Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

Abstract

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

Methods: The American Heart Association, through its Epidemiology and Prevention 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 annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Keywords: AHA Scientific Statements; cardiovascular diseases; epidemiology; risk factors; statistics; stroke.

Figure.. AHA’s My Life Check—Life’s Essential 8.

Source: Reprinted from Lloyd-Jones et al. Copyright © 2022, American Heart Association, Inc.

Chart 3-1.. Prevalence (percent) of tobacco use in the United States in the past 30 days by product,* school level, sex, and race and ethnicity† (NYTS, 2021).

A, High school students. B, Middle school students. E-cigarette indicates electronic cigarette; and NYTS, National Youth Tobacco Survey. *Past 30-day use of e-cigarettes was determined by asking “During the past 30 days, on how many days did you use e-cigarettes?” Past 30-day use of cigarettes was determined by asking “During the past 30 days, on how many days did you smoke cigarettes?” Past 30-day use of cigars was determined by asking “During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?” Smokeless tobacco was defined as use of chewing tobacco, snuff, dip, snus, or dissolvable tobacco products. Past 30-day use of smokeless tobacco was determined by asking the following question: “During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, snus, or dissolvable products?” Responses from these questions were combined to derive overall smokeless tobacco use. Past 30-day use of hookahs was determined by asking “During the past 30 days, on how many days did you smoke tobacco in a hookah or water pipe?” Past 30-day use of pipe tobacco (not hookahs) was determined by asking “In the past 30 days, on how many days did you smoke pipes filled with tobacco?” Because of missing data on the past 30-day use questions, denominators for each tobacco product might be different. †Black people, White people, and people of other race are non-Hispanic; Hispanic people could be of any race. ‡In 2021, any tobacco product use was defined as use of any tobacco product (e-cigarettes, cigarettes, cigars [cigars, cigarillos, or little cigars], smokeless tobacco [chewing tobacco, snuff, or dip, snus, or dissolvable tobacco products], hookahs, pipe tobacco, nicotine pouches, bidis [small brown cigarettes wrapped in a leaf], or heated tobacco products) on ≥1 day during the past 30 days. §Any combustible tobacco product use was defined as use of cigarettes, cigars (cigars, cigarillos, or little cigars), hookahs, pipe tobacco, or bidis on ≥1 day during the past 30 days. ∥In 2021, multiple tobacco product use was defined as use of ≥2 tobacco products (e-cigarettes, cigarettes, cigars [cigars, cigarillos, or little cigars], smokeless tobacco [chewing tobacco, snuff, or dip, snus, or dissolvable tobacco products], hookahs, pipe tobacco, nicotine pouches, bidis, or heated tobacco products) on ≥1 day during the past 30 days. Source: Data derived from Gentzke et al.

Chart 3-2.. Age-adjusted prevalence (percent) of current cigarette smoking for US adults by state (BRFSS, 2020).

White space between the map and legend has been removed. Icons and drop-down menus for interactive tools have been removed. BRFSS indicates Behavior Risk Factor Surveillance System. Source: BRFSS prevalence and trends data.

Chart 3-3.. Prevalence (age-adjusted) of current electronic cigarette use, United States (BRFSS, 2017).

White space between the map and legend has been removed. Icons and drop-down menus for interactive tools have been removed. BRFSS indicates Behavior Risk Factor Surveillance System. Source: BRFSS prevalence and trends data.

Chart 3-4.. Past-month cigarette use among US youths in NSDUH and MTF: 2002 to 2019.

MTF indicates Monitoring the Future; and NSDUH, National Survey on Drug Use and Health. Source: Reprinted from NSDUH.^,

Chart 3-5.. Age-standardized global mortality rates attributable to tobacco per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 4-1.. Percentage of US youth 6 to 11 and 12 to 17 years of age who were physically active for at least 60 minutes, 2019 to 2020.

Error bars represent 95% CIs. Source: Data derived from National Survey of Children’s Health.

Chart 4-2.. Percentage of US youth in grades 9 to 12 who met both aerobic and muscle strengthening PA recommendations, 2011 to 2019.

PA indicates physical activity. Source: Data derived from Youth Risk Behavior Survey.

Chart 4-3.. Percentage of US students in grades 9 through 12 who played video or computer games or used a computer* for ≥3 hours on an average school day, overall and by sex and race and ethnicity, 2019.

Error bars represent 95% CIs. *Counts time spent playing games, watching videos, texting, or using social media on their smartphone, computer, Xbox, PlayStation, iPad, or other tablet for something that was not schoolwork. Source: Data derived from Youth Risk Behavior Surveillance System.

Chart 4-4.. Percentage of US students in grades 9 through 12 who watched television for ≥3 hours on an average school day, overall and by sex and race and ethnicity, 2019.

Error bars represent 95% CIs. Source: Data derived from Youth Risk Behavior Surveillance System.

Chart 4-5.. Percentage meeting the aerobic PA guidelines among US adults ≥18 years of age, overall and by sex and race and ethnicity, 2018.

Percentages are age adjusted. The aerobic guidelines of the 2018 Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time PA for ≥150 min/wk, vigorous activity for ≥75 min/wk, or an equivalent combination. Error bars represent 95% CIs. NH indicates non-Hispanic; and PA, physical activity. Source: Data derived from National Health Interview Survey.

Chart 4-6.. Prevalence of self-reported physical inactivity among US adults ≥18 years of age by state and territory, 2017 to 2020.

States in white had insufficient data, defined as a sample size <50, a relative SE ≥30%, or no data in at least 1 year. Source: Reprinted from Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System.

Chart 4-7.. Trends in the percentage of physical inactivity among US adults ≥18 years of age, overall and by sex, 1998 to 2018.

Data are age adjusted to the year 2000 standard population for adults ≥18 years of age. Physical inactivity is defined as reporting no engagement in leisure-time physical activity in bouts lasting ≥10 minutes. Source: Data derived from Healthy People 2020 using the National Health Interview Survey.

Chart 4-8.. Percentage meeting the aerobic PA guidelines among US adults ≥25 years of age, by educational attainment, 2018.

Data are age adjusted to the year 2000 standard population for adults ≥18 years of age. The 2018 Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time PA for ≥150 min/wk, vigorous activity for ≥75min/wk, or an equivalent combination (eg, aerobic guideline). The 2018 Physical Activity Guidelines for Americans also recommend engaging in muscle-strengthening activities ≥2 d/wk (eg, muscle-strengthening guideline). Error bars represent 95% CIs. PA indicates physical activity. Source: Data derived from Healthy People 2020 using the National Health Interview Survey.

Chart 4-9.. Presence of health-promoting amenities and detracting elements in neighborhoods of US youth 0 to 17 years of age, 2019 to 2020.

Error bars represent 95% CIs. Health-promoting amenities included parks, recreation centers, sidewalks, and libraries. Health-detracting elements included litter or garbage on the street or sidewalk, poorly kept or rundown housing, and vandalism such as broken windows or graffiti. Source: Data derived from National Survey of Children’s Health.

Chart 4-10.. Age-standardized global mortality rates attributable to low PA per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and PA, physical activity. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 5-1.. Estimated mean sodium intake, by 24-hour urinary excretion, United States, 2013 to 2014.

Estimates based on nationally representative sample of 827 nonpregnant, noninstitutionalized US adults 20 to 69 years of age who completed a 24-hour urine collection in NHANES 2013 to 2014. NHANES indicates National Health and Nutrition Examination Survey. Source: Data derived from Cogswell et al using NHANES.

Chart 5-2.. Sources of sodium intake in adults in 3 geographic regions in the United States, 2013 to 2014.

Sources of sodium intake were determined by four 24-hour dietary recalls with special procedures in which duplicate samples of salt added to food at the table and in home food preparation were collected in 450 adults recruited in 3 geographic regions (Birmingham, AL; Palo Alto, CA; and Minneapolis–St. Paul, MN) with equal numbers of males and females from 4 racial and ethnic groups (Asian, Black, Hispanic, and non-Hispanic White individuals). Source: Reprinted from Harnack et al. Copyright © 2017 American Heart Association, Inc.

Chart 5-3.. Trends in use of MVMM, vitamin D, and n-3 fatty acid supplements among adults in the United States (NHANES, 1999-2012).

MVMM indicates multivitamin/mineral; and NHANES, National Health and Nutrition Examination Survey. Source: Data derived from Kantor et al.

Chart 5-4.. Age-standardized global mortality rates attributable to dietary risks per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 6-1.. Prevalence of obesity among youth 2 to 19 years of age by sex, race, and Hispanic origin, United States, 2017 to March 2020.

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NHANES, National Health and Nutrition Examination Survey; and NH, non-Hispanic Source: Unpublished tabulation using NHANES.

Chart 6-2.. Trends in obesity among children and adolescents 2 to 19 years of age by age, United States, 1963 to 1965 through 2017 to 2018.

Source: Reprinted from Fryar et al using National Health and Nutrition Examination Survey.

Chart 6-3.. Age-adjusted prevalence of obesity among adults ≥20 years of age by sex, race, and Hispanic origin, United States, 2017 to March 2020.

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NHANES, National Health and Nutrition Examination Survey; and NH, non-Hispanic. Source: Unpublished tabulation using NHANES.

Chart 6-4.. Prevalence of obesity among adults ≥20 years of age by age and sex, United States, 2017 to 2018.

Source: Reprinted from Hales et al using National Health and Nutrition Examination Survey.

Chart 6-5.. Age-adjusted prevalence of severe obesity among adults ≥20 years of age, by sex, race, and Hispanic origin, United States, 2017 to March 2020.

In March 2020, the COVID-19 pandemic halted NHANES field operations. As data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NHANES, National Health and Nutrition Examination Survey; and NH, non-Hispanic. Source: Unpublished tabulation using NHANES.

Chart 6-6.. Age-adjusted prevalence of obesity (body mass index ≥30 kg/m²) for US adults ≥18 years of age, United States, 2020.

White space and drop-down menus have been removed from the original chart. Source: Reprinted from Centers for Disease Control and Prevention, Obesity Prevalence Map using Behavioral Risk Factor Surveillance System prevalence and trends data.

Chart 6-7.. Age-adjusted prevalence of obesity and severe obesity in US adults.

A, Men. B, Women. Source: Reproduced with permission from Ogden et al. Copyright © 2020 American Medical Association. All rights reserved.

Chart 6-8.. Age-standardized global rates of DALYs attributable to high body mass index per 100 000, both sexes, 2019.

DALY indicates disability-adjusted life-year. Source: Reprinted from Roth et al. Copyright 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Chart 6-9.. Age-standardized global mortality rates attributable to high body mass index per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 7-1.. Proportions of US youth with guideline-defined high (or, for HDL-C, low) and acceptable lipid levels in the period of 1999 to 2016, NHANES.

A, High (or for HDL-C, low) lipid levels. B, Acceptable lipid levels. TC, HDL-C, and non–HDL-C are shown for all youth 6 to 19 years of age, and triglycerides, LDL-C, and any/all lipids plus apoB are shown for fasting adolescents 12 to 19 years of age. A, For high (or, for HDL-C, low) lipid levels, the earlier and later periods shown for each lipid are as follows: 1999 to 2006 and 2009 to 2016 for TC; 2007 to 2010 and 2013 to 2016 for HDL-C; 2007 to 2010 and 2013 to 2016 for non–HDL-C; 1999 to 2006 and 2007 to 2014 for triglycerides; 1999 to 2006 and 2007 to 2014 for LDL-C; 2007 to 2010 and 2013 to 2016 for any of TC, HDL-C, or non–HDL-C; and 2007 to 2010 and 2011 to 2014 for any lipid or apoB. B, For acceptable lipid levels, the earlier and later periods shown for each lipid are as follows: 1999 to 2000 and 2015 to 2016 for TC; 2007 to 2008 and 2015 to 2016 for HDL-C; 2007 to 2008 and 2015 to 2016 for non–HDL-C; 1999 to 2000 and 2013 to 2014 for triglycerides; 1999 to 2000 and 2013 to 2014 for LDL-C; 2007 to 2008 and 2015 to 2016 for TC, HDL-C, and non–HDL-C; and 2007 to 2008 and 2013 to 2014 for all lipids and apoB. High (or, for HDL-C, low) and acceptable levels were defined according to the 2011 National Heart, Lung, and Blood Institute pediatric guideline as follows: for TC, ≥200 and <170 mg/dL, respectively; for LDL-C, ≥130 and <110 mg/dL; for HDL-C, <40 and >45 mg/dL; for non–HDL-C, ≥145 and <120 mg/dL; for triglycerides, ≥130 and <90 mg/dL; and for apoB, ≥110 and <90 mg/dL. apoB indicates apolipoprotein B; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey; and TC, total cholesterol. Source: Data derived from Perak et al.

Chart 7-2.. Age-adjusted trends in mean serum TC among US adults ≥20 years of age by race and ethnicity and survey year (NHANES 1999–2002, 2007–2010, and 2017–2020).

Values are in milligrams per deciliter. In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and TC, total cholesterol. *Data for the category of Mexican American people were consistently collected in all NHANES years, but the combined category of Hispanic people was used starting only in 2007. Consequently, for long-term trend data, the category of Mexican American people is used. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 7-3.. Age-adjusted trends in the prevalence of serum TC ≥200 mg/dL in US adults ≥20 years of age by race and ethnicity, sex, and survey year (NHANES 2013–2016 and 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and TC, total cholesterol. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 7-4.. Age-adjusted trends in the prevalence of serum TC ≥240 mg/dL in US adults ≥20 years of age, by race and ethnicity, sex, and survey year (NHANES 2013–2016 and 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and TC, total cholesterol. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 7-5.. Age-standardized global mortality rates attributable to high LDL-C per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and LDL-C, low-density lipoprotein cholesterol. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 8-1.. Prevalence of hypertension in US adults ≥20 years of age by sex and age (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Hypertension is defined in terms of NHANES BP measurements and health interviews. A person was considered to have hypertension if he or she had SBP ≥130 mm Hg or DBP ≥80 mm Hg, if he or she said “yes” to taking antihypertensive medication, or if the person was told on 2 occasions that he or she had hypertension. BP indicates blood pressure; COVID-19, coronavirus disease 2019; DBP, diastolic blood pressure; NHANES, National Health and Nutrition Examination Survey; and SBP, systolic blood pressure. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 8-2.. Age-adjusted prevalence trends for hypertension in US adults ≥20 years of age by race and ethnicity, sex, and survey year (NHANES 1999–2002, 2007–2010, and 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Hypertension is defined in terms of NHANES BP measurements and health interviews. A person was considered to have hypertension if he or she had SBP ≥130 mm Hg or DBP ≥80 mm Hg or if he or she said “yes” to taking antihypertensive medication. BP indicates blood pressure; COVID-19, coronavirus disease 2019; DBP, diastolic blood pressure; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and SBP, systolic blood pressure. *The category of Mexican American people was consistently collected in all NHANES years, but the combined category of Hispanic people was used only starting in 2007. Consequently, for long-term trend data, the category of Mexican American people is used. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 8-3.. Extent of awareness, treatment, and control of HBP by race and ethnicity, United States (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Hypertension is defined in terms of NHANES BP measurements and health interviews. A person was considered to have hypertension if he or she had SBP ≥130 mm Hg or DBP ≥80 mm Hg or if he or she said “yes” to taking antihypertensive medication. BP indicates blood pressure; COVID-19, coronavirus disease 2019; DBP, diastolic blood pressure; HBP, high blood pressure; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and SBP, systolic blood pressure. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 8-4.. Extent of awareness, treatment, and control of HBP by age, United States (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Hypertension is defined in terms of NHANES BP measurements and health interviews. A person was considered to have hypertension if he or she had SBP ≥130 mm Hg or DBP ≥80 mm Hg or if he or she said “yes” to taking antihypertensive medication. BP indicates blood pressure; COVID-19, coronavirus disease 2019; DBP, diastolic blood pressure; HBP, high blood pressure; NHANES, National Health and Nutrition Examination Survey; and SBP, systolic blood pressure. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 8-5.. Extent of awareness, treatment, and control of HBP by race and ethnicity and sex, United States (NHANES, 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Hypertension is defined in terms of NHANES BP measurements and health interviews. A person was considered to have hypertension if he or she had SBP ≥130 mm Hg or DBP ≥80 mm Hg or if he or she said “yes” to taking antihypertensive medication. BP indicates blood pressure; COVID-19, coronavirus disease 2019; DBP, diastolic blood pressure; HBP, high blood pressure; NH, non-Hispanic; NHANES, National Health and Nutrition Examination Survey; and SBP, systolic blood pressure. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 8-6.. Age-standardized global mortality rates attributable to high SBP per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and SBP, systolic blood pressure. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 9-1.. Age-adjusted prevalence of diagnosed diabetes in US adults ≥20 years of age by race and ethnicity and sex (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NH, non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 9-2.. Age-adjusted prevalence of diagnosed diabetes in US adults ≥20 years of age by race and ethnicity and years of education (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. COVID-19 indicates coronavirus disease 2019; NH, non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 9-3.. Age-adjusted percentage of adults with diagnosed diabetes, US states and territories, 2020.

Reprinted image has been altered to remove background colors, white space, and page headers and footers. Source: Reprinted from Behavioral Risk Factor Surveillance System prevalence and trends data.

Chart 9-4.. Incidence of type 1 and type 2 diabetes overall and by race and ethnicity among US youths ≤19 years of age (SEARCH study, 2002–2015).

Models included a change point at the year 2011 to compare trends in incidence rates between 2002 to 2010 and 2011 to 2015. People who were AI were from primarily 1 southwestern tribe. SEARCH includes data on youths (<20 years of age) in Colorado (all 64 counties plus selected Indian reservations in Arizona and New Mexico under the direction of Colorado), Ohio (8 counties), South Carolina (all 46 counties), and Washington (5 counties) and in California for Kaiser Permanente Southern California health plan enrollees in 7 counties. AI indicates American Indian; API, Asian/Pacific Islander; and SEARCH, Search for Diabetes in Youth. Source: Reprinted from Divers et al.

Chart 9-5.. Prevalence of diagnosed and undiagnosed diabetes in US adults ≥20 years of age by sex (NHANES 1988–1994 and 2017-2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. The definition of diabetes changed in 1997 (from glucose ≥140 to ≥126 mg/dL). COVID-19 indicates coronavirus disease 2019; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 9-6.. Awareness, treatment, and control of diabetes in US adults ≥20 years of age (NHANES 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. Controlled is defined as currently treated (taking insulin or diabetic pills to lower blood sugar) and fasting glucose <126 mg/dL. Uncontrolled is defined as currently treated (taking insulin or diabetic pills to lower blood sugar) and fasting glucose ≥126 mg/dL. COVID-19 indicates coronavirus disease 2019; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 9-7.. Trends in age-standardized hospitalization rates for diabetes-related complications among US adults ≥18 years of age from 2000 to 2016.

A, Data include the population with diabetes. B, Data include the general population (with or without diabetes). Age adjustment is to the 2000 US standard population using age groups <45, 45 to 64, 65 to 74, and ≥75 years of age. Source: Centers for Disease Control and Prevention Diabetes Atlas using data from Healthcare Cost and Utilization Project and National Health Interview Survey.

Chart 9-8.. Age-standardized global prevalence rates of diabetes per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 9-9.. Age-standardized global mortality rates attributable to high FPG per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. High FPG is defined as serum fasting plasma glucose of >4.8 to 5.4 mmol/L. FPG indicates fasting plasma glucose; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 9-10.. Age-standardized global mortality rates of diabetes per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 10-1.. Prevalence of MetS by sex and US region among adolescents 12 to 19 years of age (NHANES, 1999–2014).

MetS indicates metabolic syndrome; and NHANES, National Health and Nutrition Examination Survey. Source: Data derived from DeBoer et al.

Chart 10-2.. Age-standardized prevalence of MetS by age and sex in Hispanic/Latino people in HCHS/SOL, United States, 2008 to 2011.

Values were weighted for survey design and nonresponse and were age standardized to the population described by the 2010 US census. HCHS/SOL indicates Hispanic Community Health Study/Study of Latinos; and MetS, metabolic syndrome. Source: Data derived from Heiss et al.

Chart 10-3.. Prevalence of MetS in US youth (NHANES, 1999–2012).

ATP-III indicates Adult Treatment Panel III; BMI, body mass index; Carbs, carbohydrates; HDL, high-density lipoprotein; MetS, metabolic syndrome; and NHANES, National Health and Nutrition Examination Survey. Source: Reproduced with permission from Lee et al. Copyright © 2016 American Academy of Pediatrics.

Chart 10-4.. Prevalence of MetS among US adults using the harmonized MetS criteria (NHANES, 2009–2018).

MetS was defined using the criteria agreed to jointly by the International Diabetes Federation; the National Heart, Lung, and Blood Institute; the American Heart Association; the World Heart Federation; the International Atherosclerosis Society; and the International Association for the Study of Obesity. MetS indicates metabolic syndrome; NH, non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: Data courtesy of Junxiu Liu using NHANES.

Chart 10-5.. Sex-stratified trends in the age-adjusted weighted prevalence of MetS using ATP III criteria and its components among US adults (NHANES, 2007–2014).

MetS was defined using modified National Cholesterol Education Program–ATP III criteria. ATP III indicates Adult Treatment Panel III; HDL, high-density lipoprotein; MetS, metabolic syndrome; and NHANES, National Health and Nutrition Examination Survey. *P_trend<0.05. **P_trend=0.05 after adjustment for age, sex, and race, as appropriate. Source: Reprinted from Shin et al with permission from Elsevier. Copyright © 2018 Elsevier.

Chart 10-6.. Ten-year progression of MetS in the ARIC study, stratified by age, sex, and race and ethnicity, United States, 1987 to 1998.

A, African American females. B, White females. C, African American males. D, White males. Data obtained from visit 1 (1987–1989), visit 2 (1990–1992), visit 3 (1993–1995), and visit 4 (1996–1998). ARIC indicates Atherosclerosis Risk in Communities; and MetS, metabolic syndrome. Source: Data derived from Vishnu et al.

Chart 10-7.. Age-standardized prevalence of MetS and MHO among obese (body mass index ≥30 kg/m²) people in different European cohorts, 1995 to 2012 (global data).

A, Males. B, Females. CHRIS indicates Collaborative Health Research in South Tyrol Study; DILGOM, Dietary, Lifestyle, and Genetics Determinants of Obesity and Metabolic Syndrome; EGCUT, Estonian Genome Center of the University of Tartu; HUNT2, Nord-Trøndelag Health Study; KORA, Cooperative Health Research in the Region of Augsburg; MetS, metabolic syndrome; MHO, metabolically healthy obesity; MICROS, Microisolates in South Tyrol Study; NCDS, National Child Development Study; NL, the Netherlands; and PREVEND, Prevention of Renal and Vascular End-Stage Disease. Source: Reprinted from van Vliet-Ostaptchouk et al. Copyright © 2014 van Vliet-Ostaptchouk et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

Chart 10-8.. Estimated pooled prevalence* of MetS in countries in the Middle East (2001–2018).

MetS indicates metabolic syndrome; and UA, United Arab. *Pooled prevalence estimates obtained with the random-effects model. Source: Data derived from Ansari-Moghaddam et al.

Chart 11-1.. Adjusted odds ratios for any APO, by prepregnancy BMI and gestational weight gain categories.

Estimates are based on a meta-analysis of individual participant data from 265 270 females from 39 European, North American, and Oceanic cohort studies. APOs include HDP (gestational hypertension or preeclampsia), gestational diabetes, PTB (<37 weeks’ gestation), small (birth weight <10th percentile) or large (birth weight >90th percentile) size for sex, and gestational age at birth. Prepregnancy BMI categories are as follows: underweight, <18.5 kg/m²; normal weight, 18.5 to 24.9 kg/m²; overweight, 25.0 to 29.9 kg/m²; and obesity, ≥30 kg/m². Gestational weight gain values corresponding to the SD cutoffs were not provided by the source, but the median gestational weight gain was 14.0 kg (95% CI, 3.9–27.0). APO indicates adverse pregnancy outcome; BMI, body mass index; HDP, hypertensive disorders of pregnancy; and PTB, preterm birth. Source: Data derived from Santos et al.

Chart 11-2.. Trends in the rates of hypertensive disorders per 10 000 delivery hospitalizations, United States, 1993 to 2014.

Source: Reprinted from Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.

Chart 11-3.. State-level rates of de novo hypertension in pregnancy per 1000 live births, United States, 2019.

Unadjusted rates are calculated for each state based on 3 736 144 females 15 to 44 years of age with a live birth. Source: Unpublished map using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.

Chart 11-4.. Standardized* prevalence of gestational diabetes among females who had a live birth by state, United States, 2016.

NYC indicates New York City. *Standardized to age and race and ethnicity distribution of US resident females with a live birth in 2012. Source: Reprinted from Deputy et al.

Chart 11-5.. Trends in the rates of PTB by gestational age (weeks) in the United States by maternal race and ethnicity, 2016 to 2018.

PTB indicates preterm birth. Source: Data derived from Martin et al.

Chart 11-6.. Trends in the rates of infants with LBW (<2500 g) in the United States by race and ethnicity of females with a live birth, 2016 to 2018.

LBW indicates low birth weight. Source: Data derived from Martin et al.

Chart 11-7.. Total, early, and late fetal mortality rates, United States, 2000 to 2012.

Total fetal mortality rate is the number of fetal deaths at ≥20 weeks of gestation per 1000 live births and fetal deaths. Early fetal mortality rate is the number of fetal deaths at 20 to 27 weeks per 1000 live births and fetal deaths at 20 to 27 weeks. Late fetal mortality rate is the number of fetal deaths at ≥28 weeks of gestation per 1000 live births and fetal deaths at ≥28 weeks of gestation. Source: Reprinted from Gregory et al.

Chart 11-8.. Late fetal mortality rates, United States, 2014 to 2016.

Late fetal mortality rate is the number of fetal deaths at ≥28 weeks of gestation per 1000 live births and fetal deaths at ≥28 weeks of gestation. Source: Data derived from Gregory et al.

Chart 11-9.. Global incidence rates of maternal hypertensive disorders per 100 000 females, 15 to 49 years of age, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 11-10.. Global incidence rates of neonatal PTB per 100 000, both sexes, at birth, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and PTB, preterm birth. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 12-1.. Percentage of NHANES participants within the KDIGO CKD risk categories defined by eGFR and ACR, United States, 2015 to 2018.

Green=low risk; yellow=moderately high risk; orange=high risk; red=very high risk. ACR indicates urinary albumin-to-creatinine ratio; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; and NHANES, National Health and Nutrition Examination Survey. Source: Reprinted from 2021 United States Renal Data System Annual Data Report, volume 1, Table 1.1, using NHANES 2015 to 2018.

Chart 12-2.. Temporal trends in ESRD prevalence by race and ethnicity, United States, 2000 to 2019.

Prevalence estimates are presented as cases per million people and are adjusted for age, sex, race, and ethnicity. ESRD indicates end-stage renal disease. Source: Reprinted from 2021 United States Renal Data System Annual Data Report, volume 2, Figure 1.8.

Chart 12-3.. Use of home dialysis among prevalent cases, 2009 to 2019.

Source: Reprinted from 2021 United States Renal Data System Annual Data Report, volume 2, Figure 2.1a.

Chart 12-4.. Temporal trends in ESRD incidence, United States, 2000 to 2019.

A, Incidence by sex. B, Incidence by race and ethnicity. Incidence estimates are presented as cases per million people and are adjusted for age, sex, race, and ethnicity. ESRD indicates end-stage renal disease. Source: Reprinted from 2021 United States Renal Data System Annual Data Report, volume 2, Figure 1.4.

Chart 12-5.. Prevalence of CKD, overall and by CKD category, among Medicare beneficiaries ≥66 years of age, United States, 1999 to 2018.

CKD indicates chronic kidney disease. Source: Reprinted from 2020 United States Renal Data System Annual Data Report, volume 1, Figure 2.1.

Chart 12-6.. Prevalence of reduced eGFR and ACR in NHANES, United States, 2003 to 2018.

A, Prevalence of eGFR by stage. B, Prevalence of ACR by category. eGFR stages 1 through 5. Adjusted for age, sex, and race; singlesample calibrated estimates of ACR; eGFR calculated with the Chronic Kidney Disease Epidemiology Collaboration equation. ACR indicates albumin-to-creatinine ration; eGFR, glomerular filtration rate; and NHANES, National Health and Nutrition Examination Survey. Source: Reprinted from 2020 United States Renal Data System Annual Data Report, volume 1, Figures 1.1 and 1.3, using NHANES data 2003 to 2006, 2007 to 2010, 2011 to 2014, and 2015 to 2018. 000

Chart 12-7.. Age-standardized global prevalence rates for CKD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. CKD indicates chronic kidney disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 12-8.. Age-standardized global mortality rates for CKD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. CKD indicates chronic kidney disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 12-9.. Adjusted prevalence of common CVDs in Medicare beneficiaries ≥66 years of age, by CKD status and stage, United States, 2018.

Special analyses, Medicare 5% sample. AF indicates atrial fibrillation; AMI, acute myocardial infarction; CAD, coronary artery disease; CKD, chronic kidney disease; CVA, cerebrovascular accident; CVD, cardiovascular disease; HF, heart failure; PAD, peripheral artery disease; PE, pulmonary embolism; SCA, sudden cardiac arrest; TIA, transient ischemic attack; VHD, valvular heart disease; and VTE, venous thromboembolism. Source: Reprinted from 2020 United States Renal Data System Annual Data Report, volume 1, Figure 4.2.

Chart 12-10.. Unadjusted prevalence of common CVDs in adult patients with ESRD, by treatment modality, United States, 2018.

AF indicates atrial fibrillation; AMI, acute myocardial infarction; CAD, coronary artery disease; CVA, cerebrovascular accident; CVD, cardiovascular disease; ESRD, end-stage renal disease; HD, hemodialysis; HF, heart failure; KTx, kidney transplant recipients; PAD, peripheral artery disease; PD, peritoneal dialysis; PE, pulmonary embolism; SCA, sudden cardiac arrest; TIA, transient ischemic attack; VHD, valvular heart disease; and VTE, venous thromboembolism. Source: Reprinted from 2020 United States Renal Data System Annual Data Report, volume 2, Figure 8.1.

Chart 12-11.. Survival probability in older adults after hospital admission for CAD, by CKD status and stage, United States, 2017 to 2019.

Older adults: age ≥66 years. CAD indicates coronary artery disease; and CKD indicates chronic kidney disease. Source: Reprinted from 2021 United States Renal Data System Annual Data Report, volume 2, Figure 3.7.

Chart 12-12.. US HF hospitalization rates among those with CKD based on eGFR and albuminuria.

Unadjusted rates of HF admissions across by level of kidney function among participants with CKD. CKD indicates chronic kidney disease; eGFR, estimated glomerular filtration rate; HF, heart failure; and uACR, urine albumin-to-creatinine ratio. Source: Reprinted from Bansal et al, Central Illustration, with permission from the American College of Cardiology Foundation. Copyright © 2019 American College of Cardiology Foundation.

Chart 13-1.. Prevalence of reporting sleep duration <7 h/night in US adults by sex and age, 2020.

Percentages are adjusted for complex sampling design, including primary sampling units, strata, and sampling weights. The survey question was, “On average, how many hours of sleep do you get in a 24-hour period?” Source: Unpublished tabulation using Behavioral Risk Factor Surveillance Survey.

Chart 13-2.. Prevalence of reporting being well rested never or some days by sex and age, 2020.

Percentages are adjusted for complex sampling design, including primary sampling units, strata, and sampling weights. The survey question was, “During the past 30 days, how often did you wake up feeling well rested?” Source: Unpublished tabulation using National Health Interview Survey.

Chart 13-3.. Prevalence of reporting difficulty falling asleep or maintaining sleep never, some, or most/all days in US adults by age, 2020.

Percentages are age adjusted for complex sampling design, including primary sampling units, strata, and sampling weights. The survey questions were, “During the past 30 days, how often did you have difficulty falling asleep?” and “During the past 30 days, how often did you have difficulty maintaining sleep?” Source: Unpublished tabulation using National Health Interview Survey.

Chart 13-4.. Prevalence of reporting sleep duration <7 h/night in US adults by sex and race, 2020.

Percentages are adjusted for complex sampling design, including primary sampling units, strata, and sampling weights. The survey question was, “On average, how many hours of sleep do you get in a 24-hour period?” NH indicates non-Hispanic. Source: Unpublished tabulation using Behavioral Risk Factor Surveillance Survey.

Chart 14-1.. Prevalence of CVD in US adults ≥20 years of age by age and sex (NHANES, 2017–2020).

These data include CHD, HF, stroke, and with and without hypertension. CHD indicates coronary heart disease; CVD, cardiovascular disease; HF, heart failure; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 14-2.. Deaths attributable to diseases of the heart, United States, 1900 to 2020.

See Glossary (Chapter 30) for an explanation of diseases of the heart. In the years 1900 to 1920, the ICD codes were 77 to 80; for 1925, 87 to 90; for 1930 to 1945, 90 to 95; for 1950 to 1960, 402 to 404 and 410 to 443; for 1965, 402 to 404 and 410 to 443; for 1970 to 1975, 390 to 398 and 404 to 429; for 1980 to 1995, 390 to 398, 402, and 404 to 429; and for 2000 to 2019, I00 to I09, I11, I13, and I20 to I51. Before 1933, data are for a death registration area, not the entire United States. In 1900, only 10 states were included in the death registration area, and this increased over the years, so part of the increase in numbers of deaths is attributable to an increase in the number of states. ICD indicates International Classification of Diseases. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-3.. Deaths attributable to CVD, United States, 1900 to 2020.

CVD (ICD-10 codes I00–I99) does not include congenital heart disease. Before 1933, data are for a death registration area, not the entire United States. CVD indicates cardiovascular disease; and ICD-10, International Classification of Diseases, 10th Revision. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-4.. Percentage breakdown of deaths attributable to CVD, United States, 2020.

Total may not add to 100 because of rounding. CHD includes ICD-10 codes I20 to I25; stroke, I60 to I69; HF, I50; HBP, I10 to I15; diseases of the arteries, I70 to I78; and other, all remaining ICD-I0 I categories. CHD indicates coronary heart disease; CVD, cardiovascular disease; HBP, high blood pressure; HF, heart failure; and ICD-10, International Classification of Diseases, 10th Revision. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-5.. CVD and other major causes of death for NH White males and females, United States, 2020.

Diseases included CVD (ICD-10 codes I00–I99); cancer (C00–C97); CLRD (J40–J47); COVID-19 (U07.1); accidents (V01–X59 and Y85–Y86); and AD (G30). AD indicates Alzheimer disease; CLRD, chronic lower respiratory disease; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; ICD-10, International Classification of Diseases, 10th Revision; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-6.. CVD and other major causes of death for NH Black males and females, United States, 2020.

Diseases included CVD (ICD-10 codes I00–I99); cancer (C00–C97); COVID-19 (U07.1); accidents (V01–X59, Y85, and Y86); assault (homicide; U01, U02, X85–Y09, and Y87.1); and diabetes (E10–E14). CLRD indicates chronic lower respiratory disease; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; ICD-10, International Classification of Diseases, 10th Revision; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-7.. CVD and other major causes of death for Hispanic or Latino males and females, United States, 2020.

Number of deaths shown may be lower than actual because of underreporting in this population. Diseases included CVD (ICD-10 codes I00–I99); COVID-19 (U07.1); cancer (C00–C97); accidents (V01–X59 and Y85–Y86); diabetes (E10–E14); and AD (G30). AD indicates Alzheimer disease; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; and ICD-10, International Classification of Diseases, 10th Revision. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-8.. CVD and other major causes of death for NH Asian or Pacific Islander males and females, United States, 2020.

Asian or Pacific Islander is a heterogeneous category that includes people at high CVD risk (eg, South Asian people) and people at low CVD risk (eg, Japanese people). More specific data on these groups are not available. Number of deaths shown may be lower than actual because of underreporting in this population. Diseases included CVD (ICD-10 codes I00–I99); cancer (C00–C97); COVID-19 (U07.1); accidents (V01–X59, Y85, and Y86); diabetes (E10–E14); and AD (G30). AD indicates Alzheimer disease; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; ICD-10, International Classification of Diseases, 10th Revision; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-9.. CVD mortality trends for US males and females, 1980 to 2020.

CVD excludes congenital cardiovascular defects (ICD-10 codes I00–I99). The overall comparability for CVD between ICD-9 (1979–1998) and ICD-10 (1999–2015) is 0.9962. No comparability ratios were applied. CVD indicates cardiovascular disease; ICD-9, International Classification of Diseases, 9th Revision; and ICD-10, International Classification of Diseases, 10th Revision. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using National Vital Statistics System.

Chart 14-10.. Death rates per 100 000 population for CVD in selected countries for adults 35 to 74 years of age, 2020.

Rates are adjusted to the European Standard Population. ICD-10 codes are I00 to I99 for CVD. CVD indicates cardiovascular disease; and ICD-10, International Classification of Diseases, 10th Revision. *Number in parentheses indicates year of most recent data available (20 is 2020). Source: Unpublished National Heart, Lung, and Blood Institute tabulation using World Health Organization Mortality Database.

Chart 14-11.. Death rates per 100 000 population for CHD in selected countries for adults 35 to 74 years of age, 2020.

Rates are adjusted to the European Standard Population. ICD-10 codes are I20 to I25 for CHD. CHD indicates coronary heart disease; and ICD-10, International Classification of Diseases, 10th Revision. *Number in parentheses indicates year of most recent data available (20 is 2020). Source: Unpublished National Heart, Lung, and Blood Institute tabulation using World Health Organization Mortality Database.

Chart 14-12.. Death rates per 100 000 population for stroke in selected countries for adults 35 to 74 years of age, 2020.

Rates are adjusted to the European Standard Population. ICD-10 codes are I60 to I69 for stroke. ICD-10 indicates International Classification of Diseases, 10th Revision. *Number in parentheses indicates year of most recent data available (20 is 2020). Source: Unpublished National Heart, Lung, and Blood Institute tabulation using World Health Organization Mortality Database.

Chart 14-13.. Death rates per 100 000 population for all causes in selected countries for adults 35 to 74 years of age, 2020.

Rates are adjusted to the European Standard Population. ICD-10 codes are A00 to Y89 for all causes. ICD-10 indicates International Classification of Diseases, 10th Revision. *Number in parentheses indicates year of most recent data available (20 is 2020). Source: Unpublished National Heart, Lung, and Blood Institute tabulation using World Health Organization Mortality Database.

Chart 14-14.. Hospital discharges for CVD, US males and females, 1993 to 2016.

Hospital discharges include people discharged alive, dead, and status unknown. Data not available for males and females separately from 1993 to 1996 and after 2016. CVD indicates cardiovascular disease; ICD-9, International Classification of Diseases, 9th Revision; and ICD-10, International Classification of Diseases, 10th Revision. *Data not available for 2015. Readers comparing data across years should note that beginning October 1, 2015, a transition was made from ICD-9 to ICD-10. This should be kept in consideration because coding changes could affect some statistics, especially when comparisons are made across these years. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Healthcare Cost and Utilization Project.

Chart 14-15.. Age-standardized global mortality rates of CVDs per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. CVD indicates cardiovascular disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 14-16.. Age-standardized global prevalence rates of CVDs per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. CVD indicates cardiovascular disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-1.. Prevalence of stroke, by age and sex, United States (NHANES, 2017–2020).

NHANES indicates National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 15-2.. Heat map of stroke risk at all combinations of SBP and DBP observed in ALLHAT.

ALLHAT indicates Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; DBP, diastolic blood pressure; and SBP, systolic blood pressure. Source: Reprinted from Itoga et al. Copyright 2021, with permission from American College of Cardiology Foundation.

Chart 15-3.. Crude stroke mortality rates among young US adults (25–64 years of age), 2010 to 2020.

Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 15-4.. Crude stroke mortality rates among older US adults (≥65 years of age), 2010 to 2020.

Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 15-5.. Stroke death rates, 2015 through 2017, among adults ≥35 years of age, by US county.

Rates are spatially smoothed to enhance the stability of rates in counties with small populations. ICD-10 codes for stroke: I60 through I69.ICD-10 indicates International Classification of Diseases, 10th Revision. Source: Reprinted from National Vital Statistics System.

Chart 15-6.. Probability of death within 1 year after first stroke, United States, 1995 to 2011.*

* Data years 1986 to 2011 for those who were 45 to 64 years of age because of the small number of events. Source: Unpublished National Heart, Lung, and Blood Institute (NHLBI) tabulation using pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the NHLBI.

Chart 15-7.. Probability of death within 5 years after first stroke, United States, 1995 to 2011.*

* Data years 1986 to 2011 for those who were 45 to 64 years of age because of the small number of events. Source: Unpublished National Heart, Lung, and Blood Institute (NHLBI) tabulation using pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the NHLBI.

Chart 15-8.. Age-adjusted death rates for stroke by sex and race and ethnicity, United States, 2020.

Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated. Stroke includes ICD-10 codes I60 through I69 (cerebrovascular disease). Mortality for NH Asian people includes Pacific Islander people. ICD-10 indicates International Classification of Diseases, 10th Revision; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 15-9.. Probability of recurrent stroke in 5 years after first stroke, United States, 1995 to 2011.*

* Data years 1986 to 2011 for those who were 45 to 64 years of age because of the small number of events. Source: Unpublished National Heart, Lung, and Blood Institute (NHLBI) tabulation using pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the NHLBI.

Chart 15-10.. Age-standardized global prevalence rates of total stroke (all subtypes) per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-11.. Age-standardized global prevalence rates of ischemic stroke per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-12.. Age-standardized global prevalence rates of ICH per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and ICH, intracerebral hemorrhage. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-13.. Age-standardized global prevalence rates of SAH per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and SAH, subarachnoid hemorrhage. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-14.. Age-standardized global mortality rates of total stroke (all subtypes) per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-15.. Age-standardized global mortality rates of ischemic stroke per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-16.. Age-standardized global mortality rates of ICH per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and ICH; intracerebral hemorrhage. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 15-17.. Age-standardized global mortality rates of SAH per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and SAH, subarachnoid hemorrhage. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 16-1.. Age-standardized global prevalence rates of AD and other dementias per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. AD indicates Alzheimer disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 16-2.. Age-standardized global mortality rates of AD and other dementias per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. AD indicates Alzheimer disease; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 17-1.. Trends in age-adjusted death rates attributable to CCDs, United States, 1999 to 2020.

CCD indicates congenital cardiovascular defect. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 17-2.. Trends in age-adjusted death rates attributable to CCDs by race and ethnicity, United States, 1999 to 2020.

CCD indicates congenital cardiovascular defect; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 17-3.. Trends in age-adjusted death rates attributable to CCDs by sex, United States, 1999 to 2020.

CCD indicates congenital cardiovascular defect. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 17-4.. Trends in age-specific death rates attributable to CCDs by age at death, United States, 1999 to 2020.

CCD indicates congenital cardiovascular defect. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 17-5.. Age-adjusted death rates attributable to CCDs by sex, race, and ethnicity, United States, 2020.

CCD indicates congenital cardiovascular defect; and NH, non-Hispanic. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 17-6.. Age-standardized global mortality rates of congenital heart anomalies per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 17-7.. Age-standardized global prevalence rates of congenital heart anomalies per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 18-1.. Primary indications (in thousands) for pacemaker placement between 1990 and 2002, United States (NHDS, NCHS).

AV indicates atrioventricular; NCHS, National Center for Health Statistics; and NHDS, National Hospital Discharge Survey. Source: Data derived from Birnie et al.

Chart 18-2.. Adjusted percent difference in AF prevalence compared with White individuals for clinically detected AF (2000–2018) and monitor-detected AF (2016–2018) in the MESA Study.

Adjusted for age, sex, height, weight, treated hypertension, current smoking, diabetes, SBP, history of HF, and history of MI; estimates for monitor-detected AF are also adjusted for monitoring duration. Vertical lines indicate 95% CI. AF indicates atrial fibrillation; HF, heart failure; MESA, Multi-Ethnic Study of Atherosclerosis; MI, myocardial infarction; and SBP, systolic blood pressure. Source: Reprinted with permission from Heckbert et al. Copyright © 2020 American Heart Association, Inc.

Chart 18-3.. Lifetime risk (cumulative incidence at 95 years of age) for AF at different ages (through 94 years of age) by sex in the FHS, 1968 to 2014.

AF indicates atrial fibrillation; and FHS, Framingham Heart Study. Source: Reprinted from Staerk et al. Copyright © 2018, The Authors. Published on behalf of the Authors by the British Medical Group. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build on this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See http://creativecommons.org/licenses/by-nc/4.0/.

Chart 18-4.. PAF of major risk factors for AF in the ARIC study, 1987 to 2007.

Cardiac disease includes a history of CAD or HF; smoking refers to current smoker. AF indicates atrial fibrillation; ARIC, Atherosclerosis Risk in Communities; BMI, body mass index; CAD, coronary artery disease;HF, heart failure; and PAF, population attributable fraction Source: Data derived from Huxley et al.

Chart 18-5.. Retrospective analysis conducted in the Korean National Health Insurance Service of individuals (N=66 692) who underwent self-reported exercise assessment 2 years before and after AF diagnosis, 2010 to 2016.

A, Ischemic stroke. B, HF. C, All-cause death. HRs with 95% CIs for ischemic stroke, HF, and all-cause death according to the change in exercise status. Bars denote weighted incidence rates; dots, HRs; and whiskers, 95% CIs computed by weighted Cox proportional hazards models with inverse probability of treatment weighting. AF indicates atrial fibrillation; HF, heart failure; and HR, hazard ratio. Source: Adapted from Ahn et al. Copyright © 2021, The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits noncommercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Chart 18-6.. Risk of stroke and systemic embolism in nonanticoagulated patients (N=21 768) by AF duration and CHA₂DS₂-VASc score from the Optum electronic health record deidentified database, 2007 to 2017.

Stroke and systemic embolism rates over the 1% threshold are shaded red; those under the 1% threshold are shaded green. AF indicates atrial fibrillation. Source: Reprinted with permission from Kaplan et al. Copyright © 2019 American Heart Association, Inc.

Chart 18-7.. Temporal trends of the 1-year adverse event rates from 2006 to 2015 in (A) 679 416 adults with newly diagnosed AF and (B) those without AF in the Korean National Health Insurance Service database.

The 1-year adverse event rates (percent per year) were calculated by dividing the number of the first lifetime event that occurred in each year by the total number of patients at the start of the year who had not experienced that event previously. P_trend <0.001. AF indicates atrial fibrillation; and HF, heart failure. Source: Reprinted from Kim et al with permission. Copyright © 2018 Elsevier.

Chart 18-8.. Age-standardized global mortality rates of AF and atrial flutter per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. AF indicates atrial fibrillation; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 18-9.. Age-standardized global prevalence rates of AF and atrial flutter per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. AF indicates atrial fibrillation; and GBD, Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 19–1.. Adjudicated causes of autopsied WHO-defined SCDs.

Adjudicated causes of autopsied WHO-defined SCDs after review of comprehensive medical records, EMS records, complete autopsy, toxicology, and postmortem chemistries. Autopsy-defined SADs had no identifiable extracardiac (eg, PE, hemorrhage, lethal toxicology) or nonarrhythmic (tamponade, acute HF) cause of death. The first percent is of total WHO-defined SCDs; the second percent is of cause of death category. Overall, autopsy-defined SADs accounted for 56% of all WHO-defined SCDs; 4% were cardiac nonarrhythmic cause of death; and 40% were noncardiac cause of death. ARVD indicates arrhythmogenic right ventricular dysplasia; CAD, coronary artery disease; CM, cardiomyopathy; DKA, diabetic ketoacidosis; EMS, emergency medical services; GI, gastrointestinal; HF, heart failure; PE, pulmonary embolism; SAD, sudden arrhythmic death; SCD, sudden cardiac death; and WHO, World Health Organization. Source: Adapted with permission from Tseng et al. Copyright © 2018 American Heart Association, Inc.

Chart 19–2.. Age-specific mortality rates for any mention of SCD by age, United States, 2020.

SCD indicates sudden cardiac death. Source: Data derived from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database.

Chart 19–3.. Age-adjusted mortality rates for any mention of SCD, United States, 1999 to 2020.

SCD indicates sudden cardiac death. Source: Data derived from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.

Chart 19–4.. Temporal trends in survival to hospital discharge after IHCA in adults and children in GWTG–Resuscitation from 2000 to 2021, United States.

GWTG indicates Get With The Guidelines; IHCA, in-hospital cardiac arrest; and PEDS, pediatrics. Source: GWTG–Resuscitation; unpublished American Heart Association data.

Chart 19–5.. Detailed causes of OHCA and IHCA in 1 US center.

A, Proportion of hospitalized patients with each cause after OHCA. B, Proportion of hospitalized patients with each cause after IHCA. Pathogenesis based on testing and evaluation in the hospital. “Other” corresponds to all other causes. IHCA indicates in-hospital cardiac arrest; and OHCA, out-of-hospital cardiac arrest. Source: Data derived from Chen et al.

Chart 20-1.. Prevalence (percent) of detectable CAC in the CARDIA study: US adults 33 to 45 years of age (2000–2001).

P<0.0001 across race-sex groups. CAC indicates coronary artery calcification; and CARDIA, Coronary Artery Risk Development in Young Adults. Source: Data derived from Loria et al.

Chart 20-2.. Prevalence by ethnicity of detectable CAC at baseline (2000–2002) and year 10 (2010–2012) among US adults 55 to 84 years of age without CVD in MESA.

CAC indicates coronary artery calcification; CVD, cardiovascular disease; and MESA, Multi-Ethnic Study of Atherosclerosis. Source: Data derived from Bild et al.^,

Chart 20-3.. Ten-year trends in severity of CAC in US individuals without clinical CVD in MESA, baseline examination 2000 to 2002.

Data adjusted to the average baseline age (67 years), sex (47% male), race and ethnicity (39% White, 28% Black, 21% Hispanic, and 12% Chinese), and scanner (electron-beam CT vs other). CAC indicates coronary artery calcification; CT, computed tomography; CVD, cardiovascular disease; and MESA, Multi-Ethnic Study of Atherosclerosis. Source: Adapted from Bild et al. This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built on, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Chart 20-4.. HRs for CHD events associated with CAC scores: US adults 45 to 84 years of age (reference group, CAC=0) in MESA, baseline examination 2000 to 2002.

Baseline examination 2000 to 2002 with median of 3.9 years of follow-up (maximum, 5.3 years). All HRs, P<0.0001. Major CHD events included MI and death attributable to CHD; any CHD events included major CHD events plus definite angina or definite or probable angina followed by revascularization. CAC indicates coronary artery calcification; CHD, coronary heart disease; HR, hazard ratio; MESA, Multi-Ethnic Study of Atherosclerosis; and MI, myocardial infarction. Source: Data derived from Detrano et al.

Chart 21-1.. Prevalence of CHD by age and sex, United States (NHANES, 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates.. CHD indicates coronary heart disease; COVID-19, coronavirus disease 2019; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 21-2.. Prevalence of MI by age and sex, United States (NHANES, 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. MI includes people who answered “yes” to the question of ever having had a heart attack or MI. COVID-19 indicates coronavirus disease 2019; MI, myocardial infarction; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 21-3.. “Ever told you had a heart attack (MI)?” Age-adjusted US prevalence by state (BRFSS prevalence and trends data, 2020).

Original chart has been modified to remove white space between map and legend. BRFSS indicates Behavioral Risk Factor Surveillance System; and MI, myocardial infarction. Source: BRFSS prevalence and trends data.

Chart 21-4.. “Ever told you had angina or CHD?” Age-adjusted US prevalence by state (BRFSS prevalence and trends data, 2020).

Original chart has been modified to remove white space between map and legend. BRFSS indicates Behavioral Risk Factor Surveillance System; and CHD, coronary heart disease. Source: BRFSS prevalence and trends data.

Chart 21-5.. Annual number of US adults per 1000 having diagnosed heart attack or fatal CHD by age and sex (ARIC Surveillance, 2005–2014 and CHS).

These data include MI and fatal CHD but not silent MI. ARIC indicates Atherosclerosis Risk in Communities; CHD, coronary heart disease; CHS, Cardiovascular Health Study; and MI, myocardial infarction. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using ARIC and CHS.

Chart 21-6.. Incidence of heart attack or fatal CHD by age, sex, and race, United States (ARIC Surveillance, 2005–2014).

ARIC indicates Atherosclerosis Risk in Communities; CHD, coronary heart disease; and MI, myocardial infarction. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using ARIC

Chart 21-7.. Incidence of MI by age, sex, and race, United States (ARIC Surveillance, 2005–2014).

ARIC indicates Atherosclerosis Risk in Communities; and MI, myocardial infarction. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using ARIC.

Chart 21-8.. Hospital discharges for CHD, United States (HCUP, 1997–2019).

Hospital discharges include people discharged alive, dead, and status unknown. CHD indicates coronary heart disease; and HCUP, Healthcare Cost and Utilization Project. *Data not available for 2015. Readers comparing data across years should note that beginning October 1, 2015, a transition was made from the 9th revision to the 10th revision of the International Classification of Diseases. This should be kept in consideration because coding changes could affect some statistics, especially when comparisons are made across these years. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using HCUP.

Chart 21-9.. Age-standardized global mortality rates of IHD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and IHD, ischemic heart disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 21-10.. Age-standardized global prevalence rates of IHD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and IHD, ischemic heart disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 21-11.. Prevalence of AP by age and sex, United States (NHANES, 2017–2020).

In March 2020, the COVID-19 pandemic halted NHANES field operations. Because data collected in the partial 2019 to 2020 cycle are not nationally representative, they were combined with previously released 2017 to 2018 data to produce nationally representative estimates. AP includes people who either answered “yes” to the question of ever having angina or AP or being diagnosed with Rose angina. AP indicates anginal pectoris; COVID-19, coronavirus disease 2019; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 22-1.. Age-standardized global mortality rates of cardiomyopathy and myocarditis per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 22-2.. Age-standardized global prevalence rates of cardiomyopathy and myocarditis per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 22-3.. Prevalence of HF among US adults ≥20 years of age by sex and age (NHANES, 2017–2020).

HF indicates heart failure; and NHANES, National Health and Nutrition Examination Survey. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using NHANES.

Chart 23-1.. Number of TAVI and SAVR procedures performed and in-hospital mortality according to type of procedure, Germany, 2011 to 2016.

A, Number of TAVI and SAVR procedures. B, In-hospital mortality. iSAVR indicates isolated surgical aortic valve replacement; SAVR, surgical aortic valve replacement; TA, transapical; TAVI, transcatheter aortic valve implantation; and TV, transvascular. Source: Reprinted from Gaede et al. Copyright © 2017, The Authors. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits noncommercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Chart 23-2.. Asia-Pacific MitraClip cases, 2011 to 2018.

SEA indicates Southeast Asia (Singapore, Malaysia, Indonesia, Brunei, Philippines, Vietnam, Thailand). Source: Data derived from Wong et al.

Chart 23-3.. Comparison of primary outcomes after MitraClip implantation for secondary MR in the COAPT and MITRA-FR trials.

A, COAPT trial. B, MITRA-FR trial. COAPT indicates Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation; MITRA-FR, Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation; and MR, mitral regurgitation. Source: A, Reprinted from Stone et al with permission from the Massachusetts Medical Society. Copyright © 2018 Massachusetts Medical Society. B, Reprinted from Obadia et al with permission from the Massachusetts Medical Society. Copyright © 2018 Massachusetts Medical Society.

Chart 23-4.. Age and sex distribution of 3343 subjects with rheumatic HD participating in the REMEDY study, 2010 to 2012.

HD indicates heart disease; and REMEDY, Global Rheumatic Heart Disease Registry. Source: Reprinted from Zühlke et al with permission of the European Society of Cardiology. Copyright © 2014, The Authors. Published by Oxford University Press on behalf of the European Society of Cardiology.

Chart 23-5.. Age-standardized global mortality rates of rheumatic HD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and HD, heart disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 23-6.. Age-standardized global prevalence rates of rheumatic HD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global Burden of Disease; and HD, heart disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 24-1.. Trends in hospitalized PE, United States, 1996 to 2019.

PE indicates pulmonary embolism. *Data not available for 2015. Readers comparing data across years should note that beginning October 1, 2015, a transition was made from the 9th revision to the 10th revision of the International Classification of Diseases. This should be kept in consideration because coding changes could affect some statistics, especially when comparisons are made across these years. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Healthcare Cost and Utilization Project.

Chart 24-2.. Trends in hospitalized DVT, United States, 2005 to 2019.

DVT indicates deep vein thrombosis. *Data not available for 2015. Readers comparing data across years should note that beginning October 1, 2015, a transition was made from the 9th revision to the 10th revision of the International Classification of Diseases. This should be kept in consideration because coding changes could affect some statistics, especially when comparisons are made across these years. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Healthcare Cost and Utilization Project.

Chart 25-1.. Estimates of prevalence of PAD in males by age and ethnicity, United States, 2000.

Amer. indicates American; NH, non-Hispanic; and PAD, peripheral artery disease. Source: Data derived from Allison et al.

Chart 25-2.. Estimates of prevalence of PAD in females by age and ethnicity, United States, 2000.

Amer. indicates American; NH, non-Hispanic; and PAD, peripheral artery disease. Source: Data derived from Allison et al.

Chart 25-3.. Geographic variation in rates of lower-extremity amputation in the United States based on Centers for Medicare & Medicaid Services data from 2000 to 2008.

Source: Reprinted from Jones et al with permission. Copyright © 2012 American College of Cardiology Foundation.

Chart 25-4.. HRs of global cardiovascular mortality with 95% CI by categories, 1976 to 2000 (baseline years).

HR indicates hazard ratio. Source: Data derived from Fowkes et al.

Chart 25-5.. Age-standardized global prevalence of lower-extremity PAD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global of Burden Disease; and PAD, peripheral artery disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 25-6.. Age-standardized global mortality rates of lower-extremity PAD per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global of Burden Disease; and PAD, peripheral artery disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 25-7.. Numbers needed to screen to avoid an AAA-associated death and a ruptured AAA, 1988 to 1999 (baseline years), with average follow-up of 4 to 15 years.

Global data. AAA indicates abdominal aortic aneurysm. Source: Data derived from Eckstein et al.

Chart 25-8.. Association between diameter and minimum and maximum risk of AAA rupture per year.

AAA indicates abdominal aortic aneurysm. Source: Data derived from Brewster et al.

Chart 25-9.. Age-standardized global mortality rates of aortic aneurysm per 100 000, both sexes, 2020.

During each annual GBD Study cycle, population health estimates are produced for the full time series. Improvements in statistical and geospatial modeling methods and the addition of new data sources may lead to changes in past results across GBD Study cycles. GBD indicates Global of Burden Disease. Source: Data courtesy of the GBD Study 2020. Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Chart 27-1.. Estimated inpatient cardiovascular operations and procedures, United States, 2016 to 2018.

Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Healthcare Cost and Utilization Project.

Chart 27-2.. Trends in heart transplantations, United States, 1975 to 2021.

Source: Data derived from the Organ Procurement and Transplantation Network.

Chart 27-3.. Heart transplantations by recipient age, United States, 2021.

Source: Data derived from the Organ Procurement and Transplantation Network.

Chart 28-1.. Direct and indirect costs of CVD (in billions of dollars), United States, average annual 2018 to 2019.

CVD indicates cardiovascular disease. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Medical Expenditure Panel Survey data and mortality data from the National Vital Statistics System.^,

Chart 28-2.. The 22 leading diagnoses for direct health expenditures, United States, average annual 2018 to 2019 (in billions of dollars).

COPD indicates chronic obstructive pulmonary disease. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Medical Expenditure Panel Survey data and excluding nursing home costs.

Chart 28-3.. Estimated direct cost (in billions of dollars) of CVD, United States, average annual (1996–1997 to 2018–2019).

*International Classification of Diseases, Ninth Revision coding for 1996 to 2015; International Classification of Diseases, 10th Revision coding for 2016 to 2019. CVD indicates cardiovascular disease. Source: Unpublished National Heart, Lung, and Blood Institute tabulation using Medical Expenditure Panel Survey for direct costs (average annual 1996–1997 to 2018–2019).