For nearly a year, COVID-19 has dominated the news, threatening to overwhelm the healthcare system and causing incalculable suffering for hundreds of thousands of families. In the shadow of this, another healthcare crisis has quietly continued to unspool in the U.S. and around the world: cardiovascular disease.

In fact, in the U.S. alone, about 655,000 people died of cardiovascular disease in 2020, a quarter million more than the approximately 400,000 killed by the coronavirus. Globally, the World Health Organization (WHO) estimates that nearly 18 million deaths a year are caused by cardiovascular disease. Many of these are preventable; some were likely a result of the knock-on effects of the virus itself as thousands of individuals were scared away from seeking treatment.

This is a good time to remind ourselves that even after the coronavirus is finally brought under control, heart attacks, strokes, and other forms of cardiovascular disease will continue to plague us. And, like Covid-19, they will impact different segments of the population differently, with the economically disadvantaged and those lacking access to regularly scheduled healthcare services suffering disproportionately.

Nearly everyone will be touched in some way by heart disease over the course of their lives. Today, roughly 16.5 million Americans over 20 years of age live with some form of it, a number that is likely to increase as the population ages. This has been made worse by the coronavirus, which has been shown to damage blood vessels in some people. Worse, a study by JAMA Cardiology looking at heart attacks during the pandemic in Washington State and Oregon found that people were more than twice as likely to die because they were reluctant to go to the hospital in spite of symptoms suggesting a heart attack was underway.

February is American Heart Month

When it was established by presidential proclamation in 1963, American Heart Month was described as “an important opportunity to emphasize the sharing of best practices, aligning measurements, advancing implementation strategies …”

Fifty-eight years later, we’re still at it.  Every year, about 805,000 Americans have a heart attack.  Of these, 605,000 are a first heart attack while the other 200,000 happen to people who have already had a heart attack. About 1 in 5 heart attacks are silent—the damage is done, but the person is not aware of it. One person dies every 36 seconds in the U.S. from cardiovascular disease, accounting for one in four deaths annually. The direct costs of treating this disease are expected to nearly triple by 2025 from $220 billion to $649 billion.

On the bright side, we know much more today about preventing cardiovascular disease than we did sixty years ago. For one thing, it’s clear that relatively modest changes in lifestyle can have a big impact. Technologies have evolved to support both the therapeutic and the prevention side, and offer hope for continued improvements in managing the disease.

From an investment point of view, the timing is good to address this issue. More than half of all investors (53%) now describe themselves as values-driven, and cardiovascular health is a strategy where doing well and doing good have the chance to intersect. At IndexIQ, we recently teamed with the American Heart Association to launch the IQ Healthy Hearts ETF (NYSE: HART), a “dual impact” ESG fund, designed to provide exposure to heart healthy companies in alignment with the AHA’s overall mission of helping people live longer, healthier lives while improving health equity.

It’s not just about stents

The first coronary stent was implanted in France in 1986.  By 2019, the global market for coronary stents was estimated to be around $7.7 billion and growing at nearly 5% a year. Abbott Labs and Boston Scientific are among the industry leaders. But while stents have doubtless saved many lives, they are a last line of defense; better to avoid surgery altogether where possible. Increasingly that’s the focus of companies seeking to address the cardiovascular market.

Considered broadly, the investment landscape encompassing heart health incorporates everything from diagnosis and treatment to telehealth and lifestyle. In every instance, new technologies are evolving to provide better early detection and monitoring, and to support heart-healthy lifestyle changes. While pharmaceuticals and surgical interventions remain a large part of the market (more than 35 million Americans take statins) other, less invasive approaches are starting to gain momentum.

These include the so-called nutraceuticals, which incorporate heart-healthy benefits into what is (hopefully) an attractive food product. Wearable devices are another area seeing rapid innovation, providing a vehicle for people to track their fitness. Some, like the latest iterations of the Apple watch, can serve an even more important function. In Apple’s case, that means using algorithms  to identify irregular heart rhythms, often a precursor to more serious heart problems. Other devices track and report on movement, while others encourage more intense exercise through interactive engagement. Still others combine the various approaches above, such as Nike, which is a leader in the athletic apparel space and which also has a popular fitness tracking app that encourages people to be more active and can “gamify” the experience of exercise, a great motivator for many.

Health equity

An interesting bit of data: where you live determines 80% of your health, according to the American Heart Association (AHA). Things like race, income, education level and food access affect people’s chances to be healthy. Collectively, the AHA describes these as the social influencers of health.

Type 2 diabetes, a condition that affects more than 34 million Americans, is an example of how this inequity can play out. Individuals with this condition are more than twice as likely to have heart disease or a stroke. For various reasons, this disease has tended to be more widespread among minority populations. Moderate to vigorous exercise is an effective (and low cost) way to control it.

All the news on the cardiovascular health front is not negative – overall death rates from heart disease and stroke have declined over the past two decades until a recent plateau. But these gains have not been equitably shared among all people. Improved education and better awareness are one way to address this. Promoting healthier diets and moving around more is another. Exercise equipment can be expensive, but walking is free, and prevention is generally less expensive than a trip to the emergency room.

It’s our belief that by investing in companies that are developing innovative diagnosis and treatment programs, as well as fitness, lifestyle, and wellness products and services, we can help advance the cause of cardiovascular health while at the same time advancing the cause of health equity.

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