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Preventing Cardiovascular Disease:
Addressing the Nation’s Leading Killer


Causes of Death, United States

"The realization has grown worldwide that clinical care---while remaining necessary and important---is not enough, and it is critical that we prevent cardiovascular diseases by preventing, from childhood on, development of the risk factors leading to them."

Rose Stamler, MA, Northwestern University Medical School
Third International Conference on Preventive Cardiology
(Preventive Medicine 1994;23:529)

Cardiovascular Disease: The Nation’s Leading Killer

Among both men and women, and across all racial and ethnic groups, cardiovascular disease is our nationís 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 nationís population) live with some form of the disease.

The term ďcardiovascular diseaseĒ 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.

Everyday, more than 2,600 Americans die of
cardiovascular diseases, an average of one death
every 33 seconds.

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.

Rates of Death Due to Total Cardiovascular Disease, 1995

Risk Behaviors Are Largely Responsible

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

Tobacco Use

Cigarette smoking is a major cause of heart disease among both men and women. Smokers have twice the risk of heart attack of nonsmokers. Nearly one-fifth of all deaths from cardiovascular disease, or about 180,000 deaths each year, are attributable to smoking. Surveillance data indicate that an estimated 1 million young people become regular smokers each year.

Lack of Physical Activity

People who are sedentary have twice the risk of heart disease of those who are physically active. Despite these risks, America remains a predominantly sedentary society. Surveys have shown that more than half of American adults do not practice the recommended level of physical activity, and more than one-fourth are completely sedentary. Physical activity reduces the risk of dying of heart disease and provides protection against other chronic diseases and conditions such as high blood pressure, diabetes, and colon cancer. It also helps reduce blood pressure in people who already have high blood pressure.

Poor Nutrition

Between 20% and 30% of the nationís adults (some 58 million people) are obese and thus have a higher risk for heart disease, high blood pressure, high cholesterol, and other chronic diseases and conditions such as diabetes. Only 27% of women and 19% of men report eating the recommended five servings of fruits and vegetables each day.

Behavioral Risk Factors Among Adults for 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. CDCís 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

Recognizing the immense burden of cardiovascular disease, in fiscal year 1998 Congress made available funding of $8.1 million to initiate a national, state-based prevention program. This amount, together with CDCís in-house funding of $2.8 million, enabled CDC to assist six states (Alabama, Georgia, Kentucky, Mississippi, Missouri, and South Carolina) in building capacity to target cardiovascular disease and to support two states (New York and North Carolina) for more comprehensive programs. These two states are developing and disseminating policy and environmental interventions with a primary focus on reducing the prevalence of poor nutrition and physical inactivity, leading risk factors for cardiovascular disease. With fiscal year 1999 funding of approximately $16 million, CDC will expand the number of states funded for cardiovascular disease prevention and control programs.

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

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 Generalís 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.

CDCís 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.

Targeting Risk Factors

Percentage of High Schoold Students Who Smoked a Cigarette int the Past Month, by SexImproving Womenís 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 statesóArizona, Massachusetts, and North Carolinaóto 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 CDCís 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 Childrenís 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.

Surveillance Provides Vital Information

National and state-based surveillance is essential to support successful cardiovascular disease prevention efforts.

Measuring the Disease Impact

CDC has developed chronic disease surveillance reports that provide extensive state-based information
on the burden of cardiovascular disease and the prevalence of associated risk factors. For example, in 1998, CDC released Chronic Diseases and Their Risk Factors: The Nationís Leading Causes of Death with tailored state profiles on the incidence of heart disease and stroke. CDC has also developed more detailed monographs to highlight the health and economic burden of cardiovascular disease in specific regions of the country. Heart Disease in Appalachia: An Atlas of County Economic Conditions, Mortality, and Medical Care Resources was recently developed by a CDC-supported prevention research center in West Virginia. This document analyzes 399 counties in 13 states ranging from New York to Mississippi, and serves as a valuable planning tool for state and local public health professionals in targeting the disproportionate burden of cardiovascular disease in these states.

Essential Information on Risk Factors

In targeting cardiovascular disease, it is crucial to know the extent to which Americans are engaging in behaviors that put them at higher risk. A unique source of such information is CDCís state-based Behavioral Risk Factor Surveillance System (BRFSS). Now active in all 50 states, this system gathers information from adults on knowledge, attitudes, and behaviors related to key health issues, such as tobacco use, dietary patterns, level of leisure-time physical activity, and use of preventive services (e.g., screening for hypertension and elevated cholesterol).

Information from the BRFSS enables CDC and the states to better target scarce health resources by determining the prevalence of risk behaviors and the populations most at risk.

Median Levels of Physical Activity Among Adults, United StatesInformation to Better Target Prevention Among Young People

Until the 1990s, little was known about the prevalence of behaviors among young people that increase their risk for cardiovascular disease in their middle or later years. The Youth Risk Behavior Surveillance System, developed by CDC in cooperation with federal, state, and private-sector partners, now provides such information.

This surveillance system includes voluntary surveys conducted by CDC among a national sample of 12,000 students as well as surveys conducted among smaller samples by state and local education agencies every two years. The information collected on the prevalence of key cardiovascular disease risk factorsótobacco use, lack of physical activity, and poor nutritionóis crucial in targeting health promotion efforts to our nationís young people.

For more information, please contact:
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention, Mail Stop K–13
4770 Buford Highway, NE
Atlanta, GA 30341-3717
Phone: (770) 488-5080

United States Department of Health and Human Services U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention

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