Behavioral Strategies for Cardiovascular Risk Reduction in Diverse and Underserved Racial/Ethnic Groups

Cardiovascular disease (CVD) is the leading cause of death and disability in the United States across all racial/ethnic groups.1 Much of the burden of CVD morbidity and mortality is associated with modifiable lifestyle risk factors. A disproportionate share of the burden of CVD and metabolic/vascular risk factors falls on racial and ethnic communities as a result of a constellation of social, environmental, biological, and systems factors.1,2 Disparities are most clearly evident for black compared with white Americans.1 Available data for other racial/ethnic minority populations indicate disparities for certain CVD risk factors or outcomes.1,3Despite widespread awareness among clinicians of primary and secondary CVD prevention goals and the potential for improving clinical outcomes by integrating lifestyle risk reduction interventions into practice, the application of these interventions is far from optimal.4 Therapeutic goals for primary and secondary prevention have been well established over the last 3 decades.5,6 Table 1, derived from the American Heart Association (AHA) scientific statements on primordial,4 primary,5 and secondary6 risk reduction and diet and lifestyle recommendations,7 delineates targeted goals and risk reduction strategies across the spectrum of prevention. Primary prevention seeks to avoid a first occurrence of CVD among individuals at risk through smoking cessation; management of blood pressure (BP), lipids, and glucose; weight control; and dietary and physical activity counseling.5 Secondary prevention aims for intensive and comprehensive management of risk factors in those with established CVD and is associated with improved survival and a reduction in recurrent events.6 Secondary prevention benchmarks for lipid management are lower than for primary prevention, but BP, smoking, dietary, and physical activity goals are the same. As a result of a growing recognition that subclinical disease develops over many years and with various …