Advances in health care have dramatically decreased the death rate from cardiovascular disease over the past three decades. Efforts to prevent heart and vascular disease, however, lag behind gains in treatment. Unfortunately, heart disease remains the #1 killer of both men and women in the United States, requiring billions of dollars in health care costs each year. Realizing MHIF’s vision of creating a world without heart and vascular disease requires moving beyond clinic walls to tackle lifestyle factors that can prevent disease in the first place. While most of the nation’s health care dollars are spent in hospitals and clinics, care received in these settings has a smaller impact than one might think. Health behaviors, socioeconomic factors and the physical environment influence the majority of health outcomes. The same is true of cardiovascular research efforts. The majority of research funds for heart and vascular disease have been focused on treatment, leaving prevention relatively understudied. Creating improved health outcomes requires innovative action. Traditional health care practices must be paired with the larger surrounding forces that influence individual and community health. MHIF’s population health research and education efforts will continue to meet this challenge.