In 2010, the American Heart Association (AHA) declared 2020 health strategy goals to reduce deaths from cardiovascular disease and stroke by 20% and to improve the cardiovascular health (CVH) of all Americans by 20%.1 The latter goal is aimed at helping everyone living in the United States to achieve, or at least move toward, ideal CVH by focusing on 7 key health behaviors and risk factors—smoking, body mass-index, diet (based on the healthy diet score), participation in physical activity, and levels of blood pressure (<120/80 mm Hg), blood glucose (<100 mg/dL), and total cholesterol (<200 mg/dL).2 What must not be forgotten is that this 2020 AHA strategy was instituted against the background of health disparities identified by the Institute of Medicine3 in 2003 that are still present in our society today. In this issue of Circulation , Dong et al4 describe a strong graded relationship between the number of ideal CVH metrics and cardiovascular disease (CVD) risk (stroke, myocardial infarction, and vascular death) among whites, blacks, and Hispanics living in the same community. Furthermore, the authors assessed stroke as a separate outcome event whereas previous studies5–8 on ideal CVH either did not include stroke or treated stroke only as a component of a composite outcome. Article see p 2975 There are several other key observations reported by Dong et al.4 First, the study highlights the observation that ideal CVH is rare. A glaring finding of the study is the dismally low prevalence of ideal CVH in the urban setting, in which no participants had all 7 ideal CVH metrics (0%) and few participants had 5 to 6 metrics (4.4%). Thus, considerable work needs to be done to achieve ideal CVH for all Americans, and these findings point to a particular …