Cardiovascular disease (CVD) has been for many years the leading single cause of death in the United States (14): it includes both coronary heart disease (CHD) and stroke. CHD is the most common form of cardiovascular disease.
In 1987 nearly 1 million deaths in the United States, half of the total number, occurred due to some form of CVD (15). In 1998, CVD remains the leading cause of death in the United States (14), although there have been some reductions in the rate. Cardiovascular disease is often thought to affect mainly men and the elderly, but it is also a major killer of women and people in the prime of life (14). An estimated 58 million Americans live with some form of the disease, and almost 10 million Americans aged 65 years and older report disabilities caused by heart disease. Stroke is also a leading cause of disability in the United States, affecting more than 1 million people nationwide (14). The health burden of this condition is rivaled by the economic burden, which has a profound impact on the health care system.
Extensive clinical and epidemiological studies have identified several major and contributing risk factors of heart disease and stroke (16). The major risk factors are listed in Table 7. Some such as increasing age, male gen
Table 6. Classification of Diabetes Mellitus
Spontaneous Diabetes Mellitus (DM) Insulin-dependent (IDDM, or type I) Non-insulin-dependent (NIDDM or type II) Nonobese NIDDM Obese NIDDM
Maturity onset diabetes of young people Secondary diabetes Gestational diabetes der, and genetic background cannot be changed, treated, or modified (16). Others, for example, smoking, high serum cholesterol, high blood pressure, physical inactivity, obesity, and overweight, are under some control by the individual. Smokers have twice the risk of heart disease compared with nonsmokers. Nearly one-fifth of all deaths from cardiovascular diseases (180,000 deaths per year) are attributable to smoking (14). Surveillance data indicate that an estimated 1 million young people become regular smokers each year (14).
The risk of heart disease increases with a rise in cholesterol levels especially when other risk factors are present (17-19). Plasma total cholesterol was accepted as a causal factor (among multiple factors) by the World Health Organization (WHO) expert committee in 1982 and by the U.S. National Institute of Health Consensus Development Conference in 1985 (17). Diet and its effects on plasma cholesterol levels are discussed in the next section. Plasma triglyceride levels have also been correlated with increased risk of heart disease (17) and are associated with increased low-density lipoprotein (LDL) cholesterol levels. High blood pressure increases the risk of a stroke, heart attack, kidney failure, and congestive heart failure. When obesity, smoking, high blood cholesterol levels, or diabetes are also present, high blood pressure increases the risk of a heart attack or stroke severalfold.
Regular moderate-to-vigorous exercise plays a significant role in preventing heart and blood vessel disease (16). Exercise helps control blood cholesterol, diabetes, and obesity as well as maintaining blood pressure. However, surveys have shown that more than half of American adults do not practice the recommended level of physical activity. Obese people are at a greater risk of heart disease, high blood pressure, high cholesterol, and other chronic diseases and diabetes (14,16). Diabetes is also a serious risk factor for heart disease with more than 80% of diabetics succumbing to some form of heart or blood vessel disease (16).
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