Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40 and Beyond.

More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.

Structurally vulnerable neighborhood environments and racial/ethnic COVID-19 inequities.

Preliminary evidence suggests that the experience of the novel coronavirus is not shared equally across geographic areas. Findings in the United States suggest that the burden of COVID-19 morbidity and mortality may be hardest felt in disadvantaged and racially segregated places. Deprived neighborhoods are disproportionately populated by people of color, the same populations that are becoming sicker and dying more often from COVID-19. This commentary examines how structurally vulnerable neighborhoods contribute to racial/ethnic inequities in SARS-COV-2 exposure and COVID-19 morbidity and mortality and considers opportunities to intervene through place-based initiatives and the implementation of a Health in All Policies strategy.