Achieving a Heart-Healthy and
Stroke-Free Nation

The Burden of Heart Disease and Stroke in the United States

• Magnitude
  
  
• Disparities
  
  
• Costs

Magnitude
Heart disease and stroke are the principal components of cardiovascular disease (CVD), the leading cause of death and disability among adults in the United States.¹ As the burden of heart disease and stroke continues to grow, CVD is projected to be the number one cause of death worldwide by the year 2020. In 1999, the overall worldwide death rate for CVD was 354.1 per 100,000 people: 303.2 per 100,000 women and 418.2 per 100,000 men.² In the United States, CVD affects 61.8 million Americans and claims nearly 1 million lives annually. More than one in five people has some form of CVD,¹ which affects people of all racial/ethnic groups and ages. Although CVD death rates decreased in the 1980s and 1990s, the actual numbers of CVD-related deaths increased because of increases in the number of older Americans. In addition, the rate of decline in deaths from heart disease and stroke has slowed significantly in recent years. Meanwhile, hospitalizations for heart failure have increased steadily since 1975.³, ⁴

In the United States, 1.1 million heart attacks occur each year, and coronary heart disease causes more than 515,000 deaths, or about one death every minute. Almost half (250,000) of those who die of coronary heart disease do not live to reach the hospital. Of those who have a heart attack, 25% of men and 38% of women will die within a year despite medical and surgical interventions. Those who survive longer are at high risk for a recurrent heart attack and death and may have significant discomfort and disability. Almost 150,000 of those who die of CVD each year are younger than age 65, and sudden or unexpected cardiac deaths among young adults have increased in recent years.¹ Heart failure is diagnosed for the first time in approximately 550,000 Americans each year, and more than 51,000 deaths annually are due to this condition.

In addition, the 700,000 strokes that occur each year cause more than 167,000 deaths, or approximately 1 death every 3 minutes. Among survivors, 15%-30% are permanently disabled.¹

These CVD events and conditions are manifestations of atherosclerosis, a disease process that often begins in childhood and adolescence. The major risk factors for atherosclerosis and its complications are high total cholesterol and high blood pressure. Diabetes also increases a person's risk for CVD. These risks arise from dietary imbalance (such as excessive intake of animal fats and calories), physical inactivity, and use of tobacco products. These underlying behavioral risks and their health consequences are rooted in social and environmental conditions that foster unhealthy lifestyle choices. Therefore, population-based approaches addressing policy and environ-mental change must be a major focus of a successful national public health approach.

Disparities
In 2000, CVD was the leading cause of death among both women and men in the United States. CVD causes more deaths among women than among men, in part because of the greater number of older women in the population. African Americans are at substantially higher risk for death from CVD than are whites. This difference is attributable in part to a greater risk for strokes and a higher prevalence of high blood pressure among African Americans. For every 100,000 people, the rate of death from CVD was 509.6 for African American men, 397.6 for white men, 397.1 for African American women, and 285.8 for white women. The rate of death due to high blood pressure per 100,000 people was 46.3 for African American men, 13.2 for white men, 40.8 for African American women, and 13.1 for white women.¹

Data indicate substantial disparities in risk factors for CVD among racial and ethnic groups in the United States (Table 1).¹ Risk behaviors and risk factors such as obesity and diabetes are more prevalent among African Americans and Mexican Americans than among non-Hispanic whites. For example, physical inactivity is higher among Mexican American women (57%) and non-Hispanic African American women (57%) than among non-Hispanic white women (39%). These disparities undoubtedly contribute to the substantially greater burden of CVD among these two population groups.

Costs
The estimated cost of CVD to the nation is expected to exceed $351 billion in 2003.¹ The direct costs for health care are projected to be $209.3 billion, while lost productivity accounts for an additional $142.5 billion. One-quarter of the lost productivity amount is due to disability that results in unemployment, and three-quarters is due to premature death (death before age 65).

These sobering figures can only be expected to increase unless effective programs and policies are implemented nationwide to reduce the burden of CVD. Future cost increases will be created in part by the aging of the population and by the growth of ethnic minority populations at high risk for CVD.³ Advances in medical technology also can be expected to increase the cost of services for each CVD event. In addition to these financial costs, CVD creates social costs to families and communities that cannot be calculated.

If all major forms of CVD were eliminated, life expectancy would be extended by almost 7 years.¹ In addition, Americans' quality of life would be greatly improved, and health care costs and dependency would be substantially reduced.

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