Laurence Sperling, MD, on Missed Opportunities in Preventing Cardiovascular Events

There are approximately 213 million missed opportunities in the prevention of cardiovascular events. In this video, Million Hearts® Executive Director Laurence Sperling, MD, reviews these missed opportunities as well as what you can do to help bridge the gaps and prevent such events among your patients. 

Additional Resources:

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. 

For more videos, visit the Resource Center.



My name is Laurence Sperling. I’m the executive direction or the Million Hearts® initiative. Also, I serve as the Katz professor in preventive cardiology and a professor in global health at Emory University School of Medicine in Atlanta, Georgia.

Despite the guidelines we have today and the knowledge base and the tools to prevent a significant number of heart attacks, strokes, and cardiovascular events, unfortunately, there remain many million missed opportunities.

We know that 9 million Americans are not utilizing aspirin appropriately for cardiovascular prevention, 40 million with uncontrolled high blood pressure, 39 million not taking statins as indicated, 54 million still using combustible tobacco, 71 million who are physically inactive. This all told is 213 million missed opportunities.

At least 50% of these missed opportunities are occurring in younger adults in our country—those in the 35- to 64‑year‑old age group. One of the concerning trends we have in our country is that in two‑thirds of the counties of the [United States], we are seeing increasing rates of mortality related to heart attack and stroke.

This tells us that we have a lot of work to do if we want to prevent those million events. I should add, related to the millions of missed opportunities, that clinicians and health systems can do a lot to bridge the gaps.

What we know is we have evidence‑based guidelines, protocols, and are focusing on implementation science. We know that by implementing proven effective and high-impact strategies we can do a great job in preventing these events.

We did develop—as part of the Million Hearts® model—what we would call the Million Hearts® mathematical model. This mathematical model focuses on population health and population attributable risk.

Here, we know that focusing on 3 major cardiovascular risk factors can have the greatest impact. These risk factors are hypertension or high blood pressure, hypercholesterolemia, and tobacco use.

The single one of these—and many people are not quite aware of this because of the high prevalence of hypertension in our population—the single risk factor where we can make the biggest difference in cardiovascular event rates is addressing hypertension.

In our country, we know that 50% of Americans have uncontrolled hypertension. If we utilize the 2017 hypertension guidelines, this drops down to 25% of Americans with uncontrolled high blood pressure.

We know that 7.5% of those who are smoking will quit smoking per year, and less than 5% of these who quit smoking are utilizing a combination of approaches of evidence‑based counseling in terms of pharmacotherapies.

We know that a significant number of those who could be benefitting from statins are not being treated with these agents. Some simple strategies implemented at a high level. We frequently talk about scaling and spreading. This is how we can really impact millions of lives in our country.

Submit Feedback