Treatments for cardiovascular conditions have never been better. Knowledge about how to improve heart health has steadily improved. Yet, in the U.S., progress in cardiovascular health has largely stalled out and in some ways worsened — even as increasingly effective treatments and interventions come to market.

The problem, said Rishi Wadhera, lead author of the Inaugural Journal of American College of Cardiology (JACC) Cardiovascular Statistics 2026 report, is “uniquely American.”

“Many other higher-income countries are grappling with rising obesity and diabetes,” said Wadhera, Harvard Medical School associate professor of medicine at Beth Israel Deaconess Medical Center and associate professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health. “But the U.S. stands out for how consistently those risks translate into worse cardiovascular outcomes, and how wide the gaps are by income, race, ethnicity, and geography.”

And, in fact, there is growing concern about a worsening problem among younger adults with just-released research showing a sharp rise in hospital death rates from severe first heart attacks among those aged 18 to 54. Most of the deaths were men, but women succumbed at higher rates.

In the JACC report, Wadhera and his colleagues presented a comprehensive picture of cardiovascular risk factors in the U.S., highlighting the disparity between medical knowledge and treatments and the chronic problems faced by tens of millions.

Among other stark statistics, the paper showed that one in two U.S. adults suffer from high blood pressure — with little change between 2009 and 2023.

Though interventions have improved, many who need help don’t get it. The report states that only two in three American adults with hypertension, considered among the most dangerous cardiovascular risk factors, receive medical treatment, with no improvement in the figure since 2009-2010.

This lack of treatment leads to deaths. From 2000 to 2019, hypertension-related cardiovascular deaths nearly doubled, from 23 to 43 per 100,000 — with men experiencing higher rates than women and Black adults higher than white adults.

Among other stark statistics, the paper showed that one in two U.S. adults suffer from high blood pressure — with little change between 2009 and 2023.

Especially concerning to Wadhera and his colleagues is that younger Americans are facing a greater burden of heart problems.

“We’re seeing cardiovascular risks factors and diseases show up earlier in life, which changes the entire arc of health for individuals and also increases the likelihood of decades of chronic illness and catastrophic health events later on,” Wadhera said. “The story of young adults was stark and compelling.”

Wadhera stressed that the report also highlighted some positive trends. Mortality from coronary artery disease dropped by about 50 percent between 2000 and 2020, and the quality of care for those who suffer a heart attack or stroke improved. Far fewer people smoke, too, limiting a major factor that plays into heart problems.

Wadhera cited the decline in smoking as an example of how research and public health campaigns can lead to meaningful improvements in health.

“The declines didn’t happen by accident,” he said. “They were the consequence of sustained education, prevention, public health efforts, health system efforts, and so on.”

He hopes that the report’s accessible presentation of trends not only helps researchers and clinicians, but also policymakers who make decisions that directly affect cardiovascular health — including on structural factors that drive disparities.

“There are obviously genetic determinants of obesity,” Wadhera said, “but at the same time, we do have to think about how our communities are constructed, how our environments are constructed, and whether they make it easy for people to make healthy choices.”

Despite overall decreases in smoking, he pointed out that smoking rates are much higher in lower-income than higher-income adults. Similarly, though most people understand the importance of diet and exercise in preventing hypertension and obesity, millions of Americans live in obesogenic environments with little public space, low-quality food, and poor transit options outside of driving.

“There’s a widening gap between what’s possible and what’s delivered,” Wadhera said. Until the nation aligns its health system, public policy, and community investments around prevention and risk-factor control, he added, the U.S. will continue to experience avoidable heart attacks, strokes, and cardiovascular deaths.