Evolving Cardiovascular Risks: Addressing Today's Clinical Challenges

The landscape of cardiovascular risks is shifting significantly, presenting both challenges and opportunities for innovation in public health. In the U.S., based on national surveillance estimates from recent years, about 36.4% of adults had no measured cardiovascular disease risk factors as defined in the underlying dataset. This statistic highlights the urgency for clinicians to act on guideline‑backed prevention: risk‑based statin therapy, tight blood pressure control, tobacco cessation, diabetes prevention, and structured lifestyle counseling.

This urgency is sharpened by shifts in who is affected—especially younger adults—and by emerging tools for risk stratification; at the same time, access, cost, and outcome‑evidence limitations warrant caution as these approaches evolve. Among younger adults, mortality from hypertensive heart disease increased over the span from 1999 to 2024, signaling a notable demographic shift in cardiovascular health. This shift underscores a need for guideline‑aligned action—routine blood pressure screening, lifestyle counseling on sodium reduction and physical activity, and evaluation for secondary causes when indicated.

Testing for genetically influenced markers such as lipoprotein(a) remains uncommon, despite its potential to refine risk assessment. Guidelines suggest measuring lipoprotein(a) at least once—especially in those with premature ASCVD or a strong family history—and considering intensification of LDL‑cholesterol lowering when levels are markedly elevated.

Key Takeaways:

• Most U.S. adults have at least one cardiovascular risk factor; planning should assume prevention at population scale while enabling targeted escalation for higher‑risk groups.
• Demographic shifts, including rising hypertensive heart disease mortality among younger adults, argue for earlier screening and lifestyle support integrated into primary care and community programs.
• Selective biomarker testing—such as a once‑in‑lifetime lipoprotein(a) measurement in appropriate patients—can refine risk conversations and guide LDL‑C–lowering intensity, alongside foundational lifestyle and guideline‑directed therapies.