ACHIEVE GreatER: Addressing Cardiometabolic Health Inequities by Early PreVEntion in the Great LakEs Region

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PROJECT ABSTRACT The overall goal of the ACHIEVE GREATER center is to reduce cardiometabolic health disparities and lifespan inequality among Black adults living in Detroit MI and Cleveland OH. Our center seeks to address the spectrum of cardiometabolic risk, from uncomplicated mild high blood pressure (BP) to more severe forms of hypertension with comorbidities, in order to develop multiple prevention strategies for disparities across the life span. In this context, we propose to directly build upon this foundation in a logical extension to a new project aiming to address racial disparities in symptomatic (Stage C) HF. This is vitally important because HF is the most common final manifestation of cardiometabolic diseases in the U.S., accounting for nearly 400,000 deaths and 900,000 hospitalizations per year and serious health disparities persist whereby HF-related morbidity and mortality are greater in Black populations for a number of reasons yet to be fully understood. While the distribution of multiple negative social determinants of health (SDoH) certainly plays a key role, growing evidence further implicates an outsized adverse impact from environmental factors among urban dwelling populations. In this regard, a number of studies show that air pollutants adversely impact HF and its prognosis. - with roughly double the relative impact in Black patients. Moreover, urban centers with a high proportion of minority population also tend to have worse air quality. Indeed, Detroit residents, 80% of whom self-identify as Black, face the highest PM2.5 concentrations in Michigan (97th percentile for the U.S.). As such, we hypothesize that air pollution is an environmental source of racial health disparities and specifically significant contributor to poor outcomes among HF patients in Detroit. To combat this problem, we propose to test an emerging therapeutic intervention, the portable air cleaners (PAC), that we hypothesize will reduce personal-level exposure to PM2.5 resulting in improved clinical outcomes for recently hospitalized HF patients and that this could mitigate racial disparities in HF clinical outcomes. This novel intervention is both practical and scalable, and thus has the potential to revolutionize the treatment of HF and reduce widespread racial disparities.