Wicked Problems and Worthy Pursuits
Resolving to Meet American Heart Association 2020 Impact Goals
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
About 83 million American adults (≈one third of the adult population) have 1 or more types of cardiovascular disease (CVD), and CVD is the underlying cause for ≈33% of American deaths (2008 data).1 Put in stark terms, CVD claims 1 American life every 39 seconds and is responsible for more deaths annually than cancer, chronic lower respiratory disease, and accidents combined.2 In 2004, the American Heart Association (AHA), the leading health organization devoted to CVDs and stroke, set an ambitious goal to reduce the mortality rates of coronary heart disease and stroke risk by 25% by the year 2010, using 1999 rates as the baseline. This goal stimulated the AHA to boldly pursue prevention, treatment, and acute-care goals through implementation of policy initiatives, scientific discovery and communication, and other strategic resources. The impact of AHA's 2010 mortality goals was dramatic: during the first decade of this century, death rates resulting from coronary heart disease and stroke fell by ≈30%.3 An optimistic reading of these data on the whole points to an obvious conclusion: although much work remains to be done, the assiduous efforts of public health advocates, researchers, and clinicians can dramatically reduce Americans' cardiovascular mortality.
Article see p 2595
The significant declines in CVD and stroke mortality rates have no doubt been attributable to a complex mix of factors, not all quantifiable, and perhaps some unknowable. However, campaigns of primordial, primary, and secondary prevention have concentrated on known cardiovascular risk factors and have likely had considerable influence on mortality rates. Some of these efforts have targeted modifiable lifestyle factors such as diet, physical activity, and smoking behaviors—and with some success. Although the trends toward increasing physical activity were modest, smoking prevalence has decreased from baseline levels by 16%.3 Medical therapies have dramatically impacted risk factors …