Forecasting the Economic Burden of Cardiovascular Disease and Stroke Through 2050: Presidential Advisory

This AHA presidential advisory — the companion to Joynt Maddox et al.’s prevalence projections — quantifies what the projected CVD epidemic will cost. The methodology is rigorous: MEPS and Census data, regression-based cost estimation, human capital productivity loss analysis, bootstrapped uncertainty intervals, costs reported in 2022 constant dollars. The projections cover 2020 through 2050.

The numbers are large enough to reframe the economics of prevention. CVD risk factor health care costs are projected to triple from $400 billion to $1.34 trillion. CVD condition costs nearly quadruple from $393 billion to $1.49 trillion. Total burden reaches $1.85 trillion — 4.6% of projected US GDP, up from 2.7% today. Stroke alone accounts for $357 billion in new costs and a 535% relative increase, driven by the combination of an aging population, rising blood pressure prevalence, and demographic growth in high-risk groups.

Per-person annual costs establish the clinical economics: stroke costs $35,000 per person per year; heart failure $18,000; coronary heart disease $13,000. Preventing a single case of stroke over a 10-year horizon generates $350,000 in health care savings, not counting productivity losses. This is the number against which the cost of aggressive prevention — statin therapy, blood pressure treatment, PCSK9 inhibitors for high-risk patients, CAC-guided risk reclassification — should be compared.

The projections are based on pre-pandemic prevalence trends (2009–2019) and explicitly exclude GLP-1 receptor agonists, which could materially alter the obesity and diabetes cost trajectories. They also exclude informal caregiving costs, estimated at an additional 11% of direct costs in prior studies. These omissions mean the projections may underestimate the true burden, or — if GLP-1s achieve broad adoption — overestimate it.

Medicare faces the most severe trajectory, with CVD costs projected to increase from $384 billion to $1.2 trillion — a 214% increase. Asian American and Hispanic American populations face 497% and 489% cost increases, respectively. Young adults face 261% increases. These are not uniform trends; they are concentrated where demographic growth and persistent access disparities intersect.

We rate the evidence moderate and the policy significance high. This Kazi et al. AHA presidential advisory, projecting US CVD economic burden to $1.85 trillion by 2050, provides the most rigorous cost foundation yet assembled for evaluating the return on cardiovascular prevention investment.