Executive Summary: Heart Disease and Stroke Statistics—2014 Update

Abstract

HomeCirculationVol. 129, No. 3Executive Summary: Heart Disease and Stroke Statistics—2014 Update Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBExecutive Summary: Heart Disease and Stroke Statistics—2014 UpdateA Report From the American Heart Association Alan S. Go, MD, Dariush Mozaffarian, MD, DrPH, FAHA, Véronique L. Roger, MD, MPH, FAHA, Emelia J. Benjamin, MD, ScM, FAHA, Jarett D. Berry, MD, FAHA, Michael J. Blaha, MD, MPH, Shifan Dai, MD, PhD, Earl S. Ford, MD, MPH, FAHA, Caroline S. Fox, MD, MPH, FAHA, Sheila Franco, MS, Heather J. Fullerton, MD, MAS, Cathleen Gillespie, MS, Susan M. Hailpern, DPH, MS, John A. Heit, MD, FAHA, Virginia J. Howard, PhD, FAHA, Mark D. Huffman, MD, MPH, Suzanne E. Judd, PhD, Brett M. Kissela, MD, MS, FAHA, Steven J. Kittner, MD, MPH, FAHA, Daniel T. Lackland, DrPH, MSPH, FAHA, Judith H. Lichtman, PhD, MPH, Lynda D. Lisabeth, PhD, MPH, FAHA, Rachel H. Mackey, PhD, MPH, FAHA, David J. Magid, MD, Gregory M. Marcus, MD, MAS, FAHA, Ariane Marelli, MD, MPH, David B. Matchar, MD, FAHA, Darren K. McGuire, MD, MHSc, FAHA, Emile R. MohlerIII, MD, FAHA, Claudia S. Moy, PhD, MPH, Michael E. Mussolino, PhD, FAHA, Robert W. Neumar, MD, PhD, Graham Nichol, MD, MPH, FAHA, Dilip K. Pandey, MD, PhD, FAHA, Nina P. Paynter, PhD, MHSc, Matthew J. Reeves, PhD, FAHA, Paul D. Sorlie, PhD, Joel Stein, MD, Amytis Towfighi, MD, Tanya N. Turan, MD, MSCR, FAHA, Salim S. Virani, MD, PhD, Nathan D. Wong, PhD, MPH, FAHA, Daniel Woo, MD, MS, FAHA and Melanie B. Turner, MPHon behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Alan S. GoAlan S. Go Search for more papers by this author , Dariush MozaffarianDariush Mozaffarian Search for more papers by this author , Véronique L. RogerVéronique L. Roger Search for more papers by this author , Emelia J. BenjaminEmelia J. Benjamin Search for more papers by this author , Jarett D. BerryJarett D. Berry Search for more papers by this author , Michael J. BlahaMichael J. Blaha Search for more papers by this author , Shifan DaiShifan Dai *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Earl S. FordEarl S. Ford *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Caroline S. FoxCaroline S. Fox Search for more papers by this author , Sheila FrancoSheila Franco *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Heather J. FullertonHeather J. Fullerton Search for more papers by this author , Cathleen GillespieCathleen Gillespie *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Susan M. HailpernSusan M. Hailpern Search for more papers by this author , John A. HeitJohn A. Heit Search for more papers by this author , Virginia J. HowardVirginia J. Howard Search for more papers by this author , Mark D. HuffmanMark D. Huffman Search for more papers by this author , Suzanne E. JuddSuzanne E. Judd Search for more papers by this author , Brett M. KisselaBrett M. Kissela Search for more papers by this author , Steven J. KittnerSteven J. Kittner Search for more papers by this author , Daniel T. LacklandDaniel T. Lackland Search for more papers by this author , Judith H. LichtmanJudith H. Lichtman Search for more papers by this author , Lynda D. LisabethLynda D. Lisabeth Search for more papers by this author , Rachel H. MackeyRachel H. Mackey Search for more papers by this author , David J. MagidDavid J. Magid Search for more papers by this author , Gregory M. MarcusGregory M. Marcus Search for more papers by this author , Ariane MarelliAriane Marelli Search for more papers by this author , David B. MatcharDavid B. Matchar Search for more papers by this author , Darren K. McGuireDarren K. McGuire Search for more papers by this author , Emile R. MohlerIIIEmile R. MohlerIII Search for more papers by this author , Claudia S. MoyClaudia S. Moy Search for more papers by this author , Michael E. MussolinoMichael E. Mussolino Search for more papers by this author , Robert W. NeumarRobert W. Neumar Search for more papers by this author , Graham NicholGraham Nichol Search for more papers by this author , Dilip K. PandeyDilip K. Pandey Search for more papers by this author , Nina P. PaynterNina P. Paynter Search for more papers by this author , Matthew J. ReevesMatthew J. Reeves Search for more papers by this author , Paul D. SorliePaul D. Sorlie Search for more papers by this author , Joel SteinJoel Stein Search for more papers by this author , Amytis TowfighiAmytis Towfighi Search for more papers by this author , Tanya N. TuranTanya N. Turan Search for more papers by this author , Salim S. ViraniSalim S. Virani Search for more papers by this author , Nathan D. WongNathan D. Wong Search for more papers by this author , Daniel WooDaniel Woo Search for more papers by this author and Melanie B. TurnerMelanie B. Turner Search for more papers by this author and on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Originally published21 Jan 2014https://doi.org/10.1161/01.cir.0000442015.53336.12Circulation. 2014;129:399–410Table of Contents†Summary e291. About These Statistics e362. Cardiovascular Health e39Health Behaviors3. Smoking/Tobacco Use e604. Physical Inactivity e655. Nutrition e736. Overweight and Obesity e87Health Factors and Other Risk Factors7. Family History and Genetics e968. High Blood Cholesterol and Other Lipids e1019. High Blood Pressure e10710. Diabetes Mellitus e11711. Metabolic Syndrome e12912. Chronic Kidney Disease e137Conditions/Diseases13. Total Cardiovascular Diseases e14214. Stroke (Cerebrovascular Disease)e16615. Congenital Cardiovascular Defects and Kawasaki Disease e19116. Disorders of Heart Rhythm e19917. Subclinical Atherosclerosis e21718. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris e22719. Cardiomyopathy and Heart Failure e24220. Valvular, Venous, and Aortic Diseases e24821. Peripheral Artery Disease e256Outcomes22. Quality of Care e25923. Medical Procedures e27524. Economic Cost of Cardiovascular Disease e280Supplemental Materials25. At-a-Glance Summary Tables e28526. Glossary e290SummaryEach year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease–related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled.For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year’s edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update.The 2014 Update Expands Data Coverage of the Epidemic of Poor Cardiovascular Health Behaviors and Their Antecedents and ConsequencesAdjusted estimated population attributable fractions for cardiovascular disease (CVD) mortality were as follows1: 40.6% (95% confidence interval [CI], 24.5%–54.6%) for high blood pressure; 13.7% (95% CI, 4.8%–22.3%) for smoking; 13.2% (95% CI, 3.5%–29.2%) for poor diet; 11.9% (95% CI, 1.3%–22.3%) for insufficient physical activity; and 8.8% (95% CI, 2.1%–15.4%) for abnormal blood glucose levels.Although significant progress has been made over the past 4 decades, in 2012, among Americans ≥18 years of age, 20.5% of men and 15.9% of women continued to be cigarette smokers. In 2011, 18.1% of students in grades 9 through 12 reported current cigarette use.The percentage of the nonsmoking population with exposure to secondhand smoke (as measured by serum cotinine levels ≥0.05 ng/mL) declined from 52.5% in 1999 to 2000 to 40.1% in 2007 to 2008. More than half of children 3 to 11 years of age (53.6%) and almost half of those 12 to 19 years of age (46.5%) had detectable levels, compared with just over a third of adults 20 years of age and older (36.7%).The proportion of youth (≤18 years of age) who report engaging in no regular physical activity is high, and the proportion increases with age.In 2011, among adolescents in grades 9 through 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 (defined as any activity that increased heart rate or breathing rate) at least once in the previous 7 days, despite recommendations that children engage in such activity 7 days per week.In 2012, 29.9% of adults reported engaging in no aerobic leisure-time physical activity.In 2009 to 2010, <1% of Americans met at least 4 of 5 healthy dietary goals. Among adults aged ≥20 years, only 12.3% met recommended goals for fruits and vegetables; 18.3% met goals for fish; 0.6% met goals for sodium; 51.9% met goals for sugar-sweetened beverages; and 7.3% met goals for whole grains. These proportions were even lower in children, with only 29.4% of adolescents aged 12 to 19 years meeting goals for low sugar-sweetened beverage intake.The estimated prevalence of overweight and obesity in US adults (≥20 years of age) is 154.7 million, which represented 68.2% of this group in 2010. Nearly 35% 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 to 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. From 1971-1974 to 2007-2010, the prevalence of obesity in children 6 to 11 years of age has increased from 4.0% to 18.8%.Obesity (body mass index ≥30 kg/m2) is associated with marked excess mortality in the US population. Even more notable is the excess morbidity associated with overweight and obesity in terms of risk factor development and incidence of diabetes mellitus, CVD end points (including coronary heart disease, stroke, and heart failure), and numerous other health conditions, including asthma, cancer, end-stage renal disease, degenerative joint disease, and many others.Prevalence and Control of Cardiovascular Health Factors and Risks Remain an Issue for Many AmericansAn estimated 31.9 million adults ≥20 years of age have total serum cholesterol levels ≥240 mg/dL, with a prevalence of 13.8%.Based on 2007 to 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 similar for men and women. African American adults have among the highest prevalence of hypertension (44%) in the world.Among hypertensive Americans, ≈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.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 strikingly 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.Rates of Death Attributable to CVD Have Declined, but the Burden of Disease Remains HighThe 2010 overall rate of death attributable to CVD was 235.5 per 100 000. The rates were 278.4 per 100 000 for white males, 369.2 per 100 000 for black males, 192.2 per 100 000 for white females, and 260.5 per 100 000 for black females.From 2000 to 2010, death rates attributable to CVD declined 31.0%. In the same 10-year period, the actual number of CVD deaths per year declined by 16.7%. Yet in 2010, CVD (I00–I99; Q20–Q28) still accounted for 31.9% (787 650) of all 2 468 435 deaths, or ≈1 of every 3 deaths in the United States.On the basis of 2010 death rate data, >2150 Americans die of CVD each day, an average of 1 death every 40 seconds. About 150 000 Americans who died of CVD in 2010 were <65 years of age. In 2010, 34% of deaths attributable to CVD occurred before the age of 75 years, which is before the current average life expectancy of 78.7 years.Coronary heart disease alone caused ≈1 of every 6 deaths in the United States in 2010. In 2010, 379 559 Americans died of CHD. Each year, an estimated ≈620 000 Americans have a new coronary attack (defined as first hospitalized myocardial infarction or coronary heart disease death) and ≈295 000 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 23 seconds, an American will die of one.From 2000 to 2010, the relative rate of stroke death fell by 35.8% and the actual number of stroke deaths declined by 22.8%. Yet each year, ≈795 000 people continue to experience a new or recurrent stroke (ischemic or hemorrhagic). Approximately 610 000 of these are first events and 185 000 are recurrent stroke events. In 2010, 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 someone dies of one approximately every 4 minutes.The decline in stroke mortality over the past decades, a major improvement in population health observed for both sexes and all race and age groups, has resulted from reduced stroke incidence and lower case fatality rates. The significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. The hypertension control efforts initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality, with lower blood pressure distributions in the population. Control of diabetes mellitus and high cholesterol and smoking cessation programs, particularly in combination with hypertension treatment, also appear to have contributed to the decline in stroke mortality.2In 2010, 1 in 9 death certificates (279 098 deaths) in the United States mentioned heart failure. Heart failure was the underlying cause in 57 757 of those deaths in 2010. The number of any-mention deaths attributable to heart failure was approximately as high in 1995 (287 000) as it was in 2010 (279 000). Additionally, hospital discharges for heart failure remained stable from 2000 to 2010, with first-listed discharges of 1 008 000 and 1 023 000, respectively.The 2014 Update Provides Critical Data About Cardiovascular Quality of Care, Procedure Utilization, and CostsIn light of the current national focus on healthcare utilization, costs, and quality, it is critical to monitor and understand the magnitude of healthcare delivery and costs, as well as the quality of healthcare delivery, related to CVD risk factors and conditions. The Statistical Update provides these critical data in several sections.Quality-of-Care Metrics for CVDsQuality data are available from the AHA’s Get With The Guidelines programs for coronary heart disease, heart failure, and resuscitation and from the American Stroke Association/AHA’s Get With The Guidelines program for acute stroke. Similar data from the Veterans Healthcare Administration, national Medicare and Medicaid data, and Acute Coronary Treatment and Intervention Outcomes Network (ACTION)–Get With The Guidelines Registry data are also reviewed. These data show impressive adherence to guideline recommendations for many, but not all, metrics of quality of care for these hospitalized patients. Data are also reviewed on screening for CVD risk factor levels and control.Cardiovascular Procedure Use and CostsThe total number of inpatient cardiovascular operations and procedures increased 28%, from 5 939 000 in 2000 to 7 588 000 in 2010 (National Heart, Lung, and Blood Institute computation based on National Center for Health Statistics annual data).The total direct and indirect cost of CVD and stroke in the United States for 2010 is estimated to be $315.4 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 premature mortality (indirect costs).By comparison, in 2008, the estimated cost of all cancer and benign neoplasms was $201.5 billion ($77.4 billion in direct costs, and $124 billion in mortality indirect costs). CVD costs more than any other diagnostic group.The AHA, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the Statistics Update.This annual Statistical Update is the product of an entire year’s worth of effort by dedicated professionals, volunteer physicians and scientists, and outstanding AHA staff members, without whom publication of this valuable resource would be impossible. Their contributions are gratefully acknowledged.Alan S. Go, MDMelanie B. Turner, MPHOn behalf of the American Heart Association Statistics Committee and Stroke Statistics SubcommitteeNote: Population data used in the compilation of National Health and Nutrition Examination Survey (NHANES) prevalence estimates are for the latest year of the NHANES survey being used. Extrapolations for NHANES prevalence estimates are based on the census resident population for 2010 because this is the most recent year of NHANES data used in the Statistical Update.AcknowledgmentsWe wish to thank Lucy Hsu, Michael Wolz, Sean Coady, and Khurram Nasir for their valuable comments and contributions. We would like to acknowledge Lauren Rowell for her administrative assistance.Table 1. Males and CVD: At-a-Glance TableDiseases and Risk FactorsBoth SexesTotal MalesWhite MalesBlack MalesMexican American MalesSmoking Prevalence, 2012*42.1 M (18.1%)23.0 M (20.5%)22.0%21.6%16.6%†PA‡ Prevalence, 2012*20.7%24.6%26.0%23.7%19.3%†Overweight and obesity Prevalence, 2010 Overweight and obesity, BMI >25.0 kg/m2§154.7 M (68.2%)79.9 M (72.9%)73.1%68.7%81.3% Obesity, BMI >30.0 kg/m2§78.4 M (34.6%)36.8 M (33.6%)33.8%37.9%36.0%Blood cholesterol Prevalence, 2010 Total cholesterol >200 mg/dL§98.9 M (43.4%)45.3 M (41.3%)40.5%38.6%48.1% Total cholesterol >240 mg/dL§31.9 M (13.8%)14.0 M (12.7%)12.3%10.8%15.2% LDL cholesterol >130 mg/dL§71.0 M (31.1%)35.2 M (31.9%)30.1%33.1%39.9% HDL cholesterol <40 mg/dL§48.7 M (21.8%)34.6 M (31.8%)33.1%20.3%34.2%HBP Prevalence, 2010§77.9 M (33.0%)37.2 M (33.6%)33.4%42.6%30.1% Mortality, 2010‖63 11928 37320 8196670N/ADM Prevalence, 2010 Physician-diagnosed DM§19.7 M (8.3%)9.6 M (8.7%)7.7%13.5%11.4% Undiagnosed DM§8.2 M (3.5%)5.3 M (4.7%)4.5%4.8%6.6% Prediabetes§87.3 M (38.2%)50.7 M (46.0%)47.7%35.7%47.0% Incidence, diagnosed DM§1.9 MN/AN/AN/AN/A Mortality, 2010‖69 07135 49028 4865640N/ATotal CVD Prevalence, 2010§83.6 M (35.3%)40.7 M (36.7%)36.6%44.4%33.4% Mortality, 2010‖¶787 650387 318330 33046 266N/AStroke Prevalence, 2010§6.8 M (2.8%)3.0 M (2.6%)2.4%4.3%2.3% New and recurrent strokes‖795.0 K370.0 K325.0 K45.0 KN/A Mortality, 2010‖129 47652 36743 4246938N/ACHD Prevalence, CHD, 2010§15.4 M (6.4%)8.8 M (7.9%)8.2%6.8%6.7% Prevalence, MI, 2010§7.6 M (2.9%)5.0 M (4.2%)4.4%3.9%3.6% Prevalence, AP, 2010§7.8 M (3.2%)3.7 M (3.3%)3.3%2.4%3.4% New and recurrent CHD#**915.0 K530.0 K465.0 K65.0 KN/A New and recurrent MI**720.0 K420.0 KN/AN/AN/A Incidence, AP (stable angina)‡‡565.0 K370.0 KN/AN/AN/A Mortality, 2010, CHD‖379 559207 580181 38620 615N/A Mortality, 2010, MI‖122 07167 43559 1816445N/AHF Prevalence, 2010§5.1 M (2.1%)2.7 M (2.5%)2.5%4.1%1.9% Incidence, 2010‡‡825 000395 000350 00045 000N/A Mortality, 2010‖57 75724 38521 5402444N/AAP indicates angina pectoris (chest pain); BMI, body mass index; CHD, coronary heart disease (includes heart attack, angina pectoris chest pain, or both); CVD, cardiovascular disease; DM, diabetes mellitus; HBP, high blood pressure; HDL, high-density lipoprotein; HF, heart failure; K, thousands; LDL, low-density lipoprotein; M, millions; MI, myocardial infarction (heart attack); N/A, data not available; and PA, physical activity.*Age ≥18 y (National Health Interview Survey).†All Hispanic (National Health Interview Survey).‡Met 2008 full Federal PA guidelines for adults.§Age ≥20 y.‖All ages.¶Total CVD mortality includes deaths from congenital heart disease.#New and recurrent MI and fatal CHD.**Age ≥35 y.‡‡Age ≥45 y.Table 2. Females and CVD: At-a-Glance TableDiseases and Risk FactorsBoth SexesTotal FemalesWhite FemalesBlack FemalesMexican American FemalesSmoking Prevalence, 2012*42.1 M (18.1%)19.1 M (15.9%)19.2%14.2%7.5%†PA‡ Prevalence, 2012*20.7%17.1%19.9%10.8%12.2%†Overweight and obesity Prevalence, 2010 Overweight and obesity, BMI >25.0 kg/m2§154.7 M (68.2%)74.8 M (63.7%)60.2%79.9%78.2% Obesity, BMI >30.0 kg/m2§78.4 M (34.6%)41.6 M (35.6%)32.5%53.9%44.8%Blood cholesterol Prevalence, 2010 Total cholesterol >200 mg/dL§98.9 M (43.4%)53.6 M (44.9%)45.8%40.7%44.7% Total cholesterol >240 mg/dL§31.9 M (13.8%)17.9 M (14.7%)15.6%11.7%13.5% LDL cholesterol >130 mg/dL§71.0 M (31.1%)35.8 M (30.0%)29.3%31.2%30.4% HDL cholesterol <40 mg/dL§48.7 M (21.8%)14.1 M (12.3%)12.4%10.2%15.1%HBP Prevalence, 2010§77.9 M (33.0%)40.7 M (32.2%)30.7%47.0%28.8% Mortality, 2010‖63 11934 74626 7986923N/ADM Prevalence, 2010 Physician-diagnosed DM§19.7 M (8.3%)10.1 M (7.9%)6.2%15.4%12.0% Undiagnosed DM§8.2 M (3.5%)2.9 M (2.3%)1.8%2.9%4.7% Prediabetes§87.3 M (38.2%)33.6 M (30.5%)30.0%29.0%31.9% Incidence, diagnosed DM§1.9 MN/AN/AN/AN/A Mortality, 2010‖69 07133 58125 7646486N/ATotal CVD Prevalence, 2010§83.6 M (35.3%)42.9 M (34.0%)32.4%48.9%30.7% Mortality, 2010‖787 650400 332342 58149 977N/AStroke Prevalence, 2010§6.8 M (2.8%)3.8 M (3.0%)2.9%4.7%1.4% New and recurrent strokes‖795.0 K425.0 K365.0 K60.0 KN/A Mortality, 2010‖129 47677 10965 6959027N/ACHD Prevalence, CHD, 2010§15.4 M (6.4%)6.6 M (5.1%)4.6%7.1%5.3% Prevalence, MI, 2010§7.6 M (2.9%)2.6 M (1.7%)1.5%2.3%1.7% Prevalence, AP, 2010§7.8 M (3.2%)4.1 M (3.2%)2.8%5.4%3.3% New and recurrent CHD#**915.0 K385.0 K330.0 K55.0 KN/A New and recurrent MI**720.0 K300.0 KN/AN/AN/A Incidence, AP (stable angina)‡‡565.0 K195.0 KN/AN/AN/A Mortality, 2010, CHD‖379 559171 979148 89119 015N/A Mortality, 2010, MI‖122 07154 63647 0236298N/AHF Prevalence, 2010§5.1 M (2.1%)2.4 M (1.8%)1.8%3.0%1.1% Incidence, 2010‡‡825 000430 000375 00055 000N/A Mortality, 2010‖57 75733 37229 7503084N/AAP indicates angina pectoris (chest pain); BMI, body mass index; CHD, coronary heart disease (includes heart attack, angina pectoris chest pain, or both); CVD, cardiovascular disease; DM, diabetes mellitus; HBP, high blood pressure; HDL, high-density lipoprotein; HF, heart failure; K, thousands; LDL, low-density lipoprotein; M, millions; MI, myocardial infarction (heart attack); N/A, data not available; and PA, physical activity.*Age ≥18 y (National Health Interview Survey).†All Hispanic (National Health Interview Survey).‡Met 2008 full Federal PA guidelines for adults.§Age ≥20 y.‖All ages.¶Total CVD mortality includes deaths from congenital heart disease.#New and recurrent MI and fatal CHD.**Age ≥35 y.‡‡Age ≥45 y.Table 3. Race/Ethnicity and CVD: At-a-Glance TableDiseases and Risk FactorsBoth SexesWhitesBlacksMexican AmericansHispanics/LatinosAsians: Both SexesAmerican Indian/Alaska Native: Both SexesMalesFemalesMalesFemalesMalesFemalesMalesFemalesSmoking Prevalence, 2012*42.1 M (18.1%)22.0%19.2%21.6%14.2%11.3%16.6%7.5%10.4%18.8%PA† Prevalence, 2012*20.7%20.6%21.4%14.9%15.7%18.7%16.8%Overweight and obesity Prevalence, 2010 Overweight and obesity, BMI >25.0 kg/m2‡154.7 M (68.2%)73.1%60.2%68.7%79.9%81.3%78.2%N/AN/AN/AN/A Overweight and obesity, BMI >30.0 kg/m2‡78.4 M (34.6%)33.8%32.5%37.9%53.9%36.0%44.8%N/AN/AN/AN/ABlood cholesterol Prevalence, 2010 Total cholesterol >200 mg/dL‡98.9 M (43.4%)40.5%45.8%38.6%40.7%48.1%44.7%N/AN/AN/AN/A Total cholesterol >240 mg/dL‡31.9 M (13.8%)12.3%15.6%10.8%11.7%15.2%13.5%N/AN/AN/AN/A LDL cholesterol >130 mg/dL‡71.0 M (31.1%)30.1%29.3%33.1%31.2%39.9%30.4%N/AN/AN/AN/A HDL cholesterol <40 mg/dL‡48.7 M (21.8%)33.1%12.4%20.3%10.2%34.2%15.1%N/AN/AN/AN/AHBP Prevalence, 2010‡77.9 M (33.0%)33.4%30.7%42.6%47.0%30.1%28.8%20.9%*21.27%*24.8%* Mortality, 2010§63 11920 81926 79866706923N/AN/AN/AN/A1578331DM Prevalence, 2010 Physician-diagnosed DM‡19.7 M (8.3%)7.7%6.2%13.5%15.4%11.4%12.0%N/AN/AN/AN/A Undiagnosed DM‡8.2 M (3.5%)4.5%1.8%4.8%2.9%6.6%4.7%N/AN/AN/AN/A Prediabetes‡87.3 M (38.2%)47.7%30.0%35.7%29.0%47.0%31.9%N/AN/AN/AN/A Incidence, diagnosed DM‡1.9 MN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A Mortality, 2010§69 07128 48625 76456406486N/AN/AN/AN/A1838857Total CVD Prevalence, 2010‡83.6 M (35.3%)36.6%32.4%44.4%48.9%33.4%30.7%N/AN/AN/AN/A Mortality, 2010§‖787 650330 330342 58146 26649 977N/AN/AN/AN/A16 8293667Stroke Prevalence, 2010‡6.8 M (2.8%)2.4%2.9%4.3%4.7%2.3%1.4%2.7%*1.8%*4.3%*¶ New and recurrent strokes§795.0 K325.0 K365.0 K45.0 K60.0 KN/AN/AN/AN/AN/AN/A Mortality, 2010§129 47643 42465 69569389027N/AN/AN/AN/A3833559CHD Prevalence, CHD, 2010‡15.4 M (6.4%)8.2%4.6%6.8%7.1%6.7%5.3%N/AN/AN/AN/A Prevalence, MI, 2010‡7.6 M (2.9%)4.4%1.5%3.9%2.3%3.6%1.7%N/AN/AN/AN/A Prevalence, AP, 2010‡7.8 M (3.2%)3.3%2.8%2.4%5.4%3.4%3.3%N/AN/AN/AN/A New and recurrent CHD#**915.0 K465.0 K330.0 K65.0 K55.0 KN/AN/AN/AN/AN/AN/A Mortality, CHD, 2010§379 559181 386148 89120 61519 015N/AN/AN/AN/A78211831 Mortality, MI, 2010§122 07159 18147 02364456298N/AN/AN/AN/A2530594HF Prevalence, 2010‡5.1 M (2.1%)2.5%1.8%4.1%3.0%1.9%1.1%N/AN/AN/AN/A Incidence, 2010‡‡825 000350 000375 00045 00055 000N/AN/AN/AN/AN/AN/A Mortality, 2010§57 75721 54029 75024443084N/AN/AN/AN/A714225AP, angina pectoris (chest pain); BMI, body mass index; CHD, coronary heart disease (includes heart attack, angina pectoris chest pain, or both); CVD, cardiovascular disease; DM, diabetes mellitus; HBP, high blood pressure; HDL, high-density lipoprotein; HF, heart failure; K, thousands; LDL, low-density lipoprotein; M, millions; MI, myocardial infarction (heart attack); N/A, data not available; and PA, physical activity;.*Age ≥18 y (National Health Interview Survey, 2012).†Met 2008 full Federal PA guidelines for adults.‡Age ≥20 y.§All ages.‖Total CVD mortality includes deaths from congenital heart disease.¶Figure not considered reliable.#New and recurrent MI and fatal CHD.**Age ≥35 y.‡‡Age ≥45 y.Table 4. Children, Youth, and CVD: At-a-Glance TableDiseases and Risk FactorsBoth SexesTotal MalesTotal FemalesNH WhitesNH BlacksMexican AmericansMalesFemalesMalesFemalesMalesFemalesSmoking, % High school students, grades 9–12 Current cigarette smoking, 201118.119.916.121.518.913.77.419.5*15.2* Current cigar smoking, 201113.117.88.019.07.515.18.517.2*9.1*PA† Prevalence, grades 9–12, 2011‡ Met currently recommended levels of PA, %49.559.938.562.142.657.131.957.1*33.0*Overweight and obesity Prevalence, 2010 Children and adolescents, ages 2–19 y, overweight or obese23.9 M (31.8%)12.7 M (33.0%)11.2 M (30.4%)30.1%25.6%36.9%41.3%40.5%38.2% Children and adolescents, age 2–19 y, obese‡12.7 M (16.9%)7.2 M (18.6%)5.5 M (15.0%)16.1%11.7%24.3%24.3%24.0%18.2%Blood cholesterol, mg/dL, 2010 Mean total cholesterol Ages 4–11 y161.9162.3161.5160.9161.6165.2157.9159.6160.7 Ages 12–19 y158.2156.1160.3156.8161.1154.1160.6157.8158.0 Mean HDL cholesterol Ages 4–11 y53.655.151.953.951.459.955.353.550.5 Ages 12–19 y51.449.253.648.453.053.955.447.55