"Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop," said Alan S. Go, M.D., chairman of the report's writing committee and chief of the Cardiovascular and Metabolic Conditions Section of the Kaiser Permanente Northern California Division of Research in Oakland. "If not, we'll quickly lose the momentum we've gained in reducing heart attack and stroke rates and improving survival over the last few decades."

Between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7 percent, but still accounted for nearly one in three deaths in the nation. That's 2,150 people dying from CVD each day -- about one death every 40 seconds.

In 2010, the American Heart Association set a goal to improve cardiovascular health of all Americans by 20 percent and reduce heart disease and stroke deaths 20 percent by 2020.

However, according to projections in the 2013 report, heart health may only improve by 6 percent if current trends continue. The biggest barriers to success are projected increases in obesity and diabetes, and only modest improvements in diet and physical activity. On a positive note, smoking, high cholesterol and high blood pressure rates are projected to decline.

Among heart disease and stroke risk factors, the most recent data shows:

• More adults age 20 and over are obese (34.6 percent) than normal or underweight (31.8 percent); 68.2 percent are overweight or obese.
• Among children ages 2-19, 31.8 percent are overweight or obese.
• Thirty-two percent of adults report no aerobic activity; 17.7 percent of girls and 10 percent of boys, grades 9-12, report fewer than an hour of aerobic activity in the past week.
• 13.8 percent of adults have total cholesterol of 240 mg/dL or higher.
• Thirty-three percent of adults have high blood pressure; African-Americans have among the highest prevalence of high blood pressure (44 percent) worldwide.
• 8.3 percent of adults have diagnosed diabetes, and 8.2 percent have undiagnosed diabetes; 38.2 percent have prediabetes.

Despite four decades of improvement, 21.3 percent of men and 16.7 percent of women age 18 and over still smoke cigarettes; 18.1 percent of students in grades 9-12 report cigarette smoking.

"As the leader in the fight against heart disease and stroke, we are taking a more aggressive and innovative approach, including taking some pages from the playbooks of the public health sector," said Donna Arnett, Ph.D., president of the American Heart Association and chairperson of the Department of Epidemiology at the University of Alabama at Birmingham School of Public Health. "We're focusing on population-based ways to improve health factors for all Americans."

Some of these include:

• Working with healthcare systems to support and reward providers who help patients improve their health behaviors and manage their health risk factors.
• Working with insurers to cover preventive health services and reward positive health behaviors and medication adherence.
• Working with the education community to make changes in schools that support healthy diets and physical activity for children.
• Building comprehensive worksite wellness programs.
• Building healthier communities with improved access to healthier foods and green space for physical activity.

The association has a wide range of programs and policy initiatives aimed at improving cardiovascular health through risk factor prevention and health care quality, Arnett said. 

"In this race against time, it will take nationwide efforts driven by communities and systems -- a patient-by-patient approach alone won't do it," Arnett said. "But we're optimistic that if we increase our efforts for improvements in prevention and reductions in risk factors, we can be successful -- we can save lives."