Partnership Programs to Reduce Ethnic Differences in the Risk of Cardiovascular Disease
Condition: Cardiovascular Diseases; Heart Diseases; Obesity; Metabolic Syndrome X
MeSH terms: Cardiovascular Diseases; Heart Diseases; Metabolic Syndrome
Study type: Observational

Summary: 
      The purpose of this study is to improve cardiovascular disease (CVD) outcomes in racial and
      ethnic minorities. Specifically, the study seeks to systematically characterize potential
      ethnic differences in obesity-related CVD by drawing upon the fields of psychology,
      physiology, biochemistry, nursing, and clinical medicine.
    

Detailed description: 
      BACKGROUND:

      While there has been great progress in reducing CVD morbidity and mortality in the U.S. over
      the past 40 years, some minority groups have not shared fully in this progress and continue
      to have lower life expectancy and higher CVD morbidity. On average, minorities have less
      access to medical care, receive less aggressive care and fewer diagnostic and therapeutic
      cardiac procedures, and adhere poorly to prescribed medical regimens. Thus, research to
      reduce health disparities by improving CVD outcomes in minorities offers potential for a
      substantial positive public heath impact. Academic medical centers and institutions capable
      of carrying out such research, however, often lack access to and the trust of minority
      patients. Minority patients often receive fragmented care because they lack access to regular
      medical care, present to emergency departments rather than primary care physicians for
      complications of an advanced chronic CVD condition, and are less likely to follow medical
      regimens. Minority communities often harbor distrust of clinical research. Minority patients
      report greater satisfaction when receiving care from minority providers and are reluctant to
      receive treatment outside their minority healthcare serving systems.

      In general, minorities have high rates of hypertension, elevated cholesterol, cigarette
      smoking, obesity, metabolic syndrome, and diabetes, as well as other behavioral,
      environmental, and occupational risk factors for cardiovascular diseases, such as sleep
      problems - all elements that contribute to excess CVD morbidity and mortality. The causes of
      minority health disparities are complex and incompletely understood. Although evidence of
      genetic, biologic, and environmental factors is well documented, poor outcomes are also
      attributed to under-treatment. Such under-treatment may be due to limited access to health
      care or, in some cases, break-down of the medical system, or failure of the physician and/or
      patient to allow for optimal health care, even when access is not impaired. The complex
      interactions of behavior, socio-economic status (SES), culture, and ethnicity are important
      predictors of health outcomes and sources of health disparities. Despite efforts to elucidate
      genetic and environmental risk factors and to promote cardiovascular health in high-risk
      populations, trends in CVD outcomes suggest that CVD health disparities continue to widen.

      The Partnerships Program to Reduce Cardiovascular Health Disparities involves collaboration
      between research-intensive medical centers (RIMCs) that have a track record of NIH-supported
      research and patient care and minority healthcare serving systems (MSSs) that lack a strong
      research program. Each Partnership Program will: a) design and carry out multiple
      interdisciplinary research projects that investigate complex biological, behavioral,and
      societal factors that contribute to CVD health disparities and facilitate clinical research
      within the MSS to improve CVD outcomes and reduce health disparities, and b) provide
      reciprocal educational and skills development programs so that investigators will be able to
      conduct research aimed at reducing cardiovascular disparities and thereby enhance research
      opportunities, enrich cultural sensitivity, and improve cardiovascular research capabilities
      at both institutions.

      The Request for Applications for Partnership Programs to Reduce Cardiovascular Disparities
      was released in September 2003. The awards were made in September 2004.

      DESIGN NARRATIVE:

      Over the past decade, there has been an explosive increase in obesity among all age groups
      within the U.S. population. This epidemic is particularly problematic among African Americans
      in the Southeast. Although genetic factors play a contributory role, it is postulated that
      ethnic disparities in obesity and obesity-related CVD are related to a dynamic interplay
      between biological factors and the behavioral response to the unique environmental context
      within ethnic communities. Obesity is often associated with perturbations in the metabolic
      and physiologic milieu. A cluster of obesity-related abnormalities has been defined as the
      "Metabolic Syndrome". The CVD complications of obesity appears to be related to the capacity
      for adipose tissue itself to generate "adipokines" that directly predispose to
      insulin-resistance, endothelial dysfunction, inflammation, and vascular disease.

      The study will use state-of-the-art approaches to define potential ethnic differences in the
      profile of metabolic, physiologic, and biochemical features associated with obesity as well
      as the salutary responses to lifestyle modification. The program uses a multi-disciplinary
      strategy to systematically characterize potential ethnic differences in obesity-related CVD
      by drawing upon the fields of psychology, physiology, biochemistry, nursing, and clinical
      medicine. In a thematic series of inter-related studies, the program's research plan ranges
      from epidemiology studies within the ethnic communities, to patient-centered clinical trial
      interventions within ethnic community practices, to the analysis of novel biomarkers of human
      pathobiology. This collaborative multi-investigator team is built upon a complementary
      partnership between the Morehouse School of Medicine and Emory University. This partnership
      shares a joint commitment to address the striking ethnic disparities in the high-risk CVD
      population. The specific aims are: 1) to define the relative influence of
      psychosocial/cultural factors and biological mediators as determinants of ethnic disparities
      in obesity and the metabolic syndrome in a population-based bi-racial cohort; 2) to define
      the effectiveness of patient-targeted behavioral interventions to enhance the health of
      African American patients with the Metabolic Syndrome in the context of community-based
      clinical practices; 3) to assess the impact of innovative lifestyle intervention strategies
      on conventional and novel biomarkers of vascular disease risk in African Americans; and 4) to
      enhance the education/training of fellows/practitioners engaged in CVD disparities
      research/practice and promote partnerships that enhance cardiovascular health within ethnic
      communities.
    

Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        African-American and white residents in the metro Atlanta area (Cobb, DeKalb, Fulton,
        Gwinnett counties) aged 30-78 years