Cardiovascular health has improved dramatically across the United States over the past few decades, but only the wealthiest segments of the population have reaped the benefits, a new analysis finds.

Advances in cardiovascular disease have helped the heart disease that emerged in the late 1980s and have become increasingly widespread since the late 1980s, according to a new study published Wednesday in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes. They say it masks widespread income-related inequalities in vascular health.

“Significant reductions in cardiovascular risk have been one of the major clinical and public health achievements of the past half century in the United States, but the benefits have not been shared equally,” said study lead author and associate professor said Dr. Adam Richards. “Those with lower incomes benefited less, but all of the benefits were concentrated among those with higher incomes,” said Dr. M.D., George Washington University Milken School of Public Health in Washington, D.C.

According to data from the Centers for Disease Control and Prevention, death rates from heart disease decreased by 56% in the second half of the 20th century due to improved treatments and reductions in cardiovascular risk factors. Stroke mortality rates were reduced by 70%.

However, a growing body of research has revealed that the gains made during this time have not been equitably distributed since then. Richards said he and his colleagues investigated how widespread these inequalities are by thoroughly analyzing health and income data for a wider range of age groups over longer periods of time than previous studies. He said he wanted to.

Their analysis considered data on 26,633 U.S. adults assessed by the CDC’s National Health and Nutrition Examination Survey from 1988 to 1994 and 1999 to 2018. Participants were between 40 and 75 years old and had no history of cardiovascular disease at the time of enrollment. They participated in household surveys and health checks to collect data on income status and risk factors for cardiovascular disease. Incomes ranged from below the poverty level to more than five times that level. (The 2024 federal poverty level, updated annually, is $31,200 for her family of four.)

Overall, the predicted risk of a population developing a heart attack or stroke within 10 years decreased dramatically over the 30-year study period. However, these benefits only apply to people in the top two income groups.

The 10-year cardiovascular risk fell from 7.7% to 5.1% in the richest segment of the population, and from 7.6% to 6.1% in the second richest group. However, the risk for those with the lowest income increased from 8.1% to 8.7%, but the increase did not reach statistical significance.

Richards said the increase in the number of people at the top of the income scale widened the gap in cardiovascular disease risk between the two groups, which was almost non-existent when the study began in the late 1980s. By the end of the study, people below the poverty line were 70% more likely to have a heart attack or stroke than their peers with incomes five times higher, and the gap had widened by more than eight times.

The study found that mortality from cardiovascular disease among low-income groups also “contributes to a flattening of the well-documented trend in life expectancy increases, driven primarily by slowing or reversing progress in lower socio-economic groups.” Richards said this suggests that there is a possibility that

“The conversation around this is focused on desperate deaths like accidents and overdoses,” he said. “But if we focus on the fact that poor people are being left behind, our study suggests that perhaps cardiovascular disease should also be part of that discussion.”

Dr. Debra Dixon, a cardiologist at Vanderbilt University Medical Center in Nashville, Tenn., said the study’s findings could help explain how new policies, treatments and interventions are impacting different subgroups. Another gap is the lack of routine analysis. She was not involved in the new study.

For example, studies have shown that black and Hispanic patients and those with low incomes have unequal access to important cardiovascular interventions, such as procedures to treat heart valve defects.

“Innovations in treatment can help, but they will exacerbate inequalities if they are not accompanied by ways to provide access for all,” Dixon said.

Inequalities are often the result of structural racism and other social factors that determine health, said an editorial co-authored by Dixon and published alongside the study. For example, a historic and racist lending practice known as “redlining” has created a breeding ground for poor housing conditions and, coupled with a lack of access to health services in underserved areas, has led to health disparities. This contributed to perpetuating and worsening the situation. To further narrow the gap, these fundamental issues need to be addressed, she said.

But Dixon says that will require a shift in values. “We need policies that support the opportunity for everyone to live a healthy life.”