Reducing Heart Disease Risk
Based on the lessons learned from PAD, and the partnerships with the
Pastor’s Coalition and the Oportunidades Team in Mexico, we worked with
our community collaborators to develop an approach for reducing heart
disease risk in the South Dallas community. The South Dallas community
was almost 70% African-American. Deaths from coronary heart disease
(CHD) and stroke are significantly higher among African-Americans
compared with other race groups. Greater percentages of Black women
(37.9%) than White women (19.4%) and Black men (61.5%) compared with
White men (41.5%) die from CHD before age 75. Similarly, death rates
from stroke before age 75 are substantially higher among Black women
(39.0%) than White women (17.3%) and among Black men (60.7%) compared
with White men (31.1%).49 African-American adults
have the highest rates of CVD mortality and prevalence of uncontrolled
cardiovascular risk factors.50 Death rates from heart
disease and stroke were 2-3 times higher in South Dallas when compared
to other parts of the city.32
We obtained funding from the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health (NIH) to test a
community-based lifestyle intervention program, since modest but
sustained changes in physical inactivity and nutrition can reduce CVD
risk.50,51 Our program linked together the health
program activities of hospital-based planners, health center providers,
professional health educators, community health workers (CHWs), and
leaders in local African-American congregations.52 The
African-American church is an important and influential community
partner; it is the most important social institution in many
African-American communities, plays an important social role linking the
community to the larger society, is held in the highest esteem by most
African-Americans, and has a long history of engaging in community-based
health initiatives.53-55
The core of our approach was to train CHWs in the churches, by expanding
and adapting the PAD training program to focus more on CVD prevention,
and then systematically connecting the CHWs to the medical community and
to other community-based organizations addressing the social
determinants of health. The objective was to develop the supportive
environments needed to produce lasting lifestyle changes in the
community-based setting.56 Outcomes have been reported
in detail elsewhere and demonstrated improvement in eating behavior but
not physical activity.20,57,58 However, when we
compared program participants with a general sample of African-American
adults from Dallas Heart Study on cardiovascular risk factors (CVRFs),
they had significantly higher rates of treatment and control of multiple
CVD risk factors including treated hyperlipidemia, controlled diabetes,
controlled hypertension, more physically active, and less likely to
smoke.49,59