Gender Race and Ethnic Disparities Research in Cardiovascular Disease Prevention

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DESCRIPTION (provided by applicant): Gender and racial/ethnic disparities in cardiovascular disease (CVD) have been well documented over the past decade of research. The applicant for renewal of a Midcareer Research Award, Dr. Lori Mosca, and many of her mentees, have contributed substantially to advancement of our knowledge in this field as a result of the initial K24 award, during which time Dr. Mosca was promoted to Professor of Medicine at Columbia University Medical Center. Substantial questions remain regarding the reasons for discrepancies in care and outcomes, a critical scientific gap that could inform interventions designed to reduce gender and racial/disparities in the prevention and treatment of CVD. The goal of this award is to provide the applicant with protected time to increase the pool of high quality multidisciplinary patient oriented researchers dedicated to a) understanding the independent contributions of gender and race/ethnicity to CVD outcomes and b) developing novel interventions targeted to modifiable factors that may reduce disparities. The award will also support the applicant's time to interact with and learn from other senior investigators with an interest in CVD disparities research, an appropriate and important commitment for her stage of career development. Extensive preliminary data by the applicant and her mentees has documented disparities in CVD awareness, risk factor control, and barriers to prevention. The proposed research provides a timely scientific opportunity to garner data from existing and ongoing studies uniquely suited to evaluate independent contributors to disparities and inform the design of future clinical trials and interventions aimed to reduce CVD disparities. The specific aims of the research include: 1) To examine the association between race/ethnic group and a) awareness of coronary heart disease as the leading cause of death in women, b) knowledge of heart attack symptoms and actions to take when experiencing heart attack symptoms, and c) perceptions of preventive/alternative therapies for coronary heart disease risk reduction, among nationally representative samples of women surveyed triennially from 1997-2009, 2) To determine whether the effectiveness of a screening and education program for family members of patients hospitalized with CVD to improve lifestyle factors over one year varies by race/ethnic group and to examine acculturation, baseline risk, and psychosocial factors as potential confounders/effect modifiers of program effectiveness and 3) To ascertain whether control of CVD risk factors is independently associated with race/ethnic group among consecutive patients admitted to the cardiovascular disease service line of a major medical center, and to determine whether the association with medication adherence and having a paid or non-paid (family member/friend) caregiver prior to hospitalization. The significance and impact of this research is that it will extend our knowledge about health disparities and will address the etiology of differential outcomes with the goal of developing effective interventions to optimize cardiovascular health among populations that bear a disproportionate burden of CVD risk. PUBLIC HEALTH RELEVANCE: This purpose of this research is to contribute to a reduction in gender, racial, and ethnic disparities in cardiovascular disease prevention through innovative approaches to study the causes of health disparities and to use the knowledge gained to inform targeted educational programs and to design future clinical studies aimed to reduce disparities and improve cardiovascular health for all.