Heart disease and stroke are mainly consequences of atherosclerosis and high blood pressure (hypertension). Heart disease is sometimes included in the broader category of atherosclerotic and hypertensive diseases. Risk factors for heart disease and stroke have been well established for many years. Distinct from age, family history, and possible genetic determinants are modifiable risk factors that cause heart attacks and strokes, including high blood cholesterol, high blood pressure, smoking, and diabetes. Behaviors that contribute to development of risk factors for heart disease, partly by causing obesity, include adverse dietary patterns and physical inactivity.

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Social and environmental conditions that may determine such behavioral patterns, in turn, include education and income, cultural influences, family and personal habits, and opportunities to make favorable choices.For example, dietary patterns result from the influences of food production policies, marketing practices, product availability, cost, convenience, knowledge, choices that affect health, and preferences that are often based on early-life habits. Because many aspects of behavior are clearly beyond the control of the individual, the scope of heart disease and Stroke and stroke prevention, from the public health perspective, extends far beyond the individual or the patient. Thus, a comprehensive public health strategy for heart disease prevention must address the broader determinants of risk and disease burden as they affect both the population as a whole and particular groups of special concern, including those determinants that make healthier choices more likely for defeating heart disease.

Heart disease and stroke are the first and third leading causes of death, respectively, in the United States (1). Certain modifiable risk factors, including high blood pressure, high cholesterol, diabetes, tobacco use, obesity, and lack of exercise, are the main targets for primary and secondary prevention of heart disease and stroke. A substantial proportion of the population has multiple risk factors, increasing their likelihood of cardiovascular disease (2,3). To assess the prevalence of multiple risk factors for heart disease and stroke and to identify disparities in risk status among population subgroups, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 37% of the survey population had two or more risk factors for heart disease and stroke and that considerable disparities in risk factors existed among socioeconomic groups and racial/ ethnic populations. To decrease morbidity and mortality from heart disease and stroke, public health programs should improve identification of persons with multiple risk factors and focus interventions on those populations disproportionately affected.

BRFSS is a state-based, random-digit--dialed telephone survey of the noninstitutionalized, U.S. civilian population aged [greater than or equal to]18 years. CDC analyzed self-reported data from the 2003 BRFSS survey, which included 256,155 participants from 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. In 2003, the median CASRO response rate among states/territories was 53.2% (range: 34.4% [New Jersey] to 80.5% [Puerto Rico]). These rates reflect both telephone sampling efficiency and the degree of participation among eligible respondents who were contacted.