Cardiovascular disease is the leading cause of death for both men and women in the U.S., and it’s projected to become an even bigger problem in the coming years. A new RTI International study found that by 2035 the number of Americans with heart disease will rise to 131.2 million, which is 45 percent of the total population.

"Mostly driven by the aging of the population, the prevalence and costs of cardiovascular disease are expected to increase significantly in the next 20 years, with total costs reaching over $1.1 trillion by 2035," Olga Khavjou, economist in RTI's public health economics program and lead author of the study, said in a statement.

This study is an update to another RTI International study from 2011 that predicted about 100 million Americans would have cardiovascular disease by 2030. But that came true in 2015 and in the same year, the death rate from heart disease rose by 1 percent for the first time since 1969.

The updated projections for 2035 are that 123.2 million Americans will have high blood pressure, 24 million with coronary heart disease, 11.2 million will suffer a stroke and there will be 7.2 million atrial fibrillation patients.

Cardiovascular disease cost the U.S. health care system $555 billion in 2016, and by 2035 it will hit the trillions. The study outlined the issue by breaking it into direct and indirect medical costs.

Direct medical costs are expected to triple over the next two decades among Hispanic Americans, more than double among African Americans, and be higher for women than men. The expenses are projected to exceed those for other chronic diseases such as diabetes and Alzheimer’s.

The indirect costs are attributed to a loss of productivity in the workplace and at home, and they’re expected to be the highest for patients between ages 45 and 64. A heart disease patient costs their employer almost 60 hours and more than $1,100 in lost productivity per year.

White Americans are responsible for the highest indirect costs, but Hispanic Americans are expected to account for a large cost increase due to cardiovascular disease over the next 20 years.

Heart disease and stroke account for 23 percent and 4 percent respectively, but the National Institutes of Health only spends 4 percent of its budget on heart disease research. The RTI International researchers are calling on the NIH to increase funding for heart and stroke research.

To address the heart disease burden, the researchers also recommend putting more of a focus on prevention to improve population health from birth to old age, and preserving and expanding access to high-quality, affordable health care.

The ACA put prevention programs in place so patients have access to blood pressure and cholesterol screenings, smoking cessation services, behavioral counseling for obesity, and primary care and medicine to manage the disease and lessen their risk.

Many patients under 65 years old have conditions that prevent them from getting health insurance coverage because of the pre-existing condition and medical underwriting rules in most states. RTI International is pushing Congress to maintain a ban on these rules.

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