As financial toxicity in health care has become a topic of increasing concern, multiple recent papers have explored the economic and financial burdens associated with cardiovascular disease (CVD) in the United States.1-3 The findings point to significant gaps and potential solutions to reduce these burdens
Projected Cardiovascular Health Care Costs
In a 2024 presidential advisory from the American Heart Association (AHA), the authors analyzed nationally representative data to project inflation-adjusted health care costs attributable to cardiovascular risk factors and overt cardiovascular conditions through 2050. The risk factors examined were hypertension, hypercholesterolemia, and diabetes, and the specific conditions included heart failure, coronary heart disease, and atrial fibrillation.2
Analyses revealed that the estimated annual costs of cardiovascular risk factors are projected to increase 3-fold to $1344 billion by 2050, while the costs of cardiovascular conditions are projected to increase nearly 4-fold to $1490 billion
Multiple factors are driving the increasing economic burden of CVD in the US, including population aging and the high prevalence of cardiovascular risk factors, according to cardiologist Karen Joynt Maddox, MD, MPH, professor at the Washington University School of Medicine and School of Public Health in St Louis, Missouri, and co-director of the Center for Advancing Health Services, Policy & Economics Research. Dr Joynt Maddox is also a co-author of the AHA presidential advisory mentioned above.2
This is what an affordability crisis looks like, hiding in plain sight among people we assume are protected by private insurance
“Importantly, much of the projected growth in cardiovascular spending is not driven by rising costs per patient, but by the increasing number of Americans living with CVD and its risk factors,” she noted. In addition to population aging, persistent challenges with risk factors such as hypertension, diabetes, and other cardiometabolic conditions are contributing factors to these rising costs
“From a societal perspective, the biggest driver of future costs is likely to be the growing burden of disease itself,” Dr Joynt Maddox said. “Advances in treatment have also allowed many patients to live longer with CVD, which is a great success but means that more people require ongoing care over many years.”
Impact of Economic and Financial Burdens on CVD Outcomes
The available evidence suggests a bidirectional relationship in which CVD “creates substantial economic burdens for patients, families, employers, health care delivery systems, and public programs, but economics and costs also influence cardiovascular health and outcomes,” Dr Joynt Maddox explained. “CVD contributes to disability, lost productivity, caregiving demands, and premature mortality, all of which have important economic consequences for families and society.”
From the other direction, financial burdens can contribute to greater morbidity and worse disease outcomes in patients with CVD.
“When people face financial strain, they ration care, skip medications, delay follow-up, and forgo the preventive and diagnostic services that keep CVD in check,” said cardiologist Rishi K Wadhera, MD, MPP, MPhil, associate director of the Richard A and Susan F Smith Center for Outcomes Research and associate professor of medicine at Harvard Medical School in Boston, Massachusetts. Dr Wadhera is also an associate professor of health policy and management at the Harvard School of Public Health.
“For conditions like hypertension, high cholesterol, and diabetes, where control depends on consistent, day-to-day management, even small affordability barriers can translate into missed opportunities to prevent heart attacks and strokes,” he continued.
In a study published in the Journal of the American College of Cardiology in April 2026, Dr Wadhera and colleagues investigated changes in health care expenditures and financial burden among privately insured working-aged US adults (aged 25 to 64 years) with CVD and cardiovascular risk factors between 2007 and 2022. The analyses were based on nationally representative data from the Medical Expenditure Panel Survey (MEPS).3
The results demonstrated a mean increase in inflation-adjusted health care expenditures of roughly 10% between the 2 time periods, primarily due to a mean 14% increase in insurance premiums. Out-of-pocket medical costs and prescription drug spending remained largely the same.
Additionally, the findings showed that more than 1 in 3 participants spent more than 10% of their income on health care expenses, and these costs were catastrophic (exceeding 40% of income) for approximately 1 in 10 participants
“We’re seeing cardiovascular risk factor control worsen among younger working-age adults at the very same time that financial burden remains stubbornly high,” Dr Wadhera said. “Cost and worsening heart health are moving in the wrong direction together.”
Dr Wadhera and his co-authors were surprised to find that the increase in health care costs observed in their study was “driven almost entirely by escalating insurance premiums, not by what patients pay at the pharmacy counter or the doctor’s office,” he shared. “In other words, the cost of simply holding coverage is becoming the burden, often before a patient receives a single service.”
These findings highlight insurance premiums as an under-recognized burden in cardiovascular health care expenditures, Dr Wadhera noted.
“We tend to focus on copays and deductibles, but for many families the monthly premium is the line item that quietly consumes a growing share of income,” he continued. “This is what an affordability crisis looks like, hiding in plain sight among people we assume are protected by private insurance.”
A previous study based on MEPS data examined financial burden in patients with heart failure and found that 33% reported some financial hardship due to medical bills, and 13.2% reported not being able to pay their medical bills at all. The study further showed that younger age (65 years or younger) and lower education were independently associated with greater odds of subjective financial burden due to medical costs.4
Other studies and reviews published in recent years have revealed the significant economic burden associated with congenital heart disease, coronary artery disease and peripheral artery disease, and various other CVDs in the US.1,5,6
Role of Clinicians in Addressing CVD Costs
“Clinicians may feel that health care costs are largely outside of their control, but one of the most effective ways to reduce the long-term economic burden of CVD is to prevent events before they occur,” Dr Joynt Maddox advised. “Aggressive management of blood pressure, lipids, diabetes, tobacco, and other modifiable risk factors remains incredibly high-value.” She also mentioned the important role of clinicians in helping patients navigate financial barriers to care.
Dr Wadhera recommends that clinicians treat cost as a clinical variable rather than a side conversation. “Asking patients directly whether they can afford their medications and prescribing high-value generic therapies when they’re equally effective can meaningfully reduce out-of-pocket strain,” he said. “Connecting patients with pharmacists, social workers, and patient-assistance programs should be a routine part of cardiovascular care, not an afterthought.”
In addition, Dr Joynt Maddox and Dr Wadhera cited the key role of clinicians in advocating for measures to reduce the economic and financial burdens of cardiovascular care in the US
“Beyond individual patient encounters, clinicians bring an important perspective to discussions about health care policy, prevention, access to evidence-based therapies, and health care delivery reform,” Dr Joynt Maddox said. “Their experiences caring for patients help ensure that efforts to manage costs still remain primarily focused on the goal of improving health.”
Similarly, Dr Wadhera explained that individual clinicians can only do so much at the bedside to address high health care expenditures, as the drivers of these costs are structural.
He agrees that physicians can advocate for patients by bringing their experiences into policy conversations. “When a cardiologist tells lawmakers that their patient stopped a guideline-recommended medication because of cost — and consequently experienced an adverse health outcome — that carries weight.”
Broader Measures to Reduce CVD Expenditures
Broader efforts needed to reduce health care costs associated with CVD include a focus on prevention and risk factor control through ongoing investment in evidence-based “strategies such as tobacco control, blood pressure management, diabetes prevention and treatment, healthy nutrition, physical activity, and other public health approaches that reduce cardiovascular risk across the population,” Dr Joynt Maddox said. These measures should aim to address the social and environmental conditions that influence cardiovascular risk.7
“At the same time, we should continue working to improve the value of care by supporting access to preventive therapies, developing models that reward clinicians for providing high-quality care, and investing in research and innovation that improve health,” she added.8
Dr Wadhera emphasized the need to view affordability as a cardiovascular health strategy and not solely an economic goal
“We will not reverse the troubling trends in heart health among working-age Americans if patients can’t afford consistent access to care,” he said. “Reducing financial barriers isn’t separate from improving cardiovascular outcomes — it’s central to it.”
- Nikoo MZ, Kumar S, Maki MK, Krishnaswami A, Shishehbor MH, Forouzandeh F.The economic burden of cardiovascular disease in the United States.Am J Cardiol. Published online April 20, 2026. doi:10.1016/j.amjcard.2026.03.073
- Kazi DS, Elkind MSV, Deutsch A, et al; on behalf of the American Heart Association.Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: a presidential advisory from the American Heart Association.Circulation. Published online June 4, 2024. doi:10.1161/CIR.0000000000001258
- Dash S, Zheng Z, Qian Y, et al.Out-of-pocket costs and financial burden among working-age adults with cardiovascular conditions: a JACC data report on trends in the United States, 2007-2022.J Am Coll Cardiol. Published online March 10, 2026. doi:10.1016/j.jacc.2025.12.039
- Ali HR, Valero-Elizondo J, Wang SY, et al.Subjective financial hardship due to medical bills among patients with heart failure in the United States: The 2014-2018 Medical Expenditure Panel Survey.J Card Fail. Published online July 11, 2022. doi:10.1016/j.cardfail.2022.06.009
- Pickles DM, Keller K.The economic burden of complex CHD in the United States.Cardiol Young. Published online September 5, 2025. doi:10.1017/S1047951125109256
- Bauersachs R, Zeymer U, Brière JB, Marre C, Bowrin K, Huelsebeck M.Burden of coronary artery disease and peripheral artery disease: a literature review.Cardiovasc Ther. Published online November 26, 2019. doi:10.1155/2019/8295054
- Kandula VA, Smith GL, Rajaram R, et al.A costly cure: understanding and addressing financial toxicity in cardiovascular disease health care within the domain of social determinants of health.Methodist Debakey Cardiovasc J. Published online November 4, 2024. doi:10.14797/mdcvj.1466
- Joynt Maddox KE.Health economics of cardiovascular disease in the United States.Circulation. Published online August 5, 2024. doi:10.1161/CIRCULATIONAHA.124.068295
