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Changing the Conversation to Prevent Heart Disease and Stroke

During the ongoing COVID-19 pandemic, millions of Americans are still at risk for heart disease and stroke, the first and fifth leading causes of death in the United States, respectively.

Cardiovascular events are so common that Americans seem to accept them as almost inevitable, and the national conversation focuses on sophisticated medical interventions. Yet, in 2020, we know that up to 80 percent of these events are preventable. The conversation needs to change.

While heart disease and stroke can affect anyone, some groups are more likely to have conditions that increase their risk for these diseases. These are also some of the communities that have been hit hardest by COVID-19, such as African Americans, Hispanics, and American Indians. 

Social determinants of health significantly contribute to these numbers, and interventions must focus on the physical, food, and economic environments where we live, learn, work, and play. That’s why prevention and partnerships among healthcare, public health, and community organizations are essential. 

America’s cardiovascular crisis

From 1970 until 2010, the rates of death from cardiovascular disease in the United States steadily declined because of public health initiatives, healthier lifestyles, and medical therapies. For the past 10 years, however, these gains have stagnated, and evidence suggests we may even be losing ground. 

Recent data from the Centers for Disease Control and Prevention (CDC) highlight a public health crisis: in two-thirds of U.S. counties, death rates from both heart attacks and strokes increased in adults ages 35 to 64 (2010-2017). 

An estimated 1.6 million heart attacks and strokes occur each year in the United States. Cardiovascular disease is responsible for more than 870,000 deaths per year, is the greatest contributor to racial disparities in life expectancy, and costs the country hundreds of billions of dollars annually.  

Changing the conversation

To address these concerning trends, we must start by recognizing the magnitude of this public health problem, changing the conversation, and prioritizing the use of proven strategies for cardiovascular disease prevention. 

Nine million Americans are not getting appropriate aspirin therapy, 40 million have uncontrolled high blood pressure, and 39 million are not using statins to manage their cholesterol. Fifty-four million Americans smoke and 71 million don’t get enough physical activity. We are missing more than 200 million opportunities for cardiovascular disease prevention. 

Controlling high blood pressure will have the greatest impact on rates of heart attacks, strokes, and other cardiovascular events. This is because it affects 108 million Americans, only 24 percent of whom have their condition under control. 

COVID-19 makes some of these issues even more complicated, but also underscores their importance. Serious heart disease is among the conditions that increases the risk of severe illness from COVID-19. COVID-19 should not be a reason to delay or defer other needed care.  

The Million Hearts Initiative®

Million Hearts®2022 is a national initiative co-led by the CDC and the Centers for Medicare & Medicaid Services with the ambitious, but achievable, goal of preventing at least 1 million heart attacks and strokes by 2022. Its three pillars are keeping people healthy, optimizing care, and focusing on priority populations. 

Together with several hundred partners working across all 50 states and the District of Columbia, Million Hearts® is committed to changing the conversation related to heart disease and stroke, and to providing the tools, resources, and foundation to prioritize proven and effective strategies for cardiovascular disease prevention. 

Million Hearts® is one of the CDC’s six Winnable Battles;  public health priorities for which the CDC and its partners can make significant progress in a relatively short time. Millions of Americans have suffered a heart attack or stroke, and millions more are at risk of these devastating events. Each event prevented is an important step forward, one in a million, as we look toward a future of better cardiovascular health and greater focus on cardiovascular prevention. 

As a preventive cardiologist and executive director of the Million Hearts® Initiative, I understand from many perspectives — as a clinician, researcher, educator, public health leader, and family member — that cardiovascular disease touches most American hearts, either directly or through its impact on our families and communities. It’s time to change the conversation.


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