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

项目摘要 实现更大中心的总体目标是减少心脏代谢健康差距和寿命 居住在底特律、密西西比州和俄亥俄州克利夫兰的黑人成年人之间的不平等。我们的中心致力于解决光谱问题 心脏代谢风险，从简单的轻度高血压(BP)到更严重的 高血压合并合并症，以便为生活中的差异制定多种预防策略 跨度。在这方面，我们建议在新项目的逻辑扩展中直接建立在此基础上 旨在解决症状性(C期)心衰的种族差异。这一点至关重要，因为高频是 心脏代谢性疾病在美国最常见的最终表现，占近40万 每年有90万人死亡，90万人住院，严重的健康差距依然存在，与心力衰竭有关的 由于一些尚未完全了解的原因，黑人人口的发病率和死亡率更高。 虽然健康的多种负面社会决定因素(SDoH)的分布肯定起到了关键作用， 越来越多的证据进一步表明，环境因素对城市居民的不利影响过大 居住人口。在这方面，一些研究表明，空气污染物对氟化氢和 它的预后。-在黑人患者中的相对影响大约是两倍。此外，城市中心的高 少数族裔人口的比例也倾向于空气质量较差。事实上，底特律居民，其中80% 自我认同为黑人，面临着密歇根州最高的PM2.5浓度(美国为第97个百分位数)。因此， 我们假设空气污染是种族健康差异的环境来源，特别是 是底特律心力衰竭患者预后不佳的重要原因。为解决这个问题，我们建议： 测试一种新兴的治疗干预措施，便携式空气净化器(PAC)，我们假设它将减少 个人暴露于PM2.5可改善新近住院的心衰患者的临床结局 这可以缓解心力衰竭临床结局中的种族差异。这种新颖的干预既是 实用性和可伸缩性，因此有可能彻底改变心力衰竭的治疗方法，减少 普遍存在的种族差距。

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.