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 1,093,000 deaths and 46 percent of all deaths in the United States (p. 31). The projected economic cost in 2008 for these diseases is expected to be $623 billion, 23 percent of the total economic costs of illness, injuries, and death (p. 47). Of all diseases, heart disease is the leading cause of death, cerebrovascular disease is third (behind cancer), and COPD (including asthma) ranks fourth (p. 34). Cardiovascular and lung diseases account for 3 of the 4 leading causes of death (p. 34) and 4 of the 10 leading causes of infant death (p. 40). Hypertension, heart disease, asthma, and COPD are especially prevalent and account for substantial morbidity in Americans (p. 43).
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.
Mortality statistics in this chapter are for diseases or conditions classified as the underlying cause of death. Heart failure, however, is never truly an underlying cause even though 57,120 deaths in 2004 were nominally coded to it as the underlying cause. Therefore, in this chapter, mortality statistics attributed to heart failure represent it as either the underlying cause or a contributing cause of death.
The 2004 mortality statistics in this Fact Book are final counts. They differ from the 2004 mortality statistics presented in the FY 2006 Fact Book because those statistics were preliminary (though not stated).
In 2004, CVD caused 870,000 deaths?36 percent of all deaths (p. 31).
Heart disease is the leading cause of death; the main form, CHD, caused 452,000 deaths in 2004 (pp. 32, 34).
The annual number of deaths from CVD increased substantially between 1900 and 1970 and remains high (p. 33).
The death rate (not age-adjusted) for CVD increased from 1920 until it peaked in 1968. Since then, the trend has been downward. In 2005, the rate was similar to the rate in the 1920s (p. 33).
Cerebrovascular disease, the third leading cause of death, accounted for 150,000 deaths in 2004 (pp. 32, 34).
Heart disease is second only to all cancers combined in years of potential life lost (p. 34).
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. 34).
Between 1970 and 2004, the increase in deaths with heart failure as the underlying or contributing cause is a major exception to the mortality decline in CVD (p. 35).
Between 1985 and 2004, 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 steepest in whites (p. 36).
Because of the rapid decline in mortality from CHD since the peak in 1968, there were 1,036,000 fewer deaths from CHD in 2005 than would have occurred if there had been no decline (p. 37).
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. 37).
The decline in CHD mortality began earlier in the United States than in most countries and outpaced that in most countries until the 1990s (only selected countries are shown) (p. 38).
Between 1999 and 2005, the percent decline in death rates for CHD and stroke was slightly greater for whites than for blacks (p. 39).
In 2005, an estimated 80.7 million persons in the United States had some form of CVD, 73 million had hypertension, and 16 million had CHD (p. 43).
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 1999?2004 (p. 44).
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. 45).
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. 40).
Hospitalization rates for heart failure increased between 1971 and 2005 (p. 46).
The estimated economic cost of CVD for 2008 is approximately $448 billion:
$296 billion in direct health expenditures
$38 billion in indirect cost of morbidity
$114 billion in indirect cost of mortality (p. 47).
Lung diseases, excluding lung cancer, caused an estimated 227,000 deaths in 2004 (p. 31).
COPD caused 118,000 deaths in 2004 and is the fourth leading cause of death (pp. 32, 34).
Between 1999 and 2005, 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. 39).
Between 1980 and 2005, infant death rates for various lung diseases declined markedly (p. 39).
Of the 10 leading causes of infant mortality, 4 are lung diseases or have a lung disease component (p. 40). Between 1995 and 2005, changes in mortality for the causes were:
Congenital anomalies (-14 percent)
Disorders of short gestation (2 percent)
Sudden infant death syndrome (-45 percent)
Respiratory distress syndrome (-40 percent).
One in five deaths in children under 1 year of age is due to a lung disease (p. 40).
Between 1980 and 2000, the COPD death rate for women in the United States is increasing significantly compared with the rates in several other countries (p. 41).
Between 1985 and 2004, death rates for COPD increased for women in all racial/ethnic groups except Asian. For men, the rates decreased in all racial/ethnic groups except American Indians (p. 42).
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 million in 1990 to 7 million in 2005 (p. 42).
Asthma is a common chronic condition, particularly in children (pp. 43, 44, 46).
The economic cost of lung diseases is expected to be $160 billion in 2008?$99 billion in direct health expenditures and $60 billion in indirect cost of morbidity and mortality (p. 47).
An estimated 223,000 deaths, 9 percent of all deaths, were attributed to blood diseases in 2004 (p. 31). These include the following:
214,000 due to blood-clotting disorders
9,000 to diseases of the red blood cell and bleeding disorders (p. 32).
A large proportion of deaths from AMI and cerebrovascular disease involve blood-clotting problems (p. 32).
In 2008, blood-clotting disorders are expected to cost the Nation?s economy $105 billion, and other blood diseases will cost $14 billion (p. 47).
Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1984 and 2004
Cause of Death
1984 Number of Deaths
1984 Percent of Total
2004 Number of Deaths
2004 Percent of Total
All Cardiovascular, Lung, and Blood Diseases
All Other Causes
* Includes 311,000 CVD deaths involving blood-clotting diseases. ** Includes 214,000 CVD deaths involving blood-clotting diseases. ? Includes 12,000 CVD deaths due to pulmonary heart disease. ? Includes 13,000 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 13,000 deaths from pulmonary heart disease (0.5%). **Excludes 214,000 deaths from blood-clotting disorders (8.9%).
* CVD involving blood clotting (24.6%).
Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2004
Cause of Death
Cardiovascular Deaths (Thousands)
Lung Deaths (Thousands)
Blood Deaths (Thousands)
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 1,093,000. Source: Estimated by the NHLBI from Vital Statistics of the United States, NCHS.
*Data for 2005 are preliminary. * *Includes 149.8 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: Diseases shown in bold (Heart Disease, Stroke, COPD) are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Ten Leading Causes of Death Among Minority Groups, U.S., 2004
* Includes deaths among individuals of Asian extraction and Asian-Pacific Islanders. ** Includes deaths among Aleuts and Eskimos. Note: Diseases shown in bold (Heart, Stroke, COPD) are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Death Rates* for Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1985, and 2005
Cause of Death
Percent Change 1963-2005
Percent Change 1985-2005
Coronary Heart Disease
COPD and Asthma
* Data for 2005 are preliminary. ** Comparability ratio (1.0502) applied. ? Comparability ratio (1.0411) applied. Source: Vital Statistics of the United States, NCHS.
Deaths Attributed to Heart Failure,* U.S., 1970?2004
* Data for 2005 are preliminary. ** Congenital CVD and congenital respiratory diseases accounted for 53.7 deaths under age 1 per 100,000 live births (black bar), which is 40 percent of infant deaths due to all congenital anomalies. ? Between 1995 and 2005, congenital CVD declined 31 percent; congenital anomalies of the respiratory system declined 15 percent; other congenital anomalies increased 2 percent. NA: Not available. Note: Diseases shown in bold 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., 2005*
* Data for 2005 are preliminary. Note: Diseases shown in bold (Cardiovascular Disease, Sudden Infant Death Syndrome, Respiratory Distress Syndrome, Congenital Anomalies), are those addressed in Institute programs. Source: Vital Statistics of the United States, NCHS.
Death Rates* for Chronic Obstructive Pulmonary Disease in Men, Ages 35 and Older, in Selected Countries, 1980?2004
* Non-Hispanic. Note: Each line is a log linear regression derived from the actual rates. Rates from 1985?1998 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?2005
Note: Primary and secondary diagnoses. Source: National Ambulatory Medical Care Survey, NCHS.
Prevalence of Common Cardiovascular and Lung Diseases, U.S., 2005
Coronary Heart Disease
Congenital Heart Disease?
* Includes hypertension, CHD, heart failure, and stroke. ** Hypertension is defined as systolic blood pressure ? 140 mm Hg, or diastolic blood pressure ? 90 mm Hg, or being on antihypertensive medication, or being told twice of having hypertension. ? Range from 650,000 to 1,300,000. ? 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 (NHANES) of NCHS and National Health Interview Survey (NHIS) of NCHS, except as noted.
Prevalence of Cardiovascular Diseases* in Adults by Age and Sex, U.S., 1999?2004
* Hypertension, CHD, cerebrovascular disease, or heart failure. Hypertension is defined as systolic blood pressure > 140 mm Hg, or diastolic blood pressure > 90, or being on antihypertensive medication. Source: NHANES, 1999?2004 extrapolated to U.S., 2004.
Prevalence of Common Cardiovascular and Lung Diseases by Age, U.S., 2004
Note: Hypertension is defined as systolic blood pressure > 140 mm Hg, or diastolic blood pressure is > 90 mm Hg, or being on antihypertensive medication. High cholesterol is 240+ mg/dl. Overweight is BMI 25+ kg/m2. Sources: NHIS for smoking, ages ?18 and NHANES for the other risk factors, ages 20?74.
Hypertensive* Population Aware, Treated, and Controlled, Ages 18 and Older, U.S., 1976?1980 to 1999?2004
Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2007
Amount (Dollars in Billions)
(including Blood Clotting)?
Subtotal, Cardiovascular, Lung, Blood Diseases
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 2008 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 2008 total by type of direct cost. ** Morbidity costs were estimated for 2008 by multiplying NCHS estimates for 1980 by a 1980?2008 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 2008 by first multiplying the number of deaths in 2004 in each age- and sex-specific group by the 2003 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?2008 inflation factor (1.14) 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. Sources: Estimates by the NHLBI; data from the NCHS, the CMS, the Bureau of the Census, and the Institute for Health and Aging, University of California,
Total Economic Costs, U.S., 2008
Economic Costs of Cardiovascular, Lung, and Blood Diseases, U.S., 2008