Risk for heart disease is projected to spike over the next 25 years among younger women — typically considered a low-risk group — according to a new scientific statement from the American Heart Association (AHA).

The statement, published in Circulation, found that women aged 20-44 years and women of color face disproportionate risk and that among all US women, 6 in 10 will develop at least one type of cardiovascular disease by 2050.

“The sheer magnitude of this epidemic is really striking, no matter how many times you see it,” Karen E. Joynt Maddox, MD, MPH, the volunteer chair of the writing group told Medscape Medical News.

“It should be a real wake-up call for everyone who sees these numbers,” said Joynt Maddox, who is a professor of medicine and public health at Washington University School of Medicine in St. Louis.

Projections were based on National Health and Nutrition Examination Survey data (2015-2020) for baseline prevalence, the Medical Expenditure Panel Survey (2015-2019) for atrial fibrillation, and US Census population projections through 2050.

Among all women, type 2 diabetes is projected to increase from 14.9% to 25.3% and obesity from 43.9% to 61.2% — an absolute increase of 17.3 percentage points. Hypertension is expected to rise from 48.6% to 59.1%.

Clinical cardiovascular conditions are also projected to increase: coronary disease by nearly 20%, heart failure by 46.9%, stroke by 62.8%, and atrial fibrillation by 46.2%.

Adverse trends are projected to be more pronounced among women and girls identifying as American Indian/Alaska Native, multiracial, Black, or Hispanic.

Among Black women, hypertension is projected to rise from about 56% in 2020 to about 72% in 2050, diabetes from roughly 18% to about 26%, and obesity from approximately 48% to nearly 63%.

For Hispanic women, hypertension is projected to increase from about 38% to roughly 60%, diabetes from approximately 17% to about 27%, and obesity from around 44% to nearly 60% by 2050. Similar trends are seen among American Indian/Alaska Native and multiracial women.

The projections underscore the persistence of social determinants of health. The authors wrote, “Despite decades of knowledge of these health inequities, major gaps remain.”

Impact on Young Women

The most striking finding may be among women aged 20-44 years. In this group, total cardiovascular disease, excluding hypertension, is expected to increase by approximately 50% by 2050. Stroke prevalence is expected to nearly double, from about 1% to 2%.

While absolute disease burden remains highest among women aged 80 years or older, the fastest growth has occurred in younger women — a red flag for earlier-onset disease.

One positive trend: Hypercholesterolemia is projected to decline from 42.1% to 22.3%, which the authors attribute to improved lipid management and broader statin uptake.

Joynt Maddox attributes the trend to two forces: demographics (more women living into their eighties and nineties, increasing the number of cardiovascular events and demands for hospital and long-term care) and rising risk factors in younger generations.

“We are setting up a generation of young people to have early-onset cardiovascular disease if we don’t make significant changes, and soon,” she warns.

AHA surveys show that awareness about the risk for cardiovascular disease peaked around 2010 and has since declined, particularly among young women and women of color. Younger women may be less likely to perceive themselves at risk or receive routine cardiovascular counseling.

Stacey E. Rosen, MD, the volunteer president of the AHA and executive director of the Katz Institute for Women’s Health at Northwell Health in New Hyde Park, New York, noted that diminished awareness must be addressed to reverse these trends.

“The growing reliance on episodic care models rather than a continuous primary care relationship — where prevention is more likely to be discussed — has also contributed,” she said.

Changing the Trajectory

With rising hypertension in women of reproductive age, more hypertensive disorders of pregnancy, and underrecognition of cardiovascular risk in 20- to 44-year-olds, both clinicians call for an urgent rethinking of prevention tactics with respect to cardiovascular risk.

“Our healthcare system hasn’t prioritized prevention historically, but it’s imperative that we do so now,” said Joynt Maddox.

Rosen highlighted key windows of opportunity, including a reduction of siloed care. “As most young women see a gynecologist as their primary care clinician, prioritizing alignment between ob/gyn and internists, family medicine, and cardiology will enhance a ‘whole person’ approach and allow cross-disciplinary education and support.”

Joynt Maddox and Rosen reported having no relevant financial disclosures.

Lois Anzelowitz Levine is a medical and lifestyle writer in Dallas.