Page 61 - GTM-4-3

Global Translational Medicine Recent community-based CVD interventions

over several decades. These historical efforts have paved and 70% higher mortality rates from CVD compared to
the way for modern interventions which will be discussed the general population. The unique culture, history, and
in the following sections. legal status of indigenous communities provide unique
challenges and opportunities for community-based health
4. Health equity and community-based interventions. 26
cardiovascular interventions
In addition, rural communities face their own unique
Disparities in cardiovascular health across racial, ethnic, challenges in managing cardiovascular risk. Lack of
and socioeconomic lines remain a major public health both specialized and primary care physicians and other
crisis in America. Black, non-black Hispanic, indigenous, clinicians, lack of medical supplies, long travel distances
and rural communities in America experience significant to hospitals, and high incidence of food deserts contribute
health disparities and are at a notably higher risk for to a stark urban/rural divide in markers of cardiovascular
CVD. Compared to White Americans, Black Americans health. Although poverty level is a strong moderating
are nearly twice as likely to have major CVD risk factors variable, rural areas have higher CVD death rates than
such as obesity, type 2 diabetes, and hypertension, and to their urban counterparts across the board. These disparities
experience major CVD including ischemic heart disease, are the most pronounced in the southern US, where rural
heart failure, and stroke. In addition, non-Hispanic Black populations experience over double the rate of CVD
20
individuals are 33% more likely to die of CVD than non- mortality. Community-based health interventions are
27
Hispanic white individuals. Recent data from 43,000 critical pieces in boosting healthcare within underserved
21
persons also confirmed that Black women and men have communities and bridging gaps in health equity. Crucially,
the highest long-term cardiovascular mortality of any racial these interventions must consider the differences in specific
or ethnic group, even after adjusting for atherosclerotic patient populations to be effective. In African–American
CVD risk scores and coronary artery calcium. These communities, involving non-medical community
22
disparities can be attributed to social determinants of members such as hairdressers and pastors has been shown
health, including healthcare access, low socioeconomic to increase medication adherence as well as primary and
status, food deserts, racism-related stress, and lack of trust secondary health outcomes. Medication adherence,
16
in the healthcare system. 23 notably reduced in Black communities, is a major risk
For Hispanic communities, language barriers provide factor that can be attributed to lower education levels, lack
their own complications. Furthermore, a lack of Hispanic of social support and culturally competent care, and high
clinicians, lower socioeconomic markers among Hispanic costs. Many of these factors can be directly addressed with
immigrant communities, and food deserts caused by a community-based intervention involving other persons
geographic disparities add to the challenges to reduce in addition to physicians. A notable successful example of
CVD burden in this population. Large meta-analyses combining health professionals with community leaders
24
have found that Hispanic Americans have similar levels is the Los Angeles Barbershop Blood Pressure Study,
of minor CVD as White Americans but much higher where pharmacist-led interventions in Black-owned
18
20
incidence of type 2 diabetes. However, a unique challenge barber shops drastically reduced blood pressure. On the
in studying Hispanic populations in America is their other hand, one shortcoming of not involving physicians
incredible diversity, both genetically and socio-culturally. in community-based initiatives is a lack of integration
The term “Hispanic” is an umbrella classification that between different types of healthcare workers and actual
includes individuals of varying national origins, racial clinical care. 28
backgrounds, migration histories, and socioeconomic Recent innovations include the use of geographic
statuses. This heterogeneity poses methodological information system mapping to determine the optimal
challenges in cardiovascular research, as findings from one locations of so-called “trusted spaces” – community centers
subgroup (e.g., Mexican Americans) may not be applicable such as barber shops and nail salons where staff can provide
to another (e.g., Puerto Ricans, Cubans, or Central evidence-based care to maximize the positive impacts. In
29
Americans). Consequently, broad generalizations may Hispanic communities, programs targeting language and
undermine the credibility of study findings. As a result, cultural barriers have been particularly effective. Thirteen
some studies may find substantial CVD disparities, while weeks of behavioral classes on healthy habits taught
others find none. 24,25 in Spanish to patients with type 2 diabetes decreased
Indigenous US communities also suffer from higher hemoglobin A1c (HbA1c) from an average of 7 – 6.3% after
rates of CVD than their non-Hispanic White counterparts. 1 year. This is especially significant considering diabetes
30
Indigenous men and women have, respectively, 30% is the main cardiovascular disparity that is consistently

Volume 4 Issue 3 (2025) 53 doi: 10.36922/GTM025170040