Elsevier

The American Journal of Medicine

Volume 124, Issue 9, September 2011, Pages 827-833.e5
The American Journal of Medicine

Clinical research study
The Impact of the Aging Population on Coronary Heart Disease in the United States

https://doi.org/10.1016/j.amjmed.2011.04.010Get rights and content

Abstract

Background

The demographic shift toward an older population in the United States will result in a higher burden of coronary heart disease, but the increase has not been quantified in detail. We sought to estimate the impact of the aging US population on coronary heart disease.

Methods

We used the Coronary Heart Disease Policy Model, a Markov model of the US population between 35 and 84 years of age, and US Census projections to model the age structure of the population between 2010 and 2040.

Results

Assuming no substantive changes in risks factors or treatments, incident coronary heart disease is projected to increase by approximately 26%, from 981,000 in 2010 to 1,234,000 in 2040, and prevalent coronary heart disease by 47%, from 11.7 million to 17.3 million. Mortality will be affected strongly by the aging population; annual coronary heart disease deaths are projected to increase by 56% over the next 30 years, from 392,000 to 610,000. Coronary heart disease-related health care costs are projected to rise by 41% from $126.2 billion in 2010 to $177.5 billion in 2040 in the United States. It may be possible to offset the increase in disease burden through achievement of Healthy People 2010/2020 objectives or interventions that substantially reduce obesity, blood pressure, or cholesterol levels in the population.

Conclusions

Without considerable changes in risk factors or treatments, the aging of the US population will result in a sizeable increase in coronary heart disease incidence, prevalence, mortality, and costs. Health care stakeholders need to plan for the future age-related health care demands of coronary heart disease.

Section snippets

The Coronary Heart Disease Policy Model

The Coronary Heart Disease Policy Model is a validated state-transition (Markov) model of the incidence, prevalence, mortality, and cost of coronary heart disease in US residents 35 to 84 years of age.4 The model has 3 components. First, the demographic-epidemiologic submodel estimates the incidence of coronary heart disease (cardiac arrest, myocardial infarction, angina, or coronary heart disease death) and death from other causes, based on age, sex, systolic blood pressure, smoking,

Results

In 2010, an estimated 156 million adults 35 to 84 years of age will be living in the US. This population is expected to increase by 28% to 200 million in 2040. The 65- to 84-year-old population is expected to increase by 89% percent over this period because of the aging of baby boomers and their longer life expectancy. The increase in coronary heart disease will reflect this population growth: incidence, prevalence, mortality, and cost are all expected to increase monotonically over the next 30

Discussion

Unprecedented growth in the 65 years of age and older population in the United States is expected over the coming decades. This growth will result in a substantial increase in coronary heart disease incidence, prevalence, mortality, and cost. A quantitative estimate of the magnitude of this increase is essential information for stakeholders in the US health care system, including patients, providers, training organizations, hospitals, health plans, governments, and industry.35, 36 Despite

References (40)

  • L.A. Prosser et al.

    Cost-effectiveness of cholesterol-lowering therapies according to selected patient characteristics

    Ann Intern Med

    (2000)
  • J.T. Edelson et al.

    Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension

    JAMA

    (1990)
  • K.A. Phillips et al.

    Health and economic benefits of increased beta-blocker use following myocardial infarction

    JAMA

    (2000)
  • A.N. Tosteson et al.

    Long-term impact of smoking cessation on the incidence of coronary heart disease

    Am J Public Health

    (1990)
  • J.A. Tice et al.

    Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease: effect of grain fortification and beyond

    JAMA

    (2001)
  • K. Bibbins-Domingo et al.

    Adolescent overweight and future adult coronary heart disease

    N Engl J Med

    (2007)
  • M.J. Pletcher et al.

    Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering

    Ann Intern Med

    (2009)
  • K. Bibbins-Domingo et al.

    Projected effect of dietary salt reductions on future cardiovascular disease

    N Engl J Med

    (2010)
  • Deaths for 358 selected causes, by 5-year age groups, race and sex: United States, 1999-2000

    (2007)
  • Framingham Heart Study CD-ROM

    (2005)
  • Cited by (167)

    • Epidemiology of Coronary Artery Disease

      2022, Surgical Clinics of North America
      Citation Excerpt :

      10.9% of adults aged 45 or older and 17.0% of adults aged 65 or older are estimated to have CAD, and approximately 800,000 Americans suffer a myocardial infarction (MI) each year.2 CAD is a major source of health care costs, estimated at $126.2 billion in 2010 and expected to increase to more than $177 billion by 2040.3 Vast improvements in care have led to a steady decline in CAD deaths over the past several decades.4

    View all citing articles on Scopus

    Funding: Supported in part by the Swanson Family Fund, Tempe, Ariz, and a grant-in-aid from the American Heart Association Western States Affiliate, Burlingame, Calif. (09GRNT2060096). Dr. Odden is supported by a Ruth L. Kirschstein National Research Service Award (T32HP19025). Dr. Moran is supported by an NIH/NHLBI Mentored Career Development Award (K08HL089675) and an Empire Clinical Research Program award from New York State.

    Conflict of Interest: None.

    Authorship: All authors were involved in the design of the study, interpretation of data, and the writing of the manuscript. All authors have approved the final version.

    View full text