Addressing Heart Disease and Stroke Prevention Through Comprehensive Population-Level Approaches

More than 79 million Americans have cardiovascular disease (CVD); it is the leading cause of death in the United States (1). In 2004, CVD was responsible for almost 40% of all deaths among Americans; 15.8 million adults had heart disease, 7.9 million had heart attacks, and 5.7 million had strokes (1). Although the complex constellation of risk factors, conditions, and diseases that constitute CVD is not easily understood by the public, most people are familiar with the terms heart attack and stroke. The Division for Heart Disease and Stroke Prevention (DHDSP) of the Centers for Disease Control and Prevention (CDC) provides public health leadership in promoting cardiovascular health, reducing the burden of CVD, and eliminating disparities associated with heart disease and stroke (1). DHDSP's implementation of the recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (2) promotes and helps achieve national prevention goals for heart disease and stroke through partnerships with public and private health agencies and others, in part through the National Forum for Heart Disease and Stroke Prevention (2). DHDSP and state, federal, and nongovernment partners conduct research and surveillance of CVD morbidity, mortality, and quality of care through, for example, the Paul Coverdell National Acute Stroke Registry in 33 states (2-4). DHDSP provides training, technical assistance, and funding to increase and improve the capacity of state health departments to combat these killer diseases. DHDSP funds the District of Columbia and 33 states in the National Heart Disease and Stroke Prevention Program and 14 states in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program (4). DHDSP addresses heart disease and stroke across the prevention continuum through multipronged approaches and across multiple levels of influence on population health (2,5-13). In addition, DHDSP collaborates with national and state partners to affect systems-level policies on strategies that potentially can change behaviors of substantial numbers of Americans where they live, work, play, learn, and obtain health care (2,5,13). The theme articles in this issue of Preventing Chronic Disease reflect the focus of DHDSP and its partners on prevention, detection, and treatment of risk factors and conditions contributing to heart disease and stroke (e.g., high blood pressure and high blood cholesterol); early identification of stroke and heart attack; systems of care that directly impact heart disease and stroke; and cross-cutting tools and resources for program planning, implementation, monitoring, and evaluation (14-25). Elimination of disparities is crucial to all these areas — thus its inclusion as an overarching goal for Healthy People 2010.