Prevalence of Heart Disease --- United States, 2005
Heart disease has been the leading cause of death in the United States for the past 80 years
and is a major cause of disability. Heart disease also results in
substantial health-care expenditures; for example, coronary heart
disease is projected to cost an estimated $151.6 billion in direct and
indirect costs in 2007 (
2). Although some self-reported national data
are available (
3), state-specific prevalence data for heart disease have not been reported previously. In addition, although
racial/ethnic, geographic, and sex differences in death rates for heart disease have been documented
less information has been available regarding the prevalence of persons
living with heart disease. To estimate the prevalence of myocardial
infarction (MI) and angina/coronary heart disease (CHD) in each of the
50 states, the District of Columbia (DC), Puerto Rico, and the U.S.
Virgin Islands (USVI), CDC analyzed self-reported data from the 2005
Behavioral Risk Factor Surveillance System (BRFSS).* This report
summarizes the results of that analysis and provides the first
state-based prevalence estimates of these heart diseases. The results
indicated that substantial geographic, racial/ethnic, educational, and
sex disparities existed in the prevalence of MI and angina/CHD. To
lower the incidence of heart disease and meet the overall
Healthy People 2010 goal to eliminate health disparities,
public health programs should target disproportionately
BRFSS is a state-based, random-digit--dialed telephone survey of the noninstitutionalized, U.S. civilian population
>18 years and is administered by state health departments in collaboration with CDC. In 2005, the median response
rate among states, based on Council of American Survey and
Research Organizations (CASRO) guidelines, was 51.1%
(range: 34.6%--67.4%). This rate accounts for both the efficiency of the telephone sampling method used and participation
rates among eligible respondents who were contacted. A total of 356,112 respondents from all 50 states, DC, Puerto Rico,
and USVI participated in the survey. State (including DC) and territory sample sizes ranged from 2,422 (USVI) to
Survey respondents answered questions indicating whether a
doctor or other health professional had ever told them that they had
experienced a "heart attack, also called a myocardial infarction" or
"angina or coronary heart disease." Differences in prevalence were
assessed by age, race/ethnicity, sex, education, and state or territory
of residence. Data were weighted to reflect each state and territory's
>18 years, and results were age adjusted to the 2000 U.S.
adult standard population. Race/ethnicity identification was provided
by respondents; persons who identified themselves as multiracial were
included in a separate category.
In 2005, a total of 4.0% (95% confidence interval [CI] = 3.9--4.1) of respondents reported a history of MI, and 4.4% (CI
= 4.3--4.5) reported a history of angina/CHD (Table 1). A total of 6.5% (CI = 6.3--6.6) of respondents reported a
one or more of these conditions (MI, angina/CHD, or both). Men had a significantly higher prevalence of MI history
than women (5.5%, CI = 5.3--5.7, versus 2.9%, CI = 2.8--3.0), angina/CHD (5.5%, CI = 5.3--5.8, versus 3.4%, CI =
3.3--3.6), and one or more of these conditions (8.2%, CI = 8.0--8.5, versus 5.0%, CI = 4.9--5.2). The prevalences of history of
MI, angina/CHD, and one or more of these conditions increased among successive age groups and decreased with
higher education. Of persons with less than a high school diploma, 9.8% (CI = 9.3--10.4) reported a history of one or more of
the conditions, nearly twice the proportion among college graduates (5.0%, CI = 4.7--5.2). American Indians/Alaska Natives
and multiracial persons had substantially higher prevalences of a history of MI, angina/CHD, and one or more of these
conditions than did non-Hispanic whites. The prevalences of all of these conditions among whites and blacks were similar.
The prevalence of respondents with a history of MI ranged from 2.1% (CI = 1.5--2.9) in USVI to 6.1% (CI = 5.4--6.9)
in West Virginia. Puerto Rico (8.5%) and West Virginia (7.3%) had the highest prevalence of angina/CHD history;
Colorado (2.8%) and USVI (2.2%) had the lowest prevalence. The prevalence of any condition (MI, angina/CHD, or both)
ranged from 3.5% (CI = 2.7--4.5) in USVI to 10.4% (CI = 9.4--11.4) in West Virginia (Table 2). States and territories with
the highest prevalence of a history of any of the conditions had approximately twice the prevalence of those with the
lowest prevalence (Figure).
JR Neyer, KJ Greenlund, PhD, CH Denny, PhD,
NL Keenan, PhD, DR Labarthe, MD, PhD, JB Croft, PhD, Div for
Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.
This report describes the first state-based prevalence estimates of MI and angina/CHD. The overall
prevalence estimates in this report are comparable to previously published self-reported data on a national level
Substantial disparities by sex, race/ethnicity, and education were
observed in the prevalence of these heart conditions in the United
States in 2005. The results also suggest variation among states, with
an approximately twofold difference between states with the highest and
lowest prevalences. Many of the states with the highest prevalence were
clustered in the lower Mississippi and Ohio River valleys, areas that
have been documented previously as having high proportions of residents
with heart-disease risk factors (
6) and high heart-disease mortality
One important explanation for the geographic variation in heart-disease prevalence is variation in the proportion of
the population with heart-disease risk factors
6). A previous analysis suggested that up to 60% of the variation in state
heart-disease mortality is a result of differences in the prevalence of cardiovascular risk factors among states
7), which has been attributed to differences in cultural norms, lack of economic opportunity, poverty, and social isolation
studies that include small-area analyses, in-depth interviews, and more
precise race/ethnicity prevalence estimates, quality-of-care
assessments, and health outcomes might further define these differences
and lead to effective interventions.
The findings in this report are subject to at least four
limitations. First, BRFSS data are based on self-reported information
and are subject to recall bias. Second, BRFSS does not include persons
living in nursing homes, prisons, military bases, or other
institutions, populations whose inclusion might alter heart-disease
prevalence estimates for the entire population. Third, BRFSS is limited
to households with landline telephones and does not include persons
without telephones or who use cellular telephones exclusively. Finally,
although the BRFSS response rate was low, BRFSS data are considered
valid and reliable when compared with data from other surveys (
CDC has formed local, state, national, and international partnerships to control risk factors, reduce heart disease, and
attain the national health objectives described in
Healthy People 2010. For example, CDC has partnered with nearly 80
other organizations to form the National Forum for Heart Disease and Stroke Prevention. The forum is pursuing a
comprehensive agenda for achieving national goals for preventing heart disease and stroke
In addition, the CDC State Heart Disease and Stroke Prevention Program
funds health departments in 32 states and DC to support heart-disease
prevention through education, strategies to change physical and social
environments to decrease risk for heart disease, and elimination of
racial/ethnic disparities in heart-disease risk. CDC also funds 15
WISEWOMAN projects that provide low-income, underinsured, and uninsured
women aged 40--64 years with lifestyle interventions, referral
services, and screening for chronic-disease risk factors to prevent
cardiovascular disease; approximately 12,000 women have received
services through WISEWOMAN in the past 4 years.†
This report indicates that the prevalence of certain heart diseases varies between men and women, among various levels
of education achievement, among racial/ethnic groups, and among states and territories. These data can help health
planners (e.g., policy makers and public health officials) better target resources and can aid the development of more
tailored prevention programs for groups with disproportionately high heart-disease prevalence. The importance of preventing
controlling risk factors such as high blood pressure, high blood cholesterol, diabetes, tobacco use, physical inactivity,
and obesity to reduce the risk of heart disease is well-established
10). Measures should include prevention of risk factors,
early detection and control of risk factors, and reduction of risk in persons who have already received a diagnosis of heart
disease. Persons with known heart disease should have regular clinical follow-up and consultations to reduce their
heart-disease risk factors (
10). In addition, community- and state-level policies are needed to promote healthy lifestyles, help reduce
tobacco exposure, ensure access to healthy foods, establish
school and worksite heart-health education programs, and result in
an environment that is safe for and conducive to physical
The findings in this report are based on data provided by BRFSS state coordinators.
- Greenlund KJ, Giles WH, Keenan NL, et al. Heart disease
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- Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke
statistics---2007 update: a report from the American Heart Association
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- Lethbridge-Çejku M, Rose D, Vickerie J. Summary health statistics
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- Barnett E, Casper ML, Halverson JA, et al. Men and heart disease:
an atlas of racial and ethnic disparities in mortality. First edition.
Morgantown, WV: Office for Social Environment and Health Research, West
Virginia University; 2001. Available at http://www.cdc.gov/dhdsp/library/maps/cvdatlas/atlas_mens/mens_download.htm.
- Casper ML, Barnett E, Halverson JA, et al. Women and heart
disease: an atlas of racial and ethnic disparities in mortality. Second
edition. Morgantown, WV: Office for Social Environment and Health
Research, West Virginia University; 2000. Available at http://www.cdc.gov/dhdsp/library/maps/cvdatlas/atlas_womens/womens_download.htm.
- CDC. Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke. MMWR 2005;54:113--7.
- Byers T, Anda R, McQueen D, et al. The correspondence between
coronary heart disease mortality and risk factor prevalence among
states in the United States, 1991--1992. Prev Med 1998;27:311--6.
- Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA. Reliability
and validity of measures from the Behavioral Risk Factor Surveillance
System (BRFSS). Soz Praventivmed 2001;46(Suppl l):S3--42.
- CDC. A public health action plan to prevent heart disease and
stroke. Atlanta, GA: US Department of Health and Human Services, CDC;
2003. Available at http://www.cdc.gov/dhdsp/library/action_plan/index.htm.
- Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for
primary prevention of cardiovascular disease and stroke: 2002 update:
consensus panel guide to comprehensive risk reduction for adult
patients without coronary or other atherosclerotic vascular diseases.
American Heart Association Science Advisory and Coordinating Committee.
*Information regarding BRFSS data and methods is available at
† Additional information regarding the WISEWOMAN program is available at
§ American Heart Association Guide for
Improving Cardiovascular Health at the Community Level: A Statement for
Public Health Practitioners, Healthcare Providers, and Health Policy
Makers. Available at http://circ.ahajournals.org/cgi/reprint/107/4/645.