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January 12, 2026
7 min read
Key takeaways:
- The ACC issued its inaugural report on risk factors and CVDs that account for most CV death and disability in the U.S.
- Prevalence of most factors and diseases has risen in recent years.
The American College of Cardiology issued its inaugural JACC Cardiovascular Statistics report, highlighting the prevalence of 10 CVDs and risk factors and trends in quality of care and mortality associated with them.
Drawn from national surveys, registries and administrative data, the report, published in the Journal of the American College of Cardiology, outlines the prevalence, treatment and impact on mortality from five CV risk factors — hypertension, diabetes, obesity, LDL cholesterol and cigarette smoking — and five diseases — coronary heart disease, acute MI, heart failure, peripheral artery disease and stroke — collectively accounting for the majority of CV deaths and disability in the U.S.
Data were derived from Wadhera RK, et al. J Am Coll Cardiol. 2026;doi:10.1016/j.jacc.2025.12.027.
“Our goal was to make the state of CV health in the U.S. clear, accessible and actionable for a broad audience,” Rishi K. Wadhera, MD, MPP, cardiologist at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School, told Healio. “We curated and synthesized the most important statistics across CV risk factors, disease burden, quality of care and outcomes into a single, concise and highly visual resource. The emphasis is on clarity, accessibility and usability, so that patients, the public, clinicians, policymakers and public health leaders can quickly see where progress is being made and where critical gaps remain.
“By design, the report prioritizes interpretation and communication,” Wadhera said. “It translates complex national data into clear visuals and key messages, creating an annual snapshot that supports informed conversations, sharper decision-making and meaningful action by clinicians, health systems, public health agencies and policymakers to improve cardiovascular health.”
The researchers’ findings from their nationwide analysis of 10 CVDs and risk factors are as follows.
Hypertension
The researchers reported that, based on 2017 ACC/American Heart Association BP guideline criteria, approximately 50% of U.S. adults are affected by hypertension.
Approximately two in three adults with hypertension receive medical treatment, with no evidence of improvement between the 2009-2010 and 2021-2023 time periods, according to the report.
In addition, hypertension-related CV deaths increased from 23 per 100,000 people to 43 per 100,000 people during the past 20 years, with the biggest increase among adults aged 35 to 64 years. Hypertension-related deaths were more common in men than in women and in Black adults compared with adults of other races/ethnicities.
“We’re seeing reversals across several foundational drivers of CV health,” Wadhera told Healio. “Hypertension is a prime example — nearly one in two U.S. adults now meets criteria for high BP, and many are unaware they even have it. Despite being highly treatable, progress in detection, treatment and control has largely stalled over the past decade. Diabetes prevalence and complications continue to rise, particularly among younger adults and people with lower incomes, and obesity has reached epidemic levels across nearly every demographic group. And after years of improvement, we’re seeing warning signs in conditions like HF and stroke.”
Diabetes
During the past 15 years, the age-standardized prevalence of diabetes among U.S. adults increased from 11.9% in 2009-2010 to 14.1% in 2021-2023, with only about half of people with diabetes achieving glycemic control, according to the report.
Additionally, age-adjusted diabetes-related mortality increased from 30.4 per 100,000 people in 2009 to 54 deaths per 100,000 people in 2023, with a disparate impact among men, the researchers reported.
“Beyond established therapies such as insulin and oral antihyperglycemic medications, novel classes of antihyperglycemic agents — SGLT2 inhibitors and GLP-1 receptor agonists — have emerged in recent years and transformed diabetes management,” the researchers wrote. “Although use of these therapies is increasing, uptake remains uneven across health systems and insurance types.”
Obesity
The authors of the report said obesity has reached epidemic levels in the U.S., with more than 40% of adults having a BMI of 30 kg/m2.
Obesity-related mortality increased from 1.8 per 100,000 people to 3.1 per 100,000 people between 2010 and 2020, according to the report. In addition, only 1.6% of eligible patients received medication for obesity management between 2009 and 2021, and only about 1% of eligible patients undergo bariatric surgery.
“What’s most concerning is that these reversals are not evenly distributed — they are concentrated in younger adults and communities already facing barriers to care, setting the stage for a growing burden of cardiovascular disease in the years ahead,” Wadhera told Healio.
LDL cholesterol
In the U.S., average LDL levels slightly decreased from 115.4 mg/dL in the 2009-2010 period to 109.5 mg/dL in 2017-2020; however, the proportion of adults with prior atherosclerotic CVD who achieved the guideline-recommended LDL levels of less than 70 mg/dL remained low.
In addition, Black (23.8%) and Hispanic (23.9%) individuals without prior ASCVD but with the highest levels of 10-year ASCVD risk were less likely than white individuals (37.6%) to be on statin therapy, according to the report.
“One of the biggest surprises was how little progress we’ve made in treating and controlling common cardiometabolic risk factors like hypertension, diabetes and high cholesterol, even as therapeutic options have expanded,” Wadhera said. “We have more effective medications and clearer guidelines than ever, yet treatment and control rates for these conditions have barely budged. Another striking finding was how early cardiometabolic risk and CVD are now showing up, particularly among younger adults. That means people are living longer with chronic CV illness. Finally, what stood out was how consistent disparities were across nearly every risk factor and condition we examined. When the same patterns repeat themselves again and again, it tells us this isn’t about isolated failures, it’s about how the system is working.”
Smoking
The prevalence of cigarette smoking in the U.S. has declined from 20.3% in the 2009-2010 period to 14.5% in 2021-2023, and patterns were similar among men vs. women and across all racial/ethnic groups, the researchers reported.
The decline in cigarette smoking was mainly driven by reduced use among young adults aged 20 to 44 years, among whom use dropped by approximately half. In contrast, use was largely unchanged among middle-aged adults aged 45 to 64 years and increased among those aged 65 years or older, according to the report.
“There are real gains, and it’s important to acknowledge them. We’ve seen long-term declines in deaths from coronary heart disease, meaningful improvements in the quality of acute CV care and substantial reductions in cigarette smoking overall,” Wadhera told Healio. “But almost every gain we identified is unevenly distributed. Smoking has declined nationally, yet rates remain far higher among people with lower incomes. Treatment for cardiometabolic risk factors has improved in some populations, yet younger adults, people living in rural areas, and many racial and ethnic minority communities are less likely to receive consistent treatment or achieve good control.”
Coronary heart disease
The prevalence rates of ischemic heart disease in the U.S. decreased from 1990 to 2019; however, prevalence increased since 2019 among most subgroups, the researchers reported.
The prevalence of coronary artery disease among men and women was 5.9% and 3.4%, respectively, in 2019, and increased to 6.4% and 3.6% in 2022, according to the report.
Moreover, the prevalence of CAD was highest among white adults in 2022 (5.4%) and was the lowest among Asian adults (3.8%), according to the report.
Acute MI
Age-adjusted hospitalizations for acute MI declined from 3 per 1,000 adults in 2004 to 2.3 per 1,000 in 2010 and remained stable between 2010 and 2018, according to the report.
“The decline in age-adjusted acute MI mortality rates over the past 5 decades has been an important achievement in cardiovascular public health,” the researchers wrote.
Between 1968 and 2019, acute MI-related mortality declined from 380.3 per 100,000 people to 39.4 per 100,000 people; however, mortality increased slightly to 41.4 per 100,000 people by 2021, likely due to direct and indirect effects of the COVID-19 pandemic, according to the report.
Heart failure
Approximately 6.7 million U.S. adults are estimated to have HF, with prevalence rising with each decade of life, up to an approximately fourfold higher prevalence among adults older than 65 years vs. those younger than 65 years, the researchers reported.
In the 2021-2023 period, 82% of patients with newly diagnosed HF with reduced ejection fraction were eligible for guideline-directed quadruple medical therapy, but only 15.3% were prescribed it, the authors wrote.
Researchers reported that age-adjusted HF-related mortality appeared to decline from 1999 to 2011, but trends have since reversed, with rates of HF mortality now higher in 2021 vs. 1999.
Peripheral artery disease
As of 2000, PAD among U.S. adults — defined as ankle-brachial index less than 0.9 — was approximately 7%, or 8.5 million people, but remains underdiagnosed. Applied to today’s U.S. population, the number of adults with PAD would likely exceed 12 million, according to the report.
As of 2022, the estimated age-adjusted rate of PAD-related mortality was 2.7 per 100,000 people, and mortality rates were higher among men vs. women and highest among Black adults.
“These figures likely underestimate the true burden because PAD often contributes to death through related cardiovascular conditions or sepsis and is rarely recorded as the underlying cause of death,” the researchers wrote.
Stroke
Among U.S. adults, prevalence of self-reported stroke increased from 2.7% in the 2011-2013 period to 2.9% in 2020-2022, and rose sharply with age, from 0.9% among adults aged 18 to 44 years to 7.7% among those aged 65 years and older.
The researchers reported that stroke was responsible for approximately one in 20 deaths in the U.S.
Moreover, mortality was disproportionately high in the southeastern U.S. “stroke belt” and “stroke buckle,” along the southeastern Atlantic coast, where stroke mortality rates are, respectively, 30% and 40% higher compared with other U.S. regions.
“CVD is shaped as much by where people live, work and eat as by what happens in the health care system. You can’t treat your way out of a prevention problem,” Wadhera told Healio. “When access to insurance coverage, healthy food, safe places to exercise, affordable medications and continuous care is uneven, outcomes will be uneven too. The result is a widening gap between what’s possible and what’s delivered. Until we align our health system, public policy and community investments around prevention and long-term risk factor control, we’ll continue to see avoidable heart attacks, strokes and deaths.”
For more information:
Rishi K. Wadhera, MD, MPP, can be reached at cardiology@healio.com.
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