Cardiovascular disease is the leading cause of mortality in U.S. Hispanics. The prevalence of risk factors for cardiovascular disease is higher for Hispanics than for non-Hispanic whites and is increasing. Hispanics face unique social, cultural, and language barriers gaining access to care. These barriers are a major reason that Hispanics are less likely to receive treatment for cardiovascular disease risk factors. For these reasons, improving the primary prevention of cardiovascular disease in Hispanics is the broad, long-term objective of the proposed research. In response to NHLBI RFA HL-04-002, this project will develop a partnership between Denver Health (DH), a minority-serving healthcare system, and the University of Colorado Health Sciences Center (UCHSC), a research-intensive medical center. The first Specific Aim of the project is to develop and evaluate an interactive computer-based tool to improve community-based recognition of cardiovascular risk factors and to improve self-management skills, including adherence with clinic visits. The tool will be culturally-sensitive and bilingual. The second Specific Aim is to test the ability of a nurse-based disease management program to improve control of risk factors. Under this aim, DH's unique computerized information system will be used to develop a registry of patients with hypertension, and to characterize patients' overall risk for cardiovascular disease and their risk for non-adherent behavior. A randomized clinical trial will be used to assess the impact of a nurse-based disease management intervention in those at highest risk and with a history of non-adherence. The intervention will be based on programs already in place at DH but will be modified in response to input from community-based focus groups.
Specific Aims 3 and 4 will seek to refine current cardiovascular risk profiling in ways specific to Hispanics.
Specific Aim 3 will assess ethnic differences in the relationship between traditional risk factors (diabetes, hypertension, smoking, hyperlipidemia) and pre-clinical markers of cardiovascular disease (left ventricular mass, carotid intima media thickness, and brachial artery reactivity) over time.
Specific Aim 4 will assess the relationship among the traditional risk factors, pre-clinical markers, and a panel of circulating inflammatory markers. Also under Specific Aim 4, a randomized, placebo controlled trial will assess the efficacy of """"""""statin"""""""" medications to reduce circulating levels of these inflammatory markers.
Specific Aims 5 and 6 will develop educational programs to increase the cultural proficiency of clinical researchers, increase minority researcher participation in cardiovascular prevention research, and assist junior DH physicians in developing research careers in cardiovascular prevention.
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