentary on a stark warning from the American Heart Association (AHA): Despite prior efforts, cardiovascular disease will likely increase by 2050, driven by factors such as hypertension, obesity, and an aging population. Deepening racial and socioeconomic disparities will exacerbate the burden, with cardiovascular disease remaining a leading cause of death.

While deaths from cardiovascular conditions declined by 15% from 2010 to 2020, this fell short of the AHA’s goal to reduce them by 20%, STAT reports. Less than 10% of Americans now meet “ideal cardiovascular health” criteria, and disparities by race, socioeconomic status, and geography continue to widen.

Key takeaways from the 11 interviewed experts include:

• A crisis in primary care is impeding progress, with experts pointing to lack of an effective system for managing and preventing cardiovascular risks. Without access to consistent care, prevention efforts such as managing weight, blood pressure, and cholesterol fall short. And preventive services, including wellness checks, are often underfunded, while more profitable acute care services receive greater reimbursement, discouraging preventive care investments.
• COVID-19 added strain to the system and contributed to a surge in cardiovascular deaths by exposing and worsening existing inequities, such as outcomes among Black, Hispanic, and Asian populations. structural barriers—such as lack of access to care and economic stress—prevent individuals from adopting healthier lifestyles or managing chronic conditions.
• Despite significant medical advances, many patients fail to adhere to prescribed treatments. For example, half of the individuals on cholesterol-lowering drugs stop taking them within a year, and many skip cardiac rehabilitation after a heart attack.Experts emphasize prevention through lifestyle changes like exercise, healthy eating, and controlling blood pressure and glucose levels. However, adherence to these behaviors remains low.

Some experts advocate for wider use of inexpensive treatments, such as polypills combining medications for hypertension and cholesterol, STAT reports. Others stress the need for local, team-based primary care models that include non-physician health workers to make preventive care accessible. New therapies, including GLP-1 drugs and potential gene-editing solutions, show promise, but high costs and unequal access remain obstacles.