The National Cardiovascular Health Program

Objectives: This program supports extensive scientific evidence, links nonmedical factors, including systemic racism and the lack of economic opportunities, with poor health outcomes and increased mortality rates, all of which are preventable. Factors such as poverty, inadequate housing, poor health care, and other debilitating social conditions, commonly referred to as social determinants of health, contribute to long-standing disparities and health inequities. These social conditions contribute to the increased prevalence of cardiovascular disease (CVD) in the US population. CVD is the leading cause of death in the US; stroke is the 5th leading cause. In 2020, about 1 in 5 adults who died from CVD were younger than 65 years old. It is estimated that 1 in 9 health care dollars are spent on CVD. CVD mortality rates declined for several decades due to both clinical and public health interventions, but recently declining death rates from both heart disease and stroke have stalled. One reason is that hypertension, the primary risk factor for CVD, is very common (1 in 2 US adults has hypertension) but control is not. Only 1 in 4 adults with hypertension (26.1%) has it under control. Gains have been made in treating high cholesterol, another primary risk factor for CVD. Overall, the age-adjusted prevalence of high cholesterol decreased from 21% to 10% from 1988–1994 to 2017–2018. This improvement is due in part to individuals’ healthy behaviors such as eating a healthy diet, losing weight, being physically active, and medication adherence, along with clinical contributions from appropriate prescribing and intensification of medication. Additional public health and health system interventions aimed at preventing, detecting, and controlling elevated cholesterol and blood pressure can help to further decrease CVD mortality. This program aims to implement and evaluate evidence-based strategies contributing to the prevention and management of CVD in populations disproportionately at risk. Given the importance of health equity, this program addresses social and economic factors to help communities and health systems respond to social determinants present in their communities to offer those at risk of or burdened with CVD the best health outcomes possible.