Discovering the Full Spectrum of Cardiovascular Disease

D espite the steady decline in cardiovascular disease (CVD) mortality during the past 30 years, 1 CVD remains the No. 1 killer of adults across all racial/ethnic groups in the United States. Until recently, the majority of epidemiological studies have been based predominantly, or even exclusively, on middle-class, white, non-Hispanic cohorts. Hence, the generalizability of the findings to all populations has been uncertain. ] These key studies include the National Health and Nutrition Examination Survey (NHANES), a US population-based study; the Honolulu Heart Program (HHP), a study of Japanese-American men; the Strong Heart Study (SHS), a study of American Indians; and the Multi-Ethnic Study of Atherosclerosis (MESA). The studies were selected to represent a variety of racial/ethnic groups and study designs. It should be emphasized that informative data from many other epidemiological observational studies are included; Internet links to additional cohort studies are available in the Appendix. Key references and Internet resources for the lay public and health professionals also are included in the text and the Appendix. Recommendations for future directions and efforts conclude this article.