- Heart disease in women is projected to rise sharply over the next 25 years. By 2050, nearly 60% of women in the United States could have high blood pressure, a major risk factor for cardiovascular disease. That is up from about half of women in 2020, according to a new scientific statement from the American Heart Association.
- Young adult women are increasingly at risk. Almost one in three women ages 22 to 44 are expected to have some form of cardiovascular disease, compared with fewer than one in four today.
- Diabetes and obesity are adding fuel to the problem. Growing rates of these conditions are expected to drive much of the increase in heart disease nationwide.
- Even children are affected. By 2050, nearly 32% of girls ages 2 to 19 may have obesity, raising concerns about earlier and longer lasting heart health challenges.
Cardiovascular Disease in Women Projected to Surge
High blood pressure is rising, and experts say it will dramatically increase heart disease among women in the coming decades. A new scientific statement published in Circulation, the peer reviewed flagship journal of the American Heart Association, projects that nearly 6 in 10 women in the United States will be living with some form of cardiovascular disease (CVD) within the next 25 years.
The report, “Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050 in Women: A Scientific Statement From the American Heart Association,” builds on previous research to estimate how common heart disease and stroke may become among women and how much the growing burden could cost if current trends continue.
“One in every three women will die from cardiovascular disease — maybe it’s your grandmother, or your mother or your daughter,” said Karen E. Joynt Maddox, M.D., M.P.H., FAHA, chair of the volunteer writing group. She is a professor of medicine and public health and co director of the Center for Advancing Health Services, Policy & Economics Research at Washington University School of Medicine in St. Louis. “Additionally, more than 62 million women in the U.S. are living with some type of cardiovascular disease and that comes with a price tag of at least $200 billion, annually. Our estimates indicate that if we stay on the current path, these numbers will grow substantially over the next 25 to 30 years.”
Heart Disease, Stroke, and Risk Factors on the Rise
Researchers expect increases across every major category of cardiovascular disease in women, including heart disease, heart failure, atrial fibrillation and stroke. Key drivers such as high blood pressure, obesity and diabetes are also projected to climb.
Joynt Maddox emphasized two troubling patterns:
- Some risk factors are increasing among girls ages 2 to 19.
- The projected increases are even greater among women and girls who identify as American Indian/Alaska Native, Black, Hispanic or multiracial.
“Cardiovascular disease is the leading cause of death for women and remains their #1 health risk overall,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and executive director of the Katz Institute for Women’s Health and senior vice president of women’s health at Northwell Health in New York City. “While many people may think these conditions like high blood pressure are only occurring in older women, we know this is not the case. We know the factors that contribute to heart disease and stroke begin early in life, even among young women and girls. The impact is even greater among those experiencing adverse social determinants of health such as poverty, low literacy, rural residence and other psychosocial stressors. Identifying the types of trends outlined in this report is critical to making meaningful changes that can reverse this course.”
By 2050: High Blood Pressure, Diabetes, and Obesity
If current trends continue, the outlook by 2050 is striking:
- Nearly 60% of women are expected to have high blood pressure, compared with fewer than half today.
- More than 25% are projected to have diabetes, up from about 15%.
- More than 60% are likely to have obesity, compared with about 44% currently.
Among women of color, several increases are expected to be even larger. High blood pressure is projected to rise most among Hispanic women, increasing by more than 15%. Obesity is expected to climb most sharply among Asian women, rising by nearly 26%. Black women are projected to continue having the highest overall rates of many cardiovascular risk factors, with more than 70% expected to have high blood pressure, more than 71% obesity and nearly 28% diabetes.
Rising Cardiovascular Risk in Young Women
Although older women are still projected to carry the greatest burden of cardiovascular disease, younger women are experiencing notable increases. By 2025:
- Nearly one third of women ages 22 to 44 are expected to have some form of cardiovascular disease, compared with fewer than one in four today.
- Diabetes in this age group is projected to more than double from 6% to nearly 16%.
- More than one third are expected to have high blood pressure, an increase of more than 11%.
- More than one in six are projected to have obesity, rising by more than 18%.
Obesity Trends in Girls Raise Early Concerns
The report also highlights future risk among children and teens. By 2050, nearly 32% of girls ages 2 to 19 are projected to have obesity, an increase of more than 12%.
This trend is likely linked to lifestyle factors. More than 60% of girls are expected to have insufficient physical activity, and more than half are projected to have poor diets. Only modest improvements are expected over time. Rates are typically higher among girls of color, especially Black girls, with 40% projected to have obesity by 2050.
“This trend in increased health risks among girls and young women is particularly disturbing, as it indicates they will be facing chronic health issues for most of their lives. Women are already at increased risk for so many of these health conditions due to factors unique to them throughout their lifespan,” Rosen said. “Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times.”
Some Encouraging Signs in Heart Health
There is also positive news. High cholesterol levels are expected to decline across nearly all groups of women. Improvements are also anticipated in several behaviors that influence cardiovascular health, including healthier eating, increased physical activity and reduced smoking.
“We know that people are living longer as health conditions are being better managed. As a medical community, we have done a great job decreasing deaths from big cardiovascular events like heart attacks and strokes, but these data suggest that we need to really refocus our efforts on health, wellness and prevention,” Joynt Maddox said. “We need to keep girls and women from developing cardiovascular risk factors so that they can live long, healthy lives free of cardiovascular disease, and that means being very intentional about focusing on optimal cardiovascular health across the life course.”
The American Heart Association defines ideal heart health through its Life’s Essential 8™ — four health behaviors (eat better, be more active, quit tobacco and get healthy sleep) and four health factors (manage weight, control cholesterol, manage blood sugar and manage blood pressure).
“These ideal cardiovascular health metrics are based on extensive scientific research that recognizes the majority — as much as 80% — of heart disease and stroke can be prevented,” Rosen said. “I like to call Life’s Essential 8 a prescription for health. And one of the most exciting things about it is that we have tailored guidance for these metrics for different times in a woman’s life — from childhood through menopause and beyond. This report projects a concerning future, however, it’s not too late to take the first steps to healthier outcomes.”
Prevention, Treatment, and Lifelong Care
Experts stress that prevention is the most effective and affordable strategy to reduce cardiovascular disease. However, current efforts may not be enough, particularly for younger women and women of color.
“The most efficient, effective, and least costly way to reduce the prevalence and impact of cardiovascular disease is through prevention. Yet, these projections signal that our current prevention efforts are inadequate, particularly for women of color and younger women,” Joynt Maddox said. “In the report, we’ve identified several considerations to improve prevention, treatment and sustained care across the life course for all women.”
Promoting Healthy Behaviors
Encouraging heart healthy habits in schools, community centers, pediatric clinics and gynecology offices can help prevent disease before it starts. Digital tools may also support and reinforce positive lifestyle changes.
Managing Chronic Conditions Early
Early and consistent management of high blood pressure, diabetes and obesity can significantly lower risk. Health care teams and policymakers are encouraged to provide long term support, including early check ins, team based care and digital tools that improve access. Researchers are also urged to evaluate how newer obesity medications affect women specifically.
Improving Care for Cardiovascular Disease
Women experiencing heart attacks, heart failure, atrial fibrillation or stroke require timely and high quality treatment. Programs such as the American Heart Association’s Get With The Guidelines® help ensure care is fast, effective and equitable. For chronic conditions like atrial fibrillation and heart failure, care plans should reflect factors unique to women. Brain health, including dementia prevention, should also be part of blood pressure control and cardiovascular care.
Heart Health Across Life Stages
Each phase of life presents an opportunity to identify and address risk. Pediatricians should recognize that early menstrual periods may signal higher cardiovascular risk later in life, and menstrual history should be included in routine evaluations. Coordinated care before, during and after pregnancy is important. Ongoing research continues to explore how lifestyle changes and hormone therapy around menopause influence heart health.
Addressing Social and Demographic Factors
Social and environmental conditions affect women’s heart health in different ways. Tailored programs for Black women are urgently needed to reduce higher rates of cardiovascular disease. Health systems are encouraged to consider how access to healthy food, transportation and safe housing interact with medical risk and to design interventions that reflect these realities.
Changing the Trajectory Is Possible
Joynt Maddox also authored the American Heart Association’s 2024 presidential advisory Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050: Prevalence of Risk Factors and Disease. Simulation models from that advisory suggest meaningful reductions are achievable.
- A 10% decrease in major risk factors such as high blood pressure, high cholesterol, diabetes and obesity, combined with a 20% improvement in controlling blood pressure, blood sugar and cholesterol, could lower cardiovascular disease and stroke events, including deaths, by 17% to 23%.
- Cutting obesity in half and doubling control of major risk factors could reduce cardiovascular events and deaths by 30% to 40%.
“Society has come so far in medical advancements, but the same can’t be said for innovation and progress around cardiovascular health, wellness and prevention. These projections emphasize how critical it is that we start focusing on how to help all people stay healthy,” Joynt Maddox said. “In this new era of digital health, artificial intelligence and new metabolic medication options, health care professionals increasingly have the tools to do this, but not yet the systems.”
Rosen added that awareness of cardiovascular disease among women has been declining, making these findings especially urgent.
“Every woman of every age should understand her risk of heart disease and stroke and be empowered to take action to reduce that risk,” she said. “Know your numbers, listen to your body and be an advocate for your health. Additionally, support girls and women in your life to do the same. We can make a difference — we can be the difference.”
The scientific statement was developed by a volunteer writing group representing multiple American Heart Association councils. Scientific statements summarize current knowledge and identify areas for further research. They do not provide formal treatment recommendations, which are issued separately in official guidelines.
Co authors include Vice Chair Harmony R. Reynolds, M.D., FAHA; Demilade Adedinsewo, M.D., M.P.H.; Cheryl Bushnell, M.D., M.H.S., FAHA; Holli A. DeVon, Ph.D., FAHA; Holly C. Gooding, M.D., M.S.; Virginia J. Howard, Ph.D., FAHA; Rina Mauricio, M.D.; Eliza C. Miller, M.D., M.S.; Garima Sharma, M.D., FAHA; and R.J. Waken, Ph.D. Author disclosures are available in the manuscript.