Cardiovascular Diseases in United States

United States

Cardiovascular diseases (CVDs) refer to several conditions resulting from plaque building up in arteries, including coronary artery disease, heart attack and stroke. Heart disease and stroke were the first- and fifth-leading causes of death in the United States in 2021, respectively. Strokes can cause long-term disabilities including paralysis, speech difficulties and emotional problems. Heart failure may cause fatigue, shortness of breath, lack of appetite and impaired thinking. 

Risk factors for CVDs include high blood pressure, high cholesterol, obesity, physical inactivity, unhealthy diet, diabetes, smoking, excessive alcohol consumption, high levels of stress and family history of heart disease or stroke.

The direct and indirect costs of cardiovascular disease for the 2018-2019 fiscal year totaled approximately $407.3 billion, around 12% of all U.S. health expenditures.

According to America’s Health Rankings data, the prevalence of CVDs is higher among:

• Men compared with women.
• Adults ages 65 and older compared with those ages 18-44.
• American Indian/Alaska Native adults compared with all other racial and ethnic groups; Asian adults have the lowest prevalence of CVDs.
• Adults with less than a high school education compared with college graduates; the prevalence is significantly lower with each increase in education level.
• Adults with an annual household income less than $25,000 compared with adults with higher incomes; the prevalence is significantly higher with each decrease in income level. 
• Adults living in non-metropolitan areas compared with adults in metropolitan areas.
• Adults who have difficulty with self-care compared with adults without a disability. 
• Straight adults compared with LGBQ+ adults.
• Adults who have served in the U.S. armed forces compared with those who have not served.

Most deaths resulting from heart disease and stroke are preventable. Many of the risk factors for CVDs may be successfully reduced through lifestyle changes, medication or medical procedures. Lifestyle changes that can help prevent heart disease include:

• Eating a healthy diet with more fresh fruit and vegetables and less foods high in saturated and trans fats. 
• Getting regular physical activity.
• Not smoking, or quitting smoking.

Between 1980 and 2000, the death rate from coronary heart disease halved; 47% of this decrease was because of medical interventions like coronary artery bypass and statin therapy. Another 44% of the decline was attributable to increases in physical activity, reductions in smoking prevalence and lowering of cholesterol and blood pressure. 

The American Heart Association created Life’s Simple 7, a tool to help individuals measure and manage their heart health.

Healthy People 2030 provides several objectives related to improving cardiac health, including:

• Improving cardiovascular health among adults.
• Reducing coronary heart disease deaths.
• Reducing stroke deaths.
• Increasing control of blood pressure in adults.
• Increasing cholesterol treatment in adults. 

Additionally, the Million Hearts 2027 initiative is a national effort to prevent 1 million heart attacks and strokes in five years by promoting community and clinical prevention programs.

Ford, Earl S., Umed A. Ajani, Janet B. Croft, Julia A. Critchley, Darwin R. Labarthe, Thomas E. Kottke, Wayne H. Giles, and Simon Capewell. “Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000.” New England Journal of Medicine 356, no. 23 (June 7, 2007): 2388–98. https://doi.org/10.1056/NEJMsa053935.

Tsao, Connie W., Aaron W. Aday, Zaid I. Almarzooq, Cheryl A.M. Anderson, Pankaj Arora, Christy L. Avery, Carissa M. Baker-Smith, et al. “Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association.” Circulation 147, no. 8 (February 21, 2023). https://doi.org/10.1161/CIR.0000000000001123.