(NEW YORK) — The number of women with risk factors for cardiovascular disease could significantly increase over the next 25 years, the American Heart Association (AHA) warned on Wednesday.

Without improving prevention and early detection tools, about six in 10 women could be diagnosed with hypertension or obesity by 2050, and risk factors could appear in children and teenagers as well, according to the AHA’s scientific statement.

“Cardiovascular disease is the leading cause of death, and fewer than half of women know that fact,” Dr. Stacey Rosen, executive director of Katz Institute for Women’s Health and volunteer president of the AHA, told ABC News. “And the percentage of awareness is even lower in African Americans and Hispanics.”

Published in the journal Circulation, the AHA’s projections suggest that 59.1% of women could have high blood pressure by 2050 — up from 48.6% in 2020 — even as diet, physical activity and smoking rates are projected to improve.

About one in four women may have diabetes in 2050, up from 14.9% in 2020, and more than 60% are estimated to have obesity, an increase from 43.9% over the same period, according to the report.

Heart health risk factors won’t hit all demographic groups of women equally, the report predicted.

High blood pressure will increase the most among Hispanic women with a projected rise of 15%, the report noted.

Additionally, more than 70% of Black women could have high blood pressure and obesity may increase the most among Asian women by nearly 26%. 

Young women and girls may also see an increase in heart risk factors, partially driven by less opportunity for exercise as well as an abundance of inexpensive foods that often are not heart health.

Estimates also suggest that nearly one-third of girls between ages 2 and 19 will have obesity, an increase from 19.6% with obesity in 2020.

Dr. Jennifer Miao, a board-certified cardiologist, told ABC News that earlier hormonal changes in girls may also contribute to cardiovascular risk later in life.

“Several studies have also shown that starting menstruation at an early age can lead to increased risk of heart disease down the road,” she said.

Miao said she counsels parents that it’s never too early to start thinking of heart health for their children by “choosing good foods, physical activity over screen time and regular pediatrician check-ups.” 

Despite the report’s predictions, Rosen stressed that meaningful progress for women’s heart health is still within reach. 

“As a medical community, we have amazing tools to treat disease and detect it early, but lack when it comes to primary prevention,” Rosen said, adding that managing diseases like obesity requires a time intensive, multidisciplinary approach that the current U.S. health care system is not built to support. 

She also said that optimizing health doesn’t require a costly gym membership or expensive organic foods.

“Every bit of movement counts, whether that means taking a walk or standing more if you work at a desk,” Rosen said.

Small, sustainable changes, like cutting back on sweetened beverages, can make a meaningful difference over time, she said.

Miao added that both the medical community and local leaders can do their part. By partnering with local health clinics, expanding home visit programs and leveraging telemedicine, health systems can extend their reach and bring essential care directly to isolated and underserved populations.

Takisha Morancy, MD, is a chief emergency medicine resident, medical ethics fellow and member of the ABC News Medical Unit.

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(WASHINGTON) — President Donald Trump’s surgeon general nominee is appearing before the Senate on Wednesday for her confirmation hearing.

Dr. Casey Means was originally scheduled to testify before the Senate Health, Education, Labor and Pensions (HELP) committee in October, but it was postponed for four months after she went into labor.

If confirmed, Means would become the nation’s top doctor, leading more than 6,000 members of the U.S. Public Health Service, including physicians, nurses, scientists and engineers working at various federal health agencies.

Means’ views largely mirror those of Health and Human Services Secretary Robert F. Kennedy Jr., with a focus on tackling the chronic disease epidemic, creating a healthier food supply and expressing vaccine skepticism.

Senators are expected to grill Means on her qualifications as well as her business endeavors. In prior filings, Means pledged that, if confirmed, she would resign from her position as an adviser for a wellness company and promised to stop working as an influencer promoting supplements and other wellness products. 

“Dr. Means would clearly be an atypical or unusual person to serve in the role of surgeon general,” Dr. Richard Besser, former acting director of the Centers for Disease Control and Prevention, told ABC News. “Typically, the surgeon general has been viewed as the nation’s top doctor or America’s doctor, but Dr. Means has never practiced medicine, and so that is unusual. The part that’s not unusual is that the surgeon general’s impact is largely through influence. Dr. Means is skilled in this regard, when it comes to influence.”

Means graduated from Stanford School of Medicine in 2014 with plans to become an otolaryngology surgeon, also known as a head and neck surgeon, but she dropped out in her fifth year, according to her website.

Means went on to study functional medicine, which uses a holistic approach to prevent disease and illness by studying the root causes of health issues. The field has been criticized for promoting some interventions that are not evidence-based and for an overreliance on expensive supplements. Having never completed residency, Means is not board-certified in a medical specialty, and she does not hold an active medical license.

Over the course of her career, she co-founded Levels, an app that allows people to track their food, along with biometric data like sleep and glucose monitoring, to see how their diet is impacting their health.

Means wrote a book with her brother, Calley Means, titled “Good Energy,” which was published in May 2024 and claims to take a look at why Americans are sick and how to fix it.

The siblings rose to prominence within the Trump campaign in 2024 and among Trump allies, including Kennedy. They appeared at a September 2024 roundtable discussion on health with Kennedy hosted by Sen. Ron Johnson, R-Wisc.

“The message I’m here to share and reiterate is that American health is getting destroyed,” Casey Means said during her opening remarks at the 2024 event. “It’s being destroyed because of chronic illness.”

Meanwhile, Calley Means currently serves as senior adviser for HHS. He has worked closely with Kennedy and has touted many of his health proposals. Calley Means has a Master of Business Administration degree from Harvard University and does not have medical training.

According to a copy of her prepared testimony for her original confirmation hearing in October, obtained by ABC News, Casey Means wrote that she would work to put “Americans back on the road toward wholeness and health.”

Like Kennedy, Casey Means has called for the removal of ultra-processed foods in school lunches and has advocated for organic foods and ingredients sourced from so-called regenerative farming practices in school meals.

In her “Good Energy” newsletter, she wrote that the U.S. needed to move away “from  industrial agriculture that uses synthetic pesticides” in order to create “nutrient-rich food.”

“If she were to use the platform to truly work towards improving the school lunch program in America, that would be that would be terrific, because the Secretary talks a lot about nutrition, the importance of eating healthy food,” Besser said. “But if people can’t afford it, telling people to eat healthy food doesn’t lead to a healthier nation. and one of the ways that we could see big impact in that regard would be if the school lunch program were funded to the extent that every school could have a kitchen, and the people working in that kitchen could actually prepare real food, rather than handing out packaged food.”

While Casey Means’ nomination has received support from members of the administration, including Dr. Jay Bhattacharya, acting CDC acting director and head of the National Institutes of Health, others have expressed concern over some of her more controversial views.

On Tucker Carlson’s show in August 2024, Casey Means said birth control is being “prescribed like candy” and that Ozempic has a “stranglehold on the U.S. population.”

Means has expressed skepticism about the safety of childhood vaccines and has called for more research on the “safety of the cumulative effects” of vaccines when following the CDC vaccine schedule, she wrote in her newsletter.

“There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children. This needs to be investigated,” she continued.

Doctors and major medical organizations, such as the American Academy of Pediatrics, have said the previous childhood immunization schedule recommended by the CDC was safe and effective. The CDC recently changed the childhood immunization schedule, cutting the number of vaccines recommended  for kids.

“I will be very eager to see whether the members of the health committee use this time to lift up concerns and to get Dr. Means’ perspective on the changes the Secretary has made to the vaccine system in America,” Besser said. “I’ll be interested to see if they ask Dr Means about her perspective on the changes that have taken place at CDC and the impact that these could have on health so that it’s clear coming in where she stands on the draconian cuts that the Secretary has made to our federal public health health system.”

She has also criticized the administration of hepatitis B vaccine among infants. The CDC recently removed the universal recommendation for a birth dose of the hepatitis B vaccine among babies in the U.S.

Kennedy said on Monday he is “excited” for Casey Means’ confirmation hearing and that the health department has been waiting “a long time” for her to join the team.

“We’ve been waiting for a long time for Dr. Means to come on board,” Kennedy told ABC News on Monday at the department’s rare disease therapies event. “We are very, very excited about her coming on board. She has an extraordinary capacity to communicate to the American public — that is the function of the surgeon general.”

ABC News’ Youri Benadjaoud and Arthur Jones II contributed to this report.

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