Results:

1. Adjusted population-attributable fractions for cardiovascular disease (CVD) mortality were as follows: a) high blood pressure 40.6% (95% confidence interval [CI], 24.5-54.6), b) smoking 13.7% (95% CI, 4.8-22.3), c) poor diet 13.2% (95% CI, 3.5-29.2), d) sedentary behavior 11.9% (95% CI, 1.3-22.3), and e) abnormal glucose levels 8.8% (95% CI, 2.1-15.4).

2. Smoking rates have declined over the past 4 decades; however, as of 2011, among Americans ≥18 years of age, 21.3% of men and 16.7% of women are current cigarette smokers. In 2011, 18.1% of students in grades 9-12 reported current cigarette use. Rates of secondhand smoke exposure (based on detectable serum cotinine levels) have declined from 52.5% in 1999-2000 to 40.1% in 2007-2008, with declines higher for those under the age of 20.

3. Large numbers of Americans report no regular physical activity. In 2011, among adolescents in grades 9-12, 17.7% of girls and 10.0% of boys reported that they had not engaged in ≥60 minutes of moderate-to-vigorous physical activity. Thirty-two percent of adults reported engaging in no aerobic leisure-time physical activity.

4. Total energy consumption among US adults has increased over the past several decades, with an average total energy consumption among US adults increased by 22% in women (from 1542 to 1886 kcal/d) and by 10% in men (from 2450 to 2693 kcal/d). The increases in calories consumed during this time period are attributable primarily to greater average carbohydrate intake, in particular, of starches, refined grains, and sugars. Larger portion sizes and increased consumption of sugar-sweetened beverages, snacks, commercially prepared (especially fast food) meals, and higher energy-density foods have contributed to this increased caloric consumption.

5. The estimated prevalence of overweight and obesity in US adults (≥20 years of age) is 154.7 million. Fully 34.6% of US adults are obese (body mass index ≥30 kg/m²). Men and women of all race/ethnic groups in the population are affected by the epidemic of overweight and obesity. Among children 2-19 years of age, 31.8% are overweight and obese (which represents 23.9 million children), and 16.9% are obese (12.7 million children). Mexican-American boys and girls and African-American girls are disproportionately affected. Over the past 3 decades, the prevalence of obesity in children 6-11 years of age has increased from ≈4% to >20%. Obesity (body mass index ≥30 kg/m²) is associated with marked excess mortality in the US population.

6. An estimated 31.9 million adults have total serum cholesterol levels ≥240 mg/dl, with a prevalence of 13.8%.

7. Based on 2007-2010 data, 33.0% of US adults ≥20 years of age have hypertension. This represents 78 million US adults with hypertension. The prevalence of hypertension is nearly equal between men and women. African-American adults have among the highest prevalence of hypertension (44%) in the world. Among hypertensive adults, ≈82% are aware of their condition and 75% are using antihypertensive medication, but only 53% of those with documented hypertension have their condition controlled to target levels.

8. In 2010, an estimated 19.7 million Americans had diagnosed diabetes mellitus, representing 8.3% of the adult population. An additional 8.2 million had undiagnosed diabetes mellitus, and 38.2% had prediabetes, with abnormal fasting glucose levels. African-Americans, Mexican-Americans, Hispanic/Latino individuals, and other ethnic minorities bear a disproportionate burden of diabetes mellitus in the United States. The prevalence of diabetes mellitus is increasing dramatically over time, in parallel with the increases in prevalence of overweight and obesity. On the basis of the National Health and Nutrition Examination Survey (NHANES) 2003-2006 data, the age-adjusted prevalence of metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance, is ≈34% (35.1% among men and 32.6% among women).

9. The 2009 overall rate of death attributable to CVD was 236.1 per 100,000. The rates were 281.4 per 100,000 for white males, 387.0 per 100,000 for black males, 190.4 per 100,000 for white females, and 267.9 per 100,000 for black females. From 1999 to 2009, the relative rate of death attributable to CVD declined by 32.7%. Yet in 2009, CVD still accounted for 1 of every 3 deaths in the United States.

a) On the basis of 2009 death rate data, >2150 Americans die of CVD each day, an average of 1 death every 40 seconds. About 153,000 Americans who died of CVD in 2009 were <65 years of age.

b) Coronary heart disease alone caused ≈1 of every 6 deaths in the United States in 2009. In 2009, 386,324 Americans died of coronary heart disease. Each year, an estimated 635,000 Americans have a new coronary attack (defined as first hospitalized myocardial infarction or coronary heart disease death) and ≈280,000 have a recurrent attack. It is estimated that an additional 150,000 silent first myocardial infarctions occur each year. Approximately every 34 seconds, 1 American has a coronary event, and approximately every 1 minute, an American will die of one.

c) From 1999 to 2009, the relative rate of stroke death fell by 36.9%, and the actual number of stroke deaths declined by 23.0%. Yet each year, ≈795,000 people continue to experience a new or recurrent stroke (ischemic or hemorrhagic). Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks. In 2009, stroke caused ≈1 of every 19 deaths in the United States. On average, every 40 seconds, someone in the United States has a stroke and dies of one approximately every 4 minutes.

d) In 2009, 1 in 9 death certificates (274,601 deaths) in the United States mentioned heart failure. Heart failure was the underlying cause in 56,410 of those deaths in 2009. The number of any-mention deaths attributable to heart failure was approximately as high in 1995 (287,000) as it was in 2009 (275,000). Additionally, hospital discharges for heart failure remained essentially unchanged from 2000 to 2010, with first-listed discharges of 1,008,000 and 1,023,000, respectively.

10. The total number of inpatient CV operations and procedures increased 28%, from 5,939,000 in 2000 to 7,588,000 in 2010. The total direct and indirect costs of CVD and stroke in the United States for 2009 is estimated to be $312.6 billion. This figure includes health expenditures (direct costs, which include the cost of physicians and other professionals, hospital services, prescribed medications, home health care, and other medical durables) and lost productivity that results from morbidity and premature mortality (indirect costs). By comparison, in 2008, the estimated cost of all cancer and benign neoplasms was $228 billion ($93 billion in direct costs, $19 billion in morbidity indirect costs, and $116 billion in mortality indirect costs). CVD costs more than any other diagnostic group.