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By Surgeon General David Satcher

Heart disease may be the leading cause of death in the United States, but it need not be inevitable. That was the message of a meeting which I chaired in Washington recently at which public health experts reviewed national goals that were set in the area of heart disease and stroke through the "Healthy People 2000" initiative. These "Healthy People" goals were set at the beginning of the decade and we have been tracking them ever since. The good news is that we are very close to meeting our targets for the year 2000, but challenges remain.

Disease prevention activities -- such as lifestyle improvements by the American public and better control of the risk factors for cardiovascular disease -- have been a major factor in a 59 percent decline between 1950 and 1996 in the death toll from coronary heart disease and stroke. I commend those Americans who are making lifestyle choices to reduce their risk of heart disease and stroke.

However, men over 40 years of age still have a 50 percent lifetime chance of developing coronary heart disease, while women over 40 have a 33 percent lifetime chance. For both groups, this rate can be reduced by modifying risk factors: by lowering high blood pressure and high blood cholesterol, stopping cigarette smoking, reducing overweight and obesity, increasing physical activity, and controlling diabetes, both women and men can reduce their risk of heart disease. Many of these same risk factors reduce the risk of a stroke, our third-leading cause of death.

Heart disease not only attacks our hearts; it places a burden on our health care system. It accounts for 29 percent of all hospitalizations, more than a third of all nursing home care, and 23 percent of hospice care. It also affects our chances of longevity. If we could eliminate heart disease, the life expectancy of the average American would increase by five years! Therefore, we need to commit ourselves to prevention strategies.

Dangerous trends are developing that overshadow our progress. After decades of declining, the smoking rate among adults has stalled at about 25 percent, while the use of tobacco products has begun to increase among teenagers. And while Americans have increased consumption of whole grain in their diet and are eating more fruits and vegetables, the increasing prevalence of over weight and obesity threatens the strides we have made (26 percent from 1976-80 to 35 percent from 1988-94).

In addition to watching our diets, and our cholesterol and blood pressure levels, we need to increase the level of daily physical activity. Thirty minutes a day of activities as basic as walking the dog, washing the car, riding a bicycle, or working in the garden can improve your energy and balance, and reduce stress levels.

Meanwhile, the death rate from stroke is highest for African Americans – 62 percent greater than the national average. We need to more effectively educate racial and ethnic minorities and people from the low socioeconomic strata about the benefits of reduced risk factors.

To meet the Healthy People 2000 goals for coronary heart disease and stroke, as well as those for the next decade (new goals for the year 2010 are to be announced in January), we are planning to expand community alliances between the government and the private sector to increase awareness of the risks to health. For example we can begin this education early by working with schools and after-school programs and teaching children and adolescents about healthy lifestyles. Healthy People also calls for increased educational activities by physicians to counsel consumers to stop smoking; and it encourages businesses to provide educational materials and health promoting activities in the work place.

The progress we have made on Healthy People 2000 goals to date is evidence of what can be accomplished when a broad range of organizations and individuals join forces to address a common problem.

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To receive free materials about how to reduce your health risk factors, call the government clearinghouse at 1-800-575-WELL or go online to


Partnerships for Health in the New Millennium          January 24-28, 2000         Omni Shoreham Hotel, Washington, DC

Updated: 05/01/08