Start early, make health equity the ‘centerpiece’ for cardiometabolic interventions
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Key takeaways:
- The best interventions start early; consider the life course approach to CVD prevention.
- Any intervention must be rigorously tested and lead with a health equity approach first.
DANA POINT, Calif. — Cardiometabolic health promotion should start early, be creative and include interventions that “focus on health, not just disease” to optimize outcomes for underserved populations, according to a speaker.
Interventions designed to promote optimal CV health for people from historically marginalized groups must consider social determinants of health to have the greatest impact, Fatima Rodriguez, MD, MPH, FACC, FAHA, FASPC, associate professor in cardiovascular medicine and section chief of preventive cardiology at Stanford University, said during a presentation at the Cardiometabolic Health Congress (CMHC) Women’s Cardiometabolic Health and Wellness Masterclass. These determinants include but are not limited to a person’s neighborhood and built environment, level of economic stability, education, health care access and social and cultural ties.
“Virtual care models may increase access and improve CV risk factors for underserved populations, and a lot of this is about meeting individuals where they are,” Rodriguez said during the presentation. “However, like all interventions, digital health interventions must be tested rigorously and they have to be designed for the communities that they are intended to serve. This may seem obvious, but sometimes this gets lost. Health equity should be the centerpiece. Everything else comes after that.”
Where you live matters
Maps that separately track poverty levels and heart disease incidence in the U.S. essentially overlap with each other, Rodriguez said, illustrating how a person’s environment and income level can directly impact their heart and overall cardiometabolic health.
“Where I practice in the Bay Area, there are dramatic differences in life expectancy by ZIP code,” Rodriguez said. “In San Francisco, just 7 miles wide and 7 miles long, there is a difference in life expectancy by 13 years, based on ZIP codes. This all traces back to the historical practice of redlining.”
Social determinants of health are important; however, they do not mitigate the effects of race and racism, and data show that, as education level increases, CV health improves for white Americans but not to the same degree for Black and Hispanic Americans, Rodriguez said.
Novel interventions
When designing tech-based interventions, digital inclusion should also be considered as a social determinant of health, Rodriguez said.
“As we are designing our interventions, it is important that we ask, does our patient even have internet connectivity?” Rodriguez said. “Can we use our health system to provide additional support for those who need it?”
In one pharmacist-led initiative, developed at Mass General Brigham, researchers found that remote medication titration management was significantly associated with decreased BP and LDL levels compared with education only, suggesting that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale for people from underserved areas.
“They had significant and sustained LDL and BP reductions in patients, but that was not the impressive part,” Rodriguez said. “The impressive part is the effects were seen across all races and language preferences. [Researchers] used extra resources to get everyone to the same level. That is the definition of equity.”
In the Fostering African American Improvement in Total Health (FAITH) trial, LaPrincess C. Brewer, MD, MPH, associate professor of medicine at Mayo Clinic in Rochester, Minnesota, and colleagues assessed whether a mobile health intervention, using the American Heart Association’s Life’s Simple 7 framework, could improve CV risk factors among participants across 16 select churches in Minneapolis and Rochester, Minnesota. In that intervention, the mean Life’s Simple 7 score of the intervention group increased by a mean 1.9 points compared with 0.7 points in the control group. App engagement and usability was high, with most participants completing weekly diet and physical activity tracking.
“All digital health interventions need to be based on community input,” Rodriguez said. “They developed this intervention by working very closely with faith-based programs and getting feedback from the person it was intended to help. That is really important when we design these interventions. No surprise, they had excellent results.”
Community-based health programs can also facilitate access and engagement for CV risk factor management, Rodriguez said, citing a hypertension intervention that took place in barbershops to target Black male patrons.
“These are very common-sense interventions,” Rodriguez said. “But it requires us going to the community, finding the trusted partners and working with them.”
References:
- Brewer LC, et al. Circulation. 2022;doi:10.1161/CIRCULATIONAHA.122.059046.
- Blood AJ, et al. JAMA Cardiol. 2022;doi:10.1001/jamacardio.2022.4018.
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Rodriguez F. Obesity & lifestyle. Presented at: CMHC Women’s Cardiometabolic Health and Wellness Masterclass; Aug. 17-20, 2023; Dana Point, California.
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