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(Circulation. 2000;102:3137.)
© 2000 American Heart Association, Inc.

Special Report

Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States

Findings of the National Conference on Cardiovascular Disease Prevention

Richard Cooper, MD; Jeffrey Cutler, MD; Patrice Desvigne-Nickens, MD; Stephen P. Fortmann, MD; Lawrence Friedman, MD; Richard Havlik, MD, MPH; Gary Hogelin, MPA; John Marler, MD; Paul McGovern, PhD; Gregory Morosco, PhD, MPH; Lori Mosca, MD, PhD, MPH; Thomas Pearson, MD, PhD, MPH; Jeremiah Stamler, MD; Daniel Stryer, MD; Thomas Thom, BA

Correspondence to Lawrence Friedman, MD, National Heart, Lung, and Blood Institute, National Institutes of Health, 31 Center Dr, MSC 2482, Bethesda, MD 20892-2482.

Abstract—A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made.

Key Words: cardiovascular diseases • epidemiology • prevention

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				R. O. Bonow, L. A. Smaha, S. C. Smith Jr, G. A. Mensah, and C. Lenfant World Heart Day 2002: The International Burden of Cardiovascular Disease: Responding to the Emerging Global Epidemic Circulation, September 24, 2002; 106(13): 1602 - 1605. [Full Text] [PDF]

				K. O. Akosah, A. M. Schaper, P. Havlik, S. Barnhart, and S. Devine Improving Care for Patients With Chronic Heart Failure in the Community* : The Importance of a Disease Management Program Chest, September 1, 2002; 122(3): 906 - 912. [Abstract] [Full Text] [PDF]

				E. J. Benjamin, S. C. Smith Jr, R. S. Cooper, M. N. Hill, and R. V. Luepker Task Force #1--magnitude of the prevention problem: opportunities and challenges J. Am. Coll. Cardiol., August 21, 2002; 40(4): 588 - 603. [Full Text] [PDF]

				C. N. B. Merz, G. A. Mensah, V. Fuster, P. Greenland, and P. D. Thompson Task Force #5--the role of cardiovascular specialists as leaders in prevention: from training to champion J. Am. Coll. Cardiol., August 21, 2002; 40(4): 641 - 649. [Full Text] [PDF]

				M. J. LaMonte, J. L. Durstine, F. G. Yanowitz, T. Lim, K. D. DuBose, P. Davis, and B. E. Ainsworth Cardiorespiratory Fitness and C-Reactive Protein Among a Tri-Ethnic Sample of Women Circulation, July 23, 2002; 106(4): 403 - 406. [Abstract] [Full Text] [PDF]

				R. de Gaudemaris, T. Lang, G. Chatellier, L. Larabi, V. Lauwers-Cances, A. Maitre, and E. Diene Socioeconomic Inequalities in Hypertension Prevalence and Care: The IHPAF Study Hypertension, June 1, 2002; 39(6): 1119 - 1125. [Abstract] [Full Text] [PDF]

				M. de Lorgeril, P. Salen, F. Paillard, F. Laporte, F. Boucher, and J. de Leiris Mediterranean diet and the French paradox: Two distinct biogeographic concepts for one consolidated scientific theory on the role of nutrition in coronary heart disease Cardiovasc Res, June 1, 2002; 54(3): 503 - 515. [Full Text] [PDF]

				W. A. Wattigney, G. A. Mensah, and J. B. Croft Increased Atrial Fibrillation Mortality: United States, 1980-1998 Am. J. Epidemiol., May 1, 2002; 155(9): 819 - 826. [Abstract] [Full Text] [PDF]

				L. J. Cornelius, P. L. Smith, and G. M. Simpson What Factors Hinder Women of Color From Obtaining Preventive Health Care? Am J Public Health, April 1, 2002; 92(4): 535 - 539. [Abstract] [Full Text]

				T. A. Manolio and D. E. Bild Coronary Calcium, Race, and Genes Arterioscler Thromb Vasc Biol, March 1, 2002; 22(3): 359 - 360. [Full Text] [PDF]