Despite decades of progress in prevention and management, cardiovascular disease (CVD) remains the leading cause of mortality in the United States (US) and globally, with persistent and even widening disparities in outcomes across racial, ethnic, geographic, and socioeconomic groups. As a complement to clinical care, community-based interventions have emerged as vital tools in promoting cardiovascular health, particularly in underserved populations. This perspective focuses on recent advances in US-based community interventions for CVD, while acknowledging global relevance, and explores the historical evolution, current landscape, and future directions of community-driven CVD prevention strategies. We highlight foundational models such as the Healthy Heart Community Prevention Project in New Orleans, Louisiana, and examine recent major studies and innovations in the field from the US and across the world. Community-rooted programs demonstrate growing potential to address upstream determinants of cardiovascular health. Their continued success, however, will depend on sustained investment, robust evaluation frameworks, and alignment with clinical care pathways and health policy infrastructure.