Purpose of the plan: To chart a course for the Centers for Disease Control and Prevention (CDC) and collaborating public health agencies, with all interested partners and the public at large, to help in promoting achievement of national goals for preventing heart disease and stroke over the next two decades-through 2020 and beyond. Heart disease and stroke are among the nation's leading causes of death and major causes of disability, projected to cost more than $351 billion in 2003. In the next two decades, these conditions can be expected to increase sharply as this country's "baby boom" generation ages. The current disease burden, recent trends, and growing disparities among certain populations reinforce this projection. Yet these conditions are largely preventable. As expressed in the Steps to a HealthierUS initiative from Secretary of Health and Human Services Tommy G. Thompson, the long-term solution for our nation's health care crisis requires embracing prevention as the first step. To reverse the epidemic of heart disease and stroke through increasingly effective prevention, action is needed now. A Public Health Action Plan to Prevent Heart Disease and Stroke addresses this urgent need for action. Key partners, public health experts, and heart disease and stroke prevention specialists came together to develop targeted recommendations and specific action steps toward achievement of this goal, through a process convened by CDC and its parent agency, the U.S. Department of Health and Human Services (HHS). CDC and public health partners will provide national leadership to assure meaningful progress in implementing the plan. This includes bringing the public health community together with new and existing partners representing every interested segment of society. An important aspect of this process is continuing coordination between CDC and the National Institutes of Health (NIH), HHS, which is the co-lead agency with CDC for the heart disease and stroke focus area of Healthy People 2010. Today, support for public health programs to prevent heart disease and stroke remains low, constituting less than 3% of the aggregate budget of our state public health agencies. Despite substantial public health gains in recent years, the failure to halt and reverse the epidemic has been extremely costly. Numbers of victims and health care expenses will only escalate unless the epidemic is reversed. Fortunately, a new promise of success exists today. We have knowledge from decades of research and experience, especially because of the contributions of NIH and the American Heart Association. We also have a growing commitment to prevention, exemplified by the Secretary's Steps to a HealthierUS initiative. And we have the potential collaboration of many major national partners. The Action Plan represents a comprehensive public health strategy to assist in addressing the Healthy People 2010 goal of improving cardiovascular health through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events. This strategy depends on a balanced investment in all available intervention approaches, from policy and environmental changes designed to prevent risk factors to assurance of quality care for the victims of heart disease and stroke, and it includes education to support individual efforts to prevent or control risk factors. To successfully implement the plan, two fundamental requirements must be met. First, we must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke. Second, we must transform the nation's public health infrastructure to provide leadership and to develop and maintain effective partnerships and collaborations to support the needed actions.