JACC Debuts Data Digest on CV Health in the United States

JACC, the American College of Cardiology’s flagship journal, has embarked on a new project: an annual look at key evidence in cardiovascular medicine. The hope, the report’s creators say, is that greater awareness will spark positive change.

Lead author Rishi K. Wadhera, MD (Beth Israel Deaconess Medical Center, Boston, MA), said their motivation boils down to “accountability.”

“Progress depends on . . . being honest about where we are, where we’ve made gains, and where we’re falling behind,” he told TCTMD via email. “Our goal was to make the state of cardiovascular health clear not just to researchers and clinicians, but also to patients, the public, and policymakers who shape decisions that directly affect cardiovascular health.”

Currently, the project focuses on the United States, though it may expand in the coming years. The annual format will help create a “consistent benchmark” for measuring progress over time, Wadhera added.

To that end, the 2026 paper brought together the latest data on “the five conditions that collectively account for most cardiovascular deaths and disability in America.” This list includes coronary heart disease (CHD), acute myocardial infarction, heart failure, peripheral artery disease, and stroke, with special attention paid to the main drivers of those diseases: hypertension, diabetes, obesity, LDL cholesterol, and cigarette smoking.

Information sources spanned nationally representative surveys to administrative claims, clinical registries, vital statistics, and even raw data. The report is meant to be clear and accessible, Wadhera stressed. “By design, the report prioritizes interpretation and communication. It translates complex national data into clear visuals and key messages,” with the goal of taking steps to improve health.

As JACC Editor-in-Chief Harlan Krumholz, MD (Yale University, New Haven, CT), notes in a foreword to the new report, this project reflects the field’s long-standing emphasis on evidence. The combined force of these data “informs, motivates, and unites us in purpose,” he writes. “The data tell a story—but what we do next will define its course.”

Key Findings by Disease State

In coronary heart disease:

• Only half of people with coronary heart disease receive optimal medical therapy
• Coronary artery disease steadily declined from 1990 to 2015, but prevalence rose each year from 2019 onwards
• CAD-related deaths decreased by approximately 50% between 2000 and 2020

In acute MI:

• Both hospitalization and mortality rates for acute MI have decreased overall thanks to prevention, treatment, and better systems of care. Young adults, however, are experiencing a rise in acute MI hospitalizations
• Stark imbalances in acute MI related to race and ethnicity, sex, socioeconomic status, and geography are threatening past gains
• Quality-improvement initiatives require broader and more equitable implementation to ensure consistent progress

In heart failure:

• Around 6.7 million US adults have heart failure, with differences in prevalence by age, race/ethnicity, and geography
• Mortality related to the disease declined for years only to rise again starting in 2011, especially during the COVID-19 pandemic
• Patients who have heart failure with reduced ejection fraction are beginning to receive better medical therapy, but levels are still suboptimal

In PAD:

• Approximately one in 14 US adults have lower-extremity PAD, which is often underdiagnosed
• One in 10 PAD patients with chronic limb-threatening ischemia ultimately undergo major amputation above the ankle
• Almost half of PAD patients who receive vascular interventions are not discharged on full, guideline-directed medical therapy
• PAD is the most common initial manifestation of CVD for patients with type 2 diabetes, with more than 13% of those affected experiencing adverse limb events

In stroke:

• Nearly 7.8 million US adults experience stroke, with the highest prevalence seen in the Southeast and among American Indian/Alaska Native and Black adults
• Age-adjusted stroke mortality has declined since 1975 but is showing signs of a reversal since 2013, especially for Black and middle-aged adults
• In 2023, around 160,000 stroke-related deaths occurred
• Stroke care has improved over the past 20 years, with further opportunities existing in door-to-needle times and demographic disparities

In addition to some of the vexing findings around the five disease states, the data on traditional risk factors highlight critical areas that need addressing, the authors found.

For example, hypertension continues to stubbornly impact half of US adults and stayed steady between 2009 and 2023. Diabetes is on the rise, as is related mortality, especially among young adults and those with low income. Obesity now affects more than 40% of US adults. For LDL cholesterol, most high-risk patients fail to meet targets and statins continue to be underused. While fewer and fewer people smoke tobacco cigarettes, low-income adults are twice as likely to smoke as those with higher incomes and e-cigarettes are increasingly popular among younger adults.

‘Sobering’ Numbers

Wadhera said there are a number of noteworthy themes contained in the 2026 snapshot.

“The data are sobering because they show that for many major cardiovascular risk factors, such as hypertension, diabetes, and obesity, we’ve stalled or moved in the wrong direction over the past decade,” he noted. “In some areas, mortality is rising again, particularly among younger adults and populations that have historically faced barriers to care.”

A big surprise is the lack of progress in addressing cardiometabolic risk factors despite having better therapeutic options at hand. “We have more effective medications and clearer guidelines than ever, yet treatment and control rates for these conditions have barely budged,” Wadhera commented to TCTMD. “Another striking finding was how early cardiometabolic risk and cardiovascular disease are now showing up, particularly among younger adults. That means people are living longer with chronic cardiovascular illness, rather than developing disease later in life.”

When the same patterns repeat themselves again and again, it tells us this isn’t about isolated failures—it’s about how the system is working. Rishi Wadhera

Moreover, the continued presence of disparities across racial, socioeconomic, and geographic groups is a concern, he specified. “When the same patterns repeat themselves again and again, it tells us this isn’t about isolated failures—it’s about how the system is working.

“There’s a wide gap between what we know works and what’s happening in practice,” Wadhera continued, citing a disconnect between scientific progress and real-world results. “We have highly effective therapies and clear clinical guidelines, yet far too many patients are not receiving treatment or achieving adequate control.”

Importantly, the report “reflects a belief that measurement is not a bureaucratic exercise but a moral one—because what we measure is what we choose to value, and what we report is what we commit to improve,” Wadhera and colleagues conclude.