Taking the Initiative

In 1990, heart disease and stroke emerged as the leadingcauses of death worldwide and remain the first and third leading causes of death in the United States, respectively.1,2 Cardiovascular disease (CVD) in the United States is respon-sible for 40 % of all deaths, more than the next 5 leading causes of death combined. CVD death rates have declined significantly over the past several decades as a result of decreased incidence of myocardial infarction and increased survival.3,4 Coronary heart disease is also a leading cause of premature and permanent disability in the US labor force.2 In addition, the economic consequences are grave. In 2004, total CVD costs in the United States were estimated to be $368.4 billion2; these costs are expected to increase 40 % to 50 % by the year 2010.5 Blacks, the poor, and residents of particular regions in the United States are examples of groups that shoulder a disproportionate burden of CVD.6