Cardiovascular disease (CVD), including coronary heart disease (CHD), stroke, and peripheral vascular disease, is the leading cause of death in the United States and most developed Western countries, and will remain so during the 21st century.1 In 2004, CVD was listed as the underlying cause of death in 871 517 of all 2 398 000 deaths (36.3%), or 1 of every 2.8 deaths in the United States, with CHD accounting for 52% and stroke for 17%.2 During the past several decades, CVD mortality has markedly declined in the United States, from more than 50% to approximately 36% as the underlying cause of death. Recent data suggest that the decline is largely due to improved diagnosis and treatment rather than to major successes in primary prevention. In contrast, patients with severe mental illnesses, such as schizophrenia, bipolar disorder, and depression that together affect 5% to 10% of the US population,3 lose 25 or more years of life expectancy, with the majority of the excess premature deaths due to CVD, not suicide.4 In this Commentary, we summarize disparities in CVD mortality and prevention efforts comparing the general population and individuals with severe mental illnesses and suggest the urgent need for new paradigms.
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