Over the past 50 years, there have been dramatic improvements in cardiovascular science and clinical care, accompanied by marked declines in the morbidity and mortality. Nonetheless, cardiovascular disease remains the leading cause of death and disability in the world.  Heart disease is the leading cause of death for both men and women in the US and also the leading cause of death worldwide. Coronary heart disease costs the US $108.9 billion each year and is the most common type of heart disease. Together, heart disease and stroke cost more than $312.6 billion in health care expenditures and lost productivity annually.

Until recently, it was assumed that mortality from heart disease would continue to decline, gradually resulting in improvements in health.  Unfortunately, projections have reversed.  The scope of the problem is worsening for two reasons.  First, the population is aging.  More older Americans are hospitalized for heart failure than for any other medical condition. With the aging of the population, the impact of heart failure is expected to increase substantially.  A recent AHA Policy Statement predicts as much as a three-fold increase in costs by 2030.  As bad as that is, the study did not take into account another factor that could worsen the picture even more.   

That second factor is the obesity issue.  The change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. This is particularly an issue for the southeastern US, including North Carolina.  The obesity rate in 2014 was 29.7% in NC, and this was linked to a hypertension rate of 35.5%.  Looking at the raw numbers, there was 1,831,530 cases of hypertension in 2010.  At the current rate of increase, the number of hypertension cases in NC in 2030 would be 2,413,521.  Even worse, the 2010 number of heart disease cases in (543,752) is predicted to be 5-fold worse in 2030, with 2,572,272 projected cases.