Is ideal cardiovascular health attainable?

" But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep. " ——Robert Frost, " Stopping By Woods on a Snowy Evening " I n 2000, the American Heart Association (AHA) embarked on an ambitious goal-setting process that ultimately targeted a 25% reduction in risk and death due to coronary heart disease by 2010. This was an audacious, perhaps even dream-like, goal when first conceived, but was vigorously adopted by the AHA and later harmonized with the Healthy People 2010 goal. Concerted attention was subsequently focused on goal attainment. A period of fortuitous discoveries ensued that dramatically impacted the care of patients with acute coronary syndromes. By 2008, the reduction in deaths due to coronary artery disease eclipsed 35%, and the reduction in deaths due to stroke exceeded 30%. 1 Over a similar timeframe, reductions in deaths due to all forms of cancer (the number 2 cause of death in the United States) were 21% for men and 12.3% for women from 1990 to 2006, 2 whereas for chronic obstructive lung disease, (the number 3 cause of death) death rates have actually increased. 3 Thus, the reductions in deaths due to coronary heart disease and stroke were considerably greater than the other leading chronic diseases. This is an extraordinary statement on the indefatigable efforts of the basic and clinical research communities to fervently address the leading cause of death and disability in this country. Our success has been so remarkable that stroke, previously the third-leading cause of death, may now be fourth. 1,4 We shouldn't rest on our laurels, given that the combination of heart disease and stroke remains the leading cause of death, but kudos to the cardiovascular community on our progress to date. What further amplifies the extent of this goal accomplishment is the imperfect approach to acute coronary syndromes when the 2010 goal was conceived: Acute percutaneous coronary intervention was not the standard of care for acute myocardial infarction: statin use was not ubiquitous, nor was postmyocardial infarction ␤-blocker use a norm, and even aspirin had only a limited database on efficacy, yet the 2010 goal was set. What is even more provocative, however, is that at least 50% of the reduction in death due to coronary artery disease (and stroke) is attributable to a greater representation of preventive efforts, specifically control of blood pressure, treatment of …