Cardiovascular, lung, and blood diseases constitute a large morbidity, mortality, and economic burden on individuals, families, and the Nation. Common forms are atherosclerosis, hypertension, COPD, and blood-clotting disorders?embolisms and thromboses. The most serious atherosclerotic diseases are CHD, as manifested by heart attack and angina pectoris, and cerebrovascular disease, as manifested by stroke.
In 2004, cardiovascular, lung, and blood diseases accounted for 1,099,000 deaths and 46 percent of all deaths in the United States (p. 35). The projected economic cost in 2007 for these diseases is expected to be $599 billion, 23 percent of the total economic costs of illness, injuries, and death (p. 51). Of all diseases, heart disease is the leading cause of death, cerebrovascular disease is third (behind cancer), and COPD (including asthma) ranks fourth (p. 38). Cardiovascular and lung diseases account for 3 of the 4 leading causes of death (p. 38) and 5 of the 10 leading causes of infant death (p. 44). Hypertension, heart disease, asthma, and COPD are especially prevalent and account for substantial morbidity in Americans (p. 47).
The purpose of the biomedical research conducted by the NHLBI is to contribute to the prevention and treatment of cardiovascular, lung, and blood diseases and sleep disorders. National disease statistics show that by midcentury, morbidity and mortality from these diseases had reached record high levels. Since then, however, substantial improvements have been achieved, especially over the past 40 years, as shown by the significant decline in mortality rates. Because many of these diseases begin early in life, their early detection and control can reduce the risk of disability and can delay death. Although important advances have been made in the treatment and control of cardiovascular, lung, and blood diseases, these diseases continue to be a major burden on the Nation.
In 2004, CVD caused 872,000 deaths?36 percent of all deaths (p. 35).
Heart disease is the leading cause of death; the main form, CHD, caused 452,000 deaths in 2004 (pp. 36, 38).
The annual number of deaths from CVD increased substantially between 1900 and 1970 and remains high (p. 37).
The death rate (not age-adjusted) for CVD increased from 1920 until it peaked in 1968. Since then, the trend has been downward. In 2004, the rate was similar to the rate in the 1920s (p. 37).
Cerebrovascular disease, the third leading cause of death, accounted for 150,000 deaths in 2004 (pp. 36, 38).
Heart disease is second only to all cancers combined in years of potential life lost (p. 38).
Heart disease is the leading cause of death in blacks, Hispanics, and American Indians, but second to cancer in Asians. Stroke ranks as the third or fourth leading cause of death in the minority groups, except in American Indians, where it ranks sixth (p. 38).
The rapid increase in deaths due to heart failure between 1970 and 2004 is a major exception to the mortality decline in CVD (p. 39).
Between 1985 and 2003, death rates for heart disease and stroke declined in men and women of all racial/ethnic groups. Declines in death rates for heart disease were greatest in whites and for stroke, were greatest in blacks (p. 40).
Because of the rapid decline in mortality from CHD since the peak in 1968, there were 995,000 fewer deaths from CHD in 2004 than would have occurred if there had been no decline (p. 41).
Substantial improvements have been made in the treatment of CVD. Since 1975 or 1985, case-fatality rates from hospitalized AMI, stroke, heart failure, and cardiac dysrhythmia declined appreciably (p. 41).
The decline in CHD mortality began earlier in the United States than in most countries and outpaced that in most countries (only selected countries are shown) (p. 42).
Between 1999 and 2004, the percent decline in death rates for CHD and stroke was slightly greater for whites than for blacks (p. 43).
In 2004, an estimated 79.4 million persons in the United States had some form of CVD, 72 million had hypertension, and 15.8 million had CHD (p. 47).
Since the 1960s, there has been a substantial reduction in the prevalence of CVD risk factors: hypertension, smoking, and high cholesterol, but not overweight. The decline in prevalence of hypertension from 1976?80 to 1988?94 was followed by an increase in 1994?2004 (p. 48).
Between 1976?80 and 1999?2004, the percent of persons with hypertension who were aware of their condition, on treatment for it, and having their blood pressure under control increased substantially (p. 49).
A 1999?2004 national survey showed only about 40 percent of hypertensive patients (systolic BP ? 140 mm Hg or diastolic BP ? 90 mm Hg or on antihypertensive medication) had their condition under control (p. 49).
Hospitalization rates for heart failure increased between 1971 and 2004 (p. 50).
The estimated economic cost of CVD for 2007 is approximately $432 billion:
$283 billion in direct health expenditures
$36 billion in indirect cost of morbidity
$112 billion in indirect cost of mortality (p. 51).
Lung diseases, excluding lung cancer, caused an estimated 231,000 deaths in 2004 (p. 35).
COPD caused 120,000 deaths in 2004 and is the fourth leading cause of death (pp. 36, 38).
Between 1999 and 2004, death rates for COPD and asthma decreased in both black and white men and women, with one exception: the COPD death rate increased slightly in white women (p. 43).
Between 1980 and 2004, infant death rates for various lung diseases declined markedly (p. 42).
Of the 10 leading causes of infant mortality, 4 are lung diseases or have a lung disease component (p. 44). Between 1994 and 2004, changes in mortality for the causes were:
Congenital anomalies (-15 percent)
Disorders of short gestation (-5 percent)
Sudden infant death syndrome (-50 percent)
Respiratory distress syndrome (-42 percent).
One in 5 deaths in children under 1 year of age is due to a lung disease (p. 44).
The COPD death rate for women in the United States is increasing significantly compared with the rates in several other countries (p. 45).
Between 1985 and 2003, death rates for COPD increased for women in all racial/ethnic groups except Asian. For men, they increased in American Indians, decreased in whites and Asians, and were essentially flat in blacks and Hispanics (p. 46).
Sleep disorders are increasingly being recognized as an important health problem. The number of physician office visits for sleep apnea, restless legs syndrome, and narcolepsy increased from 1,046,927 in 1990 to 6,549,402 in 2004 (p. 46).
Asthma is a common chronic condition, particularly in children (pp. 47, 48, 50).
The economic cost of lung diseases is expected to be $154 billion in 2007?$95 billion in direct health expenditures and $59 billion in indirect cost of morbidity and mortality (p. 51).
An estimated 232,000 deaths, 10 percent of all deaths, were attributed to blood diseases in 2004 (p. 35). These include the following:
222,000 due to blood-clotting disorders
10,000 to diseases of the red blood cell and bleeding disorders (p. 36).
A large proportion of deaths from AMI and cerebrovascular disease involve blood-clotting problems (p. 36).
In 2007, blood-clotting disorders are expected to cost the Nation?s economy $100 billion, and other blood diseases will cost $14 billion (p. 51).
The mean age at death for persons with sickle cell anemia increased from about 28 years in 1979 to 37.4 years in 2003 (not shown).
Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1984 and 2004
Cause of Death
Number of Deaths
Percent of Total
Number of Deaths
Percent of Total
All Cardiovascular, Lung, and Blood Diseases
All Other Causes
* Includes 311,000 CVD deaths involving blood-clotting diseases. ** Includes 222,000 CVD deaths involving blood-clotting diseases. ? Includes 12,000 CVD deaths due to pulmonary heart disease. ? Includes 14,000 CVD deaths due to pulmonary heart disease. Source: Vital Statistics of the United States, National Center for Health Statistics (NCHS).
Deaths by Major Causes, U.S., 2004
Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 2004
*Excludes deaths from pulmonary heart disease (14,000). ?Excludes deaths from blood-clotting disorders (222,000).
* CVD involving blood clotting (20.2%).
Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2004
Cause of Death
Acute Myocardial Infarction
Other Coronary Heart Disease
Cerebrovascular Diseases (Stroke)
Other Cardiovascular Diseases
Bleeding and Red Blood Cell Diseases
Chronic Obstructive Pulmonary Disease?
Other Airway Diseases
Neonatal Pulmonary Disorders
Interstitial Lung Diseases
Lung Diseases Due to External Agents
Other Lung Diseases
* Deaths from clotting or pulmonary disorders also are included as cardiovascular deaths. ? This term is preferred to the equivalent term ?chronic lower respiratory diseases? given in the 10th revision of the International Classification of Diseases (ICD). Note: Total, excluding overlap, is 1,099,000. Source: Estimated by the NHLBI from Vital Statistics of the United States, NCHS.
* Includes 154.0 deaths per 100,000 population from CHD. ? COPD and allied conditions (including asthma); the term in the ICD/10 is ?chronic lower respiratory diseases.? ? Based on the average remaining years of life up to age 77 years. Note: Bolded diseases are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Ten Leading Causes of Death Among Minority Groups, U.S., 2003
* Includes deaths among individuals of Asian extraction and Asian-Pacific Islanders. ? Includes deaths among Aleuts and Eskimos. Note: Bolded causes of death are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Death Rates* for Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1984, and 2004
Cause of Death
Coronary Heart Disease
COPD and Asthma
* Age-adjusted; rate per 100,000 population. ? Comparability ratio (1.0502) applied. ? Comparability ratio (1.0411) applied. Source: Vital Statistics of the United States, NCHS.
*Congenital CVD and congenital anomalies of the respiratory system (black bar) represented 41 percent of all infant deaths due to congenital anomalies. ?Between 1994 and 2004, congenital CVD declined 34 percent; congenital anomalies of the respiratory system declined 11 percent; other congenital anomalies declined 3 percent. NA: Not available. Note: Bolded diseases are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Deaths Under Age 1 Year Due to Cardiovascular and Lung Diseases, U.S., 2004
* Age-adjusted. ? Non-Hispanic. Note: Each line is a log linear regression derived from the actual rates. Rates from 1999?2002 are modified by the ICD revision comparability ratio. Source: Vital Statistics of the United States, NCHS.
Physician Office Visits for Sleep Disorders, U.S., 1990?2004
Source: National Ambulatory Medical Care Survey, NCHS.
Prevalence of Common Cardiovascular and Lung Diseases, U.S., 2004
Coronary Heart Disease
Congenital Heart Disease?
* Includes hypertension, CHD, heart failure, and stroke. ** Systolic blood pressure ? 140 mm Hg, diastolic blood pressure ? 90 mm Hg, on antihypertensive medication, or told twice of having hypertension. ? Range from 650,000 to 1,300,000 (Am Hrt J 2004;147:425?439). ? 12,000,000 of these had an asthma attack in the past 12 months. ^ An estimated 12,000,000 diagnosed and 12,000,000 undiagnosed. Sources: National Health and Nutrition Examination Survey of NCHS and National Health Interview Survey of NCHS, except as noted.
Prevalence of Cardiovascular Diseases* in Adults by Age, U.S., 1999?2004
*Age-adjusted. Note: Hypertension is systolic blood pressure > 140 mm Hg, diastolic blood pressure is > 90 mm Hg, or on antihypertensive medication. High cholesterol is 240+ mg/dl. Overweight is BMI 25+ kg/m2. Source: NHIS for smoking ages > 18 and NHANES for the other risk factors, ages 35?74.
Hypertensive Population Aware, Treated, and Controlled, Age 18+, U.S., 1976?80 to 1999?2004
* Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, or on antihypertensive medication. ? Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, on antihypertensive medication, or told twice of having hypertension. Here, ?treated? includes medication use and other means. Source: NHANES, NCHS.
Adult Population With Hypertension* by Age, Gender, and Race, U.S., 1999?2004
Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2007
Amount (Dollars in Billions
(including Blood Clotting)§
Diseases of the Digestive System
Diseases of the Nervous System
Diseases of the Musculoskeletal System
Diseases of the Genitourinary System
Endocrine, Nutritional, and Metabolic Diseases
Infectious and Parasitic Diseases
Diseases of the Skin
Other and Unallocated to Diseases
* Direct costs are personal health care expenditures for hospital and nursing home care, drugs, home care, and physician and other professional services. The estimation method is based on Centers for Medicare & Medicaid Services (CMS) projections for total 2007 health expenditures by type of direct costs and NCHS estimates of direct costs in 1995 for each of the major diagnostic groups. The proportion of costs for 1995 for each diagnostic group is applied to the equivalent 2007 total by type of direct cost. ? Morbidity costs were estimated for 2007 by multiplying NCHS estimates for 1980 by a 1980?2007 percent inflation factor derived from the increase in mean earnings estimated by the Bureau of the Census. ? The mortality cost for each disease group was estimated for 2007 by first multiplying the number of deaths in 2003 in each age- and sex-specific group by the 2003 present value of lifetime earnings (latest available) discounted at 3 percent; second, summing these estimates for each diagnostic group; and third, multiplying the estimates by a 2003?2007 inflation factor (1.09) based on change in mean earnings. § Costs of blood-clotting disease are estimated from predetermined proportions of CVD morbidity and mortality statistics for MI, cerebrovascular diseases, and diseases of arteries. ** Does not include lung cancer or leukemia. Note: Numbers may not add to totals due to rounding. Source: Estimates by NHLBI; data from the NCHS, the CMS, the Bureau of the Census, and the Institute for Health and Aging, University of California, San Francisco.
Total Economic Costs, U.S., 2007
Economic Costs: Cardiovascular, Lung, and Blood Diseases, U.S., 2007