M ultifactorial risk factor modification and control, especially interventions designed to reduce total cholesterol, systolic blood pressure, smoking prevalence, overweight/ obesity, diabetes mellitus, and physical inactivity, can have a profound and favorable impact on decreasing the incidence of initial and recurrent cardiovascular events. Between 1980 and 2000, mortality rates from coronary heart disease (CHD) fell by Ͼ40%. Using a previously validated statistical model (IMPACT), researchers attempted to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in risk factors among US adults aged 25 to 84 years. Approximately half of the decline in cardiovascular deaths was attributed to reductions in major risk factors (obesity and diabetes mellitus were notable exceptions), and approximately half was attributed to evidence-based medical therapies (eg, secondary prevention medications, rehabilitation, and initial treatments for acute myocardial infarction [AMI]). 1 In contrast, emergent and elective revascularization accounted for only 7% of the overall decline in deaths from CHD. Recently, similar results were reported in a Canadian study that evaluated the decrease in CHD mortality between 1994 and 2005. 2 Over the past decade, mortality rates from CHD and stroke in the United States decreased by Ͼ25% (Figure 1). 3 Although there were also impressive reductions in the prevalence of uncontrolled high blood pressure, elevated blood cholesterol, and, to a lesser extent, cigarette smoking, there was only limited impact on other risk factors, including increases in the prevalence of obesity and diabetes mellitus, and a small reduction in those not engaged in moderate or vigorous physical activity. 3 These indicators represent major challenges to achieving future goals for cardiovascular health promotion and disease reduction.In 2009, a task force representing numerous professional organizations/associations developed a Competence and Training Statement on the Prevention of Cardiovascular Disease. 4 More recently, the American Heart Association (AHA) released its bold new impact goal for the next 10 years, the 2020 Impact Goal: "to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." 3 This 2020 goal has an innovative new element to improve clinically relevant health and behavioral factors. Cardiovascular health is defined in 3 categories of ideal, intermediate, and poor on the basis of 7 simple health factors and modifiable behaviors, as detailed in the My Life Check assessment tool at http://www.mylifecheck.heart.org.This review provides a compendium of important advances in preventive and lifestyle medicine during the past decade, including discussion of some emerging but unproven interventions (ie, the polypill) as well as the value of conducting large-scale randomized clinical trials rather than relying on biological hypotheses and observational data (ie, the homocy...