Cardiovascular disease is a general diagnostic category consisting of several separate diseases of the heart and circulatory system. Cardiovascular diseases have been the major health problem and the leading cause of death in the United States for several decades. Despite impressive and sustained declines in the mortality rates from these diseases, the magnitude of the problem is still staggering. In 1997 alone, nearly 1 million people died of cardiovascular disease, which was about 40 percent of all deaths. The two most important components are coronary heart disease and cerebrovascular disease, with 460,390 dying of coronary heart disease and 158,060 dying of cerebrovascular disease in 1998. In 2000, it was estimated that cardiovascular diseases carried a direct heath expenditure cost of $186 billion and additional indirect costs of $190 billion, making these diseases a continuing major contributor to the escalating cost of health care in the United States.
These diseases have not always been the major health problem of the United States. In 1900 the five leading causes of death were: (1) pneumonia and influenza; (2) tuberculosis; (3) diarrhea, enteritis, and ulceration of the intestines; (4) diseases of the heart; and (5) intracranial lesions of vascular origin. These categories all had rates greater than 100 per 100,000 population. By 1940, only two disease categories still had rates greater than 100 per 100,000: diseases of the heart and cancer and other malignant tumors. The infectious diseases had been substantially reduced, but the "epidemic" of cardiovascular disease, especially coronary heart disease had begun. By 1963, the mortality rate from coronary heart disease reached its pear, and there has been a progressive and steady decline since then (see Figure 1). Despite the continued magnitude of the coronary heart disease problem, the focus recently has been on this dramatic reversal. Not only is the percentage of decline large (56% from 1963 to 1998), but this has greatly impacted the total number of deaths in the United States, leading to an increase in life expectancy. To illustrate the impact of this change, it is estimated that if the rate of coronary heart disease mortality had not changed from its peak in 1963, in the year 1998 an additional 684,000 Americans would have died from this cause.
WILLIAM T. FRIEDEWALD, The Gale Group Inc., Macmillan Reference USA, New York,