SFRN Centers Disparities in CVD and Stroke

If there was one word to describe the relationship between researchers at the four Disparities SFRN centers, it would be “synergy.” Each center reported working together across disciplines and institutional borders to achieve network goals.

Center Director: Robert Adams, M.D., M.S

At the Medical University of South Carolina, researchers tackled a question that’s frustrated medical professionals for years: Why is stroke recovery worse for African Americans than for white people, even with the same access to rehabilitation?

To delve into the problem, MUSC scientists working in regenerative medicine, neuroscience and nursing used novel approaches to target the disparities and better understand the problem. In the basic project, researchers saw how recovery in the animal model was hampered by the multiple risk factors of blood pressure, diabetes and high cholesterol.

“We learned we’ve got to be more aggressive in treating preexisting conditions earlier, before people have a stroke,” said Center Director Robert Adams, M.D., M.S. Researchers studying brain health imaging came to a similar conclusion.

The population project developed long-lasting team nursing strategies to better help African Americans recover from stroke. “A nurse guides the team, but community health workers have an increasingly important role to play,” Adams said. The researchers identified several barriers and facilitators of post-stroke recovery (in terms of functional and psychosocial status and quality of life). The physical and cognitive changes remaining after stroke included mood changes, medication issues and lack of support and resources. Health care professionals identified knowledge and information, care coordination and, resources within the community, which were key to facilitating stroke recovery outcomes.

Adams said his center’s research shows that the Disparities SFRN model combines the best of all worlds.

“Some research projects are very broad and others are highly focused, but this SFRN is important because it’s in between: It brings just enough focus so people who think very differently can communicate in new ways,” Adams said.

An AHA volunteer since the 1980s, Adams credits the organization for its dedication to health disparities long before others made that a priority. The Disparities SFRN continued that mission by teaching scientists from distinct backgrounds to think differently.

“It’s a tremendous, exciting opportunity for everyone to trust one another, learn new things and look at society and science in a new way,” Adams said.

Center Director: Herman Taylor, M.D.

When examining health disparities, sometimes it’s best to make a 180-degree turn, said Center Director Herman Taylor, M.D. from Morehouse School of Medicine.

“We spend 99% of our time examining how poorly Black health is maintained and virtually no time exploring how so many African Americans live long lives despite the challenges and stressors,” he said. “Focusing on the negative has indeed created important research, but there’s another story to tell: the story of survival and resilience.”

To do that, Morehouse School of Medicine partnered with Emory University to create the MSM/Emory Cardiovascular (MECA) Center for Health Equity. Center scientists went to Atlanta to find out why some Black neighborhoods had good cardiovascular health and others fared poorly, despite similar income levels.

Using surveys, data analysis and lab tests, they discovered that heart health was better in communities where people regularly connected with their neighbors and had a strong sense of optimism, purpose and control over their lives.

The findings open the door for community and psychological interventions to try to improve cardiovascular health, Taylor said.

“Optimism is an attitude that can be created,” he said. “There are lessons to be learned from this study about human resilience and the incredibly positive narrative of African Americans thriving through some of the hardest challenges imaginable.”

Those challenges still loom large. Taylor pointed to a recent study that found more than 74,000 “excess deaths” occur annually among Black Americans because their mortality rate was higher than that of white populations.

“It’s a huge public emergency. It’s why the Strategically Focused Research Network on Disparities is as important as any initiative the American Heart Association has undertaken. And it’s why we need more funding to sponsor more studies that will potentially resolve these disparities.”

Center Directors: Myles Wolf, M.D., M.Med.Sc., and Mercedes Carnethon, Ph.D., FAHA

At Northwestern University, researchers dug deep into the world of molecules to learn if food preservatives are linked with disproportionately high rates of heart and kidney disease among African Americans.

“We took an innovative approach to filling a unique niche,” said Mercedes Carnethon, Ph.D., FAHA, who credited Co-Center Director Myles Wolf, M.D., M.Med.Sc., for coming up with the idea. “We decided to look under the skin at the molecular mechanism that underlies disparities.”

Researchers zoomed in on the microscopic properties of processed and packaged foods, which are often cheaper than fresh fruits and vegetables and are often bought by people experiencing food insecurity.

They found that phosphorous, a food preservative, can cause the body to produce high levels of the hormone Fibroblast Growth Factor 23 (FGF23) and harm blood vessels leading to the heart and kidneys. They also discovered that food insecurity was linked with higher levels of FGF23.

Finally, researchers tested diets that can reduce the damage and found that eating foods low in phosphorus may improve the heart health of people who have poor access to nutritious foods

“Prior work on FGF23 had been done in people with advanced disease. This was an opportunity to step back and look at a population that didn’t have preexisting disease and see if this marker is associated with disparities,” she said.

The findings could impact public health policy similar to past studies that showed the dangers of trans fats, Carnethon said.

“As a result of that research, the United States and other countries began regulating trans fats,” she said. “We hope this research presents an empirical piece of evidence to suggest that there should be labeling for phosphates. If the strength of evidence continues to grow, there should be regulations about their use.”

Carnethon applauded the American Heart Association for coming up with a complex but cohesive way to explore disparities in cardiovascular health.

“It’s really valuable to carve out space for 12 investigators at four centers who are all pursuing one big topic at the same time and touching base with one another,” she said. “I think that sort of dedicated work on a single topic really accelerates progress.”

Center Director: Spero Manson, Ph.D.

At University of Colorado Denver, researchers explored the intersection of racial discrimination, stress and cardiovascular risk among American Indians and Alaska Natives in urban areas.

"There’s the stereotype of native people living in rural and reservation areas, but in fact, over 70% of American Indian and Alaska Native people live in cities,” said Center Director Spero Manson, Ph.D. “Because they remain so understudied, it puts them at double jeopardy.”

Researchers set out to see if racial discrimination plays a role in cardiovascular disease, and if so, what can be done to reverse that.

One study measured experiences of racial discrimination and heart health in more than 500 American Indian and Alaska Natives living in the Denver area. Researchers found that perceived racism was linked to worse mental health, sleep and eating habits. Those who experienced more racism were at higher risk for heart disease and other health problems.

“Racism will always be in the environment, but the next step is intervening,” Manson said. “If we can give individuals tools to have a greater sense of resilience and control, it might reduce the basic contributors to hypertension and cardiovascular disease."

Researchers also set out to test new ways of reducing the fear of racism in the doctor’s office.

Before their appointments, patients waiting in the reception area took part in short “values affirmation” exercises: After choosing certain primary values from a list of about 10 choices, the patients were asked to write a few sentences about the meaning and importance of this value in their lives.

The research found that American Indian and Alaska Natives who took part in the exercises had “an increased sense of self-efficacy” and were more likely to take their prescribed medication regularly and have better control of their blood pressure, Manson said.

For the three UC Denver fellows who worked on the SFRN, the experience “pushed them forward in a rapid advancement in their respective career paths,” Manson said.

“Two of the research fellows are American Indians, who are among the most underrepresented racial groups in the scientific workforce today. The fellowships contributed to their sense of ability to conduct high-quality science, to advance academically, and it gave them a sense of value to the communities with whom they are partnered.”

“In many senses, this initiative is an incubator that’s fueled new lines of inquiry for us,” Manson said. “It’s been highly successful, both in terms of launching our work forward, but also in attracting human and capital resources. It’s been a catalyst.”