Heart Disease Now Affects Nearly Half of US Adults, as Obesity and Diabetes Continue to Rise

Key Takeaways: 

• Nearly half of adults in the United States are now living with cardiovascular disease, with prevalence projected to rise further as obesity, diabetes, and hypertension increase.
  
• New data highlight worsening cardiometabolic risk factors, including declining blood pressure and glycaemic control, alongside rising concerns around sleep health, physical inactivity, and nicotine exposure.
  
• The report underscores the urgent need for prevention-focused, equitable approaches to cardiovascular, kidney, and metabolic health across the life course.
  
  
  

A comprehensive annual snapshot of cardiovascular health

The 2026 Heart Disease and Stroke Statistics Report from the American Heart Association, published in the journal Circulation, provides an updated and wide-ranging overview of heart disease, stroke, and cardiovascular risk factors. Updated annually, the report integrates the most recent data, adds new thematic chapters, and removes outdated material to reflect the evolving cardiovascular health landscape.

The latest edition draws on a year-long collaborative effort involving volunteers, scientists, clinicians, government representatives, and AHA staff. It includes an expanded chapter on nicotine and tobacco use and exposure, alongside a new chapter focused on cardiovascular, kidney, and metabolic (CKM) syndrome. Together, these additions reflect growing recognition of the interconnected nature of cardiometabolic risk factors and their cumulative impact on population health.

Cardiovascular health trajectories and nicotine exposure

According to the report, several major cardiometabolic conditions are projected to rise substantially by 2050 among adults in the United States. Hypertension prevalence is expected to reach 61 percent, diabetes 26.8 percent, and obesity 60.6 percent. In contrast, hypercholesterolaemia is the only major risk factor projected to decline, falling from 45 percent to 24 percent.

Most core health behaviours are projected to worsen over time. An important exception is sleep, where inadequate sleep duration is expected to increase. Evidence from a 2010 to 2022 meta-analysis showed that people with ideal cardiovascular health experienced a 74 percent lower risk of cardiovascular disease events compared with those with poor cardiovascular health.

Nicotine exposure remains a major concern. People who smoke have a mortality risk three times higher than those who have never smoked. While smoking prevalence among adults in the United States has declined, the use of e-cigarettes has increased sharply. National Health Interview Survey data from 2017 to 2023 indicate that e-cigarette use has quadrupled over this period.

Physical activity and sleep health

Levels of physical activity remain suboptimal across age groups and regions. Only one in five children and adolescents aged 6 to 17 years achieved at least 60 minutes of daily physical activity. Globally, around one-third of adults across 163 countries did not meet recommended activity levels.

Sleep health has emerged as a significant cardiovascular risk factor. Data from the National Health and Nutrition Examination Survey covering 2017 to 2020 showed that 30 percent of adults experienced at least one hour of sleep debt, defined as the difference between sleep duration on workdays and free days. Observational analyses linked poor sleep with higher odds of type 2 diabetes, hypercholesterolaemia, and hypertension.

Obesity, lipids, blood pressure, and diabetes

Obesity prevalence continues to rise among both children and adults in the United States. Estimates from the Global Burden of Diseases, Injuries, and Risk Factors study indicated that in 2021 more than 15 million children aged 5 to 14 years, 21 million young people aged 15 to 24 years, and 172 million adults aged 25 years or older were living with overweight or obesity.

While the prevalence of high total cholesterol has decreased, low-density lipoprotein cholesterol remains a major driver of cardiovascular mortality. Global data from 2021 attributed a cardiovascular disease mortality rate of 43.7 per 100,000 people to elevated low-density lipoprotein cholesterol.

Hypertension prevalence remained broadly stable between 2013 and 2023. However, blood pressure control worsened, declining from 54.1 percent in 2013 to 2014 to 48.3 percent in 2017 to 2020. Some improvement was observed among non-Hispanic Black adults between 2017 to 2020 and 2021 to 2023.

Diabetes prevalence also remains high. Between 2021 and 2023, an estimated 29.5 million adults had diagnosed diabetes, 96 million had prediabetes, and 9.6 million were living with undiagnosed diabetes. Among people with diagnosed diabetes, glycated haemoglobin levels increased significantly from 2017 to 2020 and again from 2021 to 2023, while overall glycaemic control rates declined.

Kidney disease, CKM syndrome, and pregnancy outcomes

The burden of kidney disease has risen markedly over the past two decades. The prevalence of end-stage kidney disease nearly doubled between 2002 and 2019, before stabilising in subsequent years. Across 114 cohort studies, both albuminuria and reduced kidney function were consistently associated with increased risk of kidney failure and mortality.

Data from NHANES between 2011 and 2020 suggest that approximately 90 percent of adults in the United States were in stage 1 or higher of CKM syndrome. People from underrepresented ethnic and racial groups experienced a disproportionately higher burden of advanced CKM stages. More advanced stages were strongly associated with increased cardiovascular disease mortality.

The report also highlights links between cardiometabolic health and pregnancy outcomes. In Japan, pregnant individuals with higher healthy lifestyle scores before pregnancy had around a one-third lower risk of adverse pregnancy outcomes compared with those with the lowest scores. Although maternal mortality rates declined across all ethnic and racial groups between 2021 and 2022, persistent disparities remain.

Cardiovascular disease, stroke, dementia, and congenital conditions

Overall cardiovascular disease prevalence reached nearly 49 percent among adults aged 20 years or older, based on NHANES data from 2021 to 2023. Prevalence increased with age in both women and men. At the population level, stronger adherence to healthy dietary patterns was associated with lower cardiovascular disease risk.

Stroke incidence declined between 1993 and 2015 among both Black and White adults, although rates remained consistently higher in Black populations. Dementia prevalence among older adults decreased between 2011 and 2021, though findings varied depending on study design and population. Evidence from selected intervention studies suggested that high-intensity training may help slow cognitive decline.

Congenital cardiovascular defects were estimated to affect around 1 in 80 babies in high-income regions of North America. Globally, survival into adulthood among people born with congenital heart disease improved substantially between 1990 and 2019. Population-based analyses linked limited prenatal care, neighbourhood deprivation, and air pollution to increased risk of heart defects, poorer outcomes, and delayed diagnosis.

Heart rhythm disorders, cardiac arrest, and heart failure

Heart rhythm disorders and heart failure continue to contribute significantly to cardiovascular morbidity. Atrial fibrillation affected an estimated 10.55 million adults in the United States, representing 4.48 percent of the adult population.

Patterns of cardiac arrest have also shifted. Opioid-related out-of-hospital cardiac arrests accounted for less than 1 percent of cases in 2000 but rose to between 7 percent and 14 percent by 2023. Coronary heart disease prevalence was estimated at 5.2 percent among adults aged 20 years or older between 2021 and 2023. Over the same period, heart failure prevalence increased from 6.7 million people in 2017 to 2020 to 7.7 million in 2021 to 2023.

A growing burden with global implications

Taken together, the 2026 Heart Disease and Stroke Statistics Report paints a picture of a growing cardiovascular disease burden affecting around half of the adult population. Despite major advances in diagnostics, prevention strategies, and treatment options, ageing populations, widening health inequalities, and rising cardiometabolic risk factors continue to place increasing pressure on healthcare systems.

The report emphasises the need for coordinated, prevention-led approaches that prioritise early intervention and equitable access to care. Without sustained action across policy, healthcare, and community settings, current trends are likely to continue, with profound long-term health and economic consequences.