July 25, 2024

More than 184 million people—about 61% of U.S. adults—are likely to have some type of cardiovascular disease by 2050, the American Heart Association (AHA) reported earlier this month. That will lead to a tripling in the costs related to heart disease. It’s a statistic that TIME senior health correspondent Alice Park cited to begin her discussion about the future of healthcare with AHA CEO Nancy Brown; cardiologist Kiran Musunuru; and Andres Acosta, associate professor of medicine at Mayo Clinic, for a TIME100 Health panel in New York on Tuesday.

The event was sponsored by AHA and is part of the TIME100 Talks series. The TIME100 Health list includes the most influential people in the health industry around the world.

Heart disease has been the leading killer of Americans since 1950. Brown, who has been CEO of the AHA since 2008, said the number of people in the U.S. living with the risk of heart disease—and the resulting cost—is “staggering.” Part of the issue, she said, is the lack of equal access to healthcare and to social determinants of health, such as healthy food and a living wage. But another issue is the way the U.S. healthcare system approaches these types of medical conditions.

“I think that this country focuses a lot on treating conditions,” Brown said. “But we’re not focusing enough on prevention and helping people earlier in their lives understand the power of things that make a difference in their life. You know, 80% of cardiovascular disease is preventable.”

Musunuru, a professor of cardiovascular medicine and genetics in the Perelman School of Medicine at the University of Pennsylvania, said cardiovascular disease can be attributed to about half genetics and about half environment or lifestyle. There are ways to reduce risk factors for developing cardiovascular disease, such as cholesterol levels, blood pressure, and even obesity. The challenge, he said, is that these risk factors develop over time. And the country’s current healthcare system attempts to cope with chronic disease with chronic treatment. While there can be merits to that approach, Musunuru said, it also puts “an outsized burden” on patients.

He suggested the healthcare system shift its focus to preventing chronic diseases, starting at an early age—like we do with vaccines to prevent infectious diseases.

“You’re not going to eliminate heart disease, but can you push off heart attack and stroke by decades?” Musunuru said. “Instead of suffering a bad heart attack at age 60, maybe dying from it, it happens at age 100 and you enjoy 40 years of life you might not have otherwise had.”

Acosta, who codirects the Nutrition Obesity Research Program and directs the Precision Medicine for Obesity Program at Mayo Clinic, discussed how some treatments can also help with reducing the risk of other diseases. Obesity, for instance, is one of the major risk factors for heart disease, and weight loss drugs like Wegovy and Zepbound are having a significant impact on treating it. AHA previously reported that people taking Wegovy decreased their risk of heart attack, stroke, or death from cardiovascular issues by 20%, compared to those taking a placebo. Acosta said this data was a “game changer” and marked a “new era” in the management of obesity and cardiovascular disease.

The panelists also highlighted the importance of genetic testing. Few people have their genetics tested, Brown said, and a priority for the AHA is encouraging people to do so.

Musunuru researches the genetics of heart disease and aims to identify genetic factors that protect against disease. Having genetic information, he said, can help medical practitioners know early on what patients’ risks are for developing certain diseases and can allow patients to take a “proactive” approach to their health.

“Your genes are the same on the day you’re born as the day you die,” Musunuru said. “If you know what’s in your genes at the time you’re born, that gives you a forecast of what your life will look like as it unfolds.”

TIME100 Talks: Reimagining the Future of Healthcare was presented by the American Heart Association.

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