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Cardiovascular disease continues to be the leading cause of death for both men and women in the US, accounting for nearly 40% of all annual deaths.Among the various cardiovascular diseases, coronary artery disease is the single largest killer. Approximately every 26 seconds, an American will suffer a coronary event, and about every minute someone will die from one. Similar to all cardiovascular diseases, about 40% of those who experience a coronary event in a given year will die as a result of the event.

Just over 900,000 Americans die of cardiovascular diseases each year, which far exceeds the 555,000 deaths from cancer, the next leading annual cause of death.More than 70 million Americans currently live with a cardiovascular disease or roughly one out of three adults. The economic impact of cardiovascular diseases on our nation's healthcare system continues to grow as the population ages. Cardiovascular diseases are the cause of more than six million hospitalizations each year and are projected to cost US$403 billion in 2006, including healthcare expenditures and lost productivity from death and disability. Cardiovascular diseases contribute substantially to total healthcare expenditures which are increasing dramatically, from 13.8% of the gross domestic product in 1993 to 16.5% in 2006, and to an expected 20.0% by 2015.

Over the last five years, the importance of obesity and diabetes in the development of cardiovascular disease has been emphasized. Unfortunately, the prevalence of obesity continues to increase.An estimated 97 million adults in the US are overweight or obese. Surveys show that more than half of American adults do not participate in the recommended level of physical activity, and more than one-fourth are completely sedentary. People who are sedentary have twice the risk of heart disease as those who are physically active. Both excess body fat and physical inactivity predispose individuals to the most common form of diabetes, type 2 diabetes.The increasing prevalence of type 2 diabetes cannot be separated from the rising prevalence of obesity and physical inactivity in our society. At least 10.3 million Americans carry a diagnosis of diabetes mellitus. Another 5.4 million are estimated to have undiagnosed diabetes. Epidemiological and pathological data documents that diabetes is an independent risk factor for cardiovascular disease in both men and women.

Although these statistics are sobering, progress is being made. From 1993 to 2003, the death rates from cardiovascular disease declined 22.1%. In the same 10-year period actual number of deaths attributed to cardiovascular disease declined 4.6%. This progress can be attributed to many of the new diagnostic tools and therapies which are outlined in this issue of US Cardiovascular Disease 2006.

At the same time, there are substantial efforts to improve the quality of medical care in the US. Unfortunately, the healthcare industry remains in its awkward adolescence regarding the implementation of proven quality initiatives as encouraged by the Institute of Medicine, the Institute of Healthcare Improvement, and others. The challenge moving forward will be to appropriately integrate these new diagnostic tools and therapies into everyday practice to improve patient outcomes and enhance the quality of patient care in the US.