Cardiovascular disease mortality has declined more than 30 percent in the last thirty years. Almost two-thirds of this decline occurred between 1970 and 1980. Despite this decreased mortality, cardiovascular disease is still the leading cause of death. It is also the disease category associated with the most rapidly rising health care costs. Secular trends in lifestyle, self-care, improved access to medical care, and improvements in diagnostic and curative medicine have all been implicated. An understanding of the mechanisms contributing to this decline is necessary in order to develop a scientific basis for palliative and preventive care. Also, the dramatic decline in cardiovascular disease mortality has raised the issue of the quality of life among the survivors. The question is raised whether more people are surviving but with worsening health in terms of increased incidence and prevalence of disease as well as increased levels of functional limitation.