Taking the Initiative

In 1990, heart disease and stroke emerged as the leading causes of death worldwide and remain the first and third leading causes of death in the United States, respectively.1,2 Cardiovascular disease (CVD) in the United States is responsible for &40% of all deaths, more than the next 5 leading causes of death combined. CVD death rates have declined significantly over the past several decades as a result of decreased incidence of myocardial infarction and increased survival.3,4 Coronary heart disease is also a leading cause of premature and permanent disability in the US labor force.2 In addition, the economic consequences are grave. In 2004, total CVD costs in the United States were estimated to be $368.4 billion2; these costs are expected to increase 40% to 50% by the year 2010.5 Blacks, the poor, and residents of particular regions in the United States are examples of groups that shoulder a disproportionate burden of CVD.6 US health objectives, as presented in Healthy People 2010, have placed a national emphasis on the prevention of CVD and its risk factors.7 The Secretary of Health and Human Services recently released the Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan) to further the “Healthy People 2010 goal of improving cardiovascular health through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events.”8 A recent American Heart Association publication focused on the optimal community approach to the prevention of CVD and its complications.9 This report, from the AHA Expert Panel on Population and Prevention Science, is entitled The American Heart Association Guide for Improving Cardiovascular Health at the Community Level: A Statement for Public Health Practitioners, Healthcare Providers, and Health Policy …