ABSTRACT
Cardiovascular disease (CVD) remains one of the most signi cant diet-related health problems in the United States and is also the leading cause of death in the United States. Heart disease and stroke, the principal components of CVD, are the rst and third leading causes of death in the United States, accounting for nearly 40% of all deaths. Nearly 930,000 Americans die of CVDs each year, which amounts to one death every 33 s. About 70 million Americans (almost one-fourth of the population) have some form of CVD, which is responsible for more than 6 million hospitalizations each year (American Heart Association, 2005). Much of the burden of heart disease and stroke could be eliminated by reducing major risk factors associated with the disease: high blood pressure, high blood cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition. About 90% of middle-aged Americans will develop high blood pressure in their lifetime, and nearly 70% of those who have it now do not have it under control (American Heart Association, 2003). In 2002, more than 106 million people were told that they had total blood cholesterol levels that were above normal or high (≥200 mg/dL or higher) (American Heart Association, 2005).
