The Cardiovascular State of the Union

s we reach the midpoint of the first decade of the twenty-first century, we are also at the midpoint in the timeline of the American Heart Association (AHA) strategic plan to reduce coronary heart disease, stroke, and risk by 25% by the year 2010. Encouraging evidence demonstrates important gains toward that goal, with decreases in coronary heart disease and stroke mortality, as well as reductions in certain risk factors such as cigarette consumption and untreated hypercholesterolemia. Still, troubling evidence indicates that other ominous risk factors-physical inactivity, overweight and obesity, diabetes, and hypertension-are on the rise, 3 especially among adolescents and young adults, and these may contribute to the next wave of the cardiovascular epidemic. And there is undeniable evidence that not all Americans have shared equally in the improved cardiovascular outcomes. Individuals in specific subgroups defined by race, ethnicity, socioeconomic status, and geography have a disproportionate burden of myocardial infarction, heart failure, stroke, and other cardiovascular events. These individuals also have a worse outcome after these events, including higher mortality rates, and a higher prevalence of unrecognized and untreated risk factors places them at greater likelihood of experiencing these events. Differences such as these arise not only from disparities in access to care and quality of care but also from disparities in awareness and access to knowledge.