Among both men and women, and across all racial and ethnic groups, cardiovascular disease is our nation’s leading killer. Approximately 960,000 Americans die of cardiovascular disease each year, accounting for more than 40% of all deaths.

Although cardiovascular disease is often thought to primarily affect men and older people, it is a major killer of women and people in the prime of life. More than half of all cardiovascular disease deaths each year occur among women. The disease is the leading cause of death among Americans in middle age, killing more than 160,000 people between the ages of 35 and 64 each year. In addition, the rate of premature deaths due to cardiovascular disease is greater among black than among white Americans.

Deaths Only Part of the Picture

A consideration of deaths alone severely understates the burden of cardiovascular disease. About 58 million Americans (almost one-fourth of the nation’s population) live with some form of the disease.

The term “cardiovascular disease” refers to a variety of diseases and conditions affecting the heart and blood vessels, principally high blood pressure, heart disease, and stroke. Almost 10 million Americans aged 65 years and older report disabilities caused by heart disease. Stroke is also a leading cause of disability in the United States, accounting for disability among more than 1 million people nationwide. Almost 6 million hospitalizations each year are due to cardiovascular disease.

Health Burden Rivaled by Economic Burden

The economic burden of cardiovascular disease has a profound impact on the U.S. health care system, and this burden continues to grow as the population ages. The cost of cardiovascular disease in the United States in 1999 is estimated to be $286.5 billion. This figure includes health expenditures and lost productivity resulting from illness and death. The use of expensive treatment, while often effective in delaying death from cardiovascular disease, is likely to continue to increase the financial impact on the nation.

A limited number of health-related behaviors practiced by people every day contribute markedly to cardiovascular disease.

Studies have shown that people can reduce their risk for cardiovascular disease by modifying their behavior. For example, people who stop smoking have a rapid and substantial reduction in their risk of dying of heart disease. Improved nutrition and physical activity help to lower cholesterol and high blood pressure and reduce obesity.

CDC’s National Leadership

CDC has provided leadership in developing a plan to ensure that every state is part of a comprehensive, integrated national program to prevent cardiovascular disease and target its major risk factors. Preventing Death and Disability from Cardiovascular Diseases: A State-Based Plan for Action outlines the core functions of state-based cardiovascular disease programs and emphasizes strategies targeting the underserved. CDC’s key partners in developing the plan include the American Heart Association; the National Heart, Lung, and Blood Institute; and state health departments.

Establishing a Nationwide Prevention Program

To support state-based programs, CDC is working with key partners (e.g., the American Heart Association) to establish critical national elements, including

• A multifaceted health communications effort that includes supporting state-based media campaigns that promote healthy behavior choices.

• Assistance from CDC’s National Standards Laboratory to improve state laboratory capacity and to tailor screening procedures for youth, elderly, and minority populations.

• Epidemiologic research to target interventions, address new and emerging risk factors, better understand the role of nutrition and physical activity in the development of cardiovascular disease, and improve treatment practices.

• State-based surveillance to better characterize the burden of cardiovascular disease, monitor progress in reducing risk behaviors, and determine the economic costs of this disease.

Strengthening the Science Base

CDC strengthens and expands the scientific basis for  prevention by examining health effects related to major risk factors. The 1996 benchmark report Physical Activity and Health: A Report of the Surgeon General brings together findings from decades of research. A major conclusion is that regular physical activity reduces the risk for cardiovascular disease. Similar groundbreaking Surgeon General’s reports on smoking and health have documented the relationship between cigarette smoking and cardiovascular disease. Recent reports have addressed tobacco use among adolescents and special populations.

CDC’s National Standards Laboratory is a state-of-the-art facility that supports research to better define the relationship of levels of cholesterol and other related lipids to the risk of developing heart disease. This laboratory has established national reference standards for cholesterol measurement that are used by laboratories around the country.

Improving Prevention Strategies

In fiscal year 1999, CDC will support at least 23 Prevention Research Centers (PRCs) at schools of public health and medical schools. The PRCs develop and evaluate promising cost-effective prevention strategies that can be readily applied in community settings. These centers serve as the focal points for targeting such issues as increasing physical activity among the elderly, reducing risk factors for heart disease among urban minority populations, and promoting health in the workplace.

Getting Health Messages Out and Acted On

CDC has collaborated with national partners to develop a health communications campaign promoting heart-healthy behaviors. In doing so, CDC has taken advantage of expertise from the field of social marketing to strengthen and fine-tune health promotion messages.

To strengthen health promotion for children, CDC has consulted with scientific, health, and education experts to develop guidelines for use by schools and other organizations serving young people. These guidelines, covering topics such as tobacco use, unhealthy eating, and physical inactivity, provide specific recommendations for effectively promoting healthy behaviors.

Improving Women’s Health

Cardiovascular disease is the leading cause of death among women. Furthermore, women are often diagnosed with cardiovascular disease in its advanced stages, when treatment is less effective. To improve detection, CDC supports three states—Arizona, Massachusetts, and North Carolina—to screen women for factors that significantly increase their risk for cardiovascular disease, including sedentary lifestyle, obesity, elevated cholesterol, high blood pressure, and smoking. This screening, conducted through CDC’s WISEWOMAN program, has been provided to more than 4,000 low-income and uninsured women aged 50 years and older, along with counseling, education, referral, and follow-up services. More than 50% of the women screened have been found to have either elevated cholesterol or high blood pressure, and more than 60% are overweight. Early results suggest that women who received interventions through the WISEWOMAN program significantly lowered their cholesterol level, increased their physical activity level, and raised their fruit and vegetable intake.

Targeting Tobacco Use in States

To reduce the prevalence of tobacco use, CDC supports and coordinates tobacco use prevention and control programs in all 50 states and the District of Columbia. These programs include strategic activities designed to reach those most at risk, including young people, members of racial and ethnic minority groups, women, and people with low socioeconomic status.

Addressing the Risk for Heart Disease and Stroke Among People With Diabetes

People with diabetes are two to four times more likely to have heart disease or stroke than people without diabetes. As part of its national strategy to address the burden of diabetes, CDC provides resources and technical assistance to state health departments, national organizations, and communities to determine the size and nature of diabetes-related problems and the reasons they exist; to develop and evaluate new strategies for diabetes prevention; to establish partnerships to prevent diabetes problems; and to increase access to quality diabetes care to improve the  prevention, detection, and treatment of diabetes complications. Each state and U.S. territory receives at least limited funding for diabetes control activities.

Investing in Our Children’s Future

Although cardiovascular disease usually becomes evident in middle or older age, progressive harmful conditions (e.g., atherosclerosis) leading to such disease begin in childhood. Reducing the health and economic burden of cardiovascular disease in the United States depends in large measure on reaching our young people early, before unhealthy behaviors are adopted.

CDC provides 15 states with the resources needed to build the state infrastructure to support high-quality, school-based health education. These programs give young people the information and skills they need to avoid health risks such as tobacco use, unhealthy dietary patterns, and inadequate physical activity. Coordinated health education also gives young people the opportunity to practice decision making, communication, and peer-resistance skills that will enable them to make healthy behavior choices.