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