Laurence Sperling, MD, on 3 Targets to Focus on in the Prevention of Cardiovascular Events

Keeping people healthy, optimizing care, and focusing on priority populations are the 3 pillars of cardiovascular event prevention on which the Million Hearts® initiative focuses. In this video, Million Hearts® Executive Director Laurence Sperling, MD, overviews these pillars and how you can implement them into your practice. 

Additional Resources:

  1. Sperling L. About the Million Hearts® Initiative. Cardiology Consultant. 2020. Accessed September 22, 2020.
  2. Million Hearts®. Centers for Disease Control and Prevention. Accessed September 22, 2020.


Laurence Sperling, MD, is the executive director of the Million Hearts® for the Centers for Disease Control and Prevention/Centers for Medicare and Medicaid Services. He is also a Katz professor in preventive cardiology and a professor of global health at the Rollins School of Public Health at Emory University in Atlanta, Georgia. 

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Laurence Sperling: Million Hearts® focuses on 3 main pillars. These pillars are keeping people healthy, optimizing care, and focusing on priority populations.

The keeping people healthy is more of a population-environment intersection. Here the goals are a 20% reduction in sodium intake at a population level. Focusing on procurement of foods, how we go about packaging foods and labeling foods, so a population approach.

Impacting physical inactivity at the level, of the built environment. Also here, reduction in tobacco at a population level.

The optimizing care, this is where clinicians really come in and health systems, and programs, protocols, team‑based care. We focus on the ABCs. The ABCs are appropriate aspirin use, blood pressure control, cholesterol management, and smoking cessation. Here our targets are greater than 80%, hitting what are guideline‑directed targets for care.

Another focus of optimizing care for Million Hearts® is cardiac rehabilitation. Cardiac rehabilitation is greatly underutilized, underappreciated. In our country, only about 25% of those who are eligible for cardiac rehab are participating in what it is a Class I recommendation for cardiovascular prevention. Million Hearts® target for cardiac rehab is at 70%.

Optimizing care still is about the lifestyle and behavioral approaches for each and every patient, but also lifestyle and behavioral approaches at the community level and population level.

Priority populations. There are many priority populations in our country. We have chosen to focus on 4. African Americans and focusing on blood pressure control; the 35- to 64‑year‑old age group—the young adults—because here, despite the evidence we have, the pharmacotherapies we have, the tools we have to prevent cardiovascular advance, we’re seeing increasing events on the young adults in our country. This is a very significant concern. This truly is a crisis. The 2 other populations we focus on are those living with heart disease, known ASCVD. This is already a high‑risk population and we know by striving to care for this population, we call this a “best buy.” We can reduce the greatest number of events in those living with heart disease. Then lastly, focusing on those who have behavioral health disorders and mental health disorders, often because they’re smoking more and are at greater risk for cardiovascular disease.