Future Research Directions to Prevent Cardiovascular Disease
and its Risk Factors among Hispanics/Latinos
The National Heart, Lung, and Blood Institute (NHLBI) convened a Workshop on July 15-16, 2010 in Rockville, MD, to provide recommendations to NHLBI that would guide future research priorities and directions related to cardiovascular prevention research in Hispanics/Latinos.
The goals were to: 1) assess the state of current knowledge regarding interventional approaches to the prevention of CVD and its risk factors among Hispanics/Latinos, 2) identify promising approaches and research gaps, and 3) inform NHLBI about national research opportunities in the design and conduct of intervention studies to prevent CVD and reduce its risk factors among Hispanics/Latinos.
According to the U.S. Census, nearly 16% of the U.S. population is of Hispanic/Latino origin and it is projected to increase to 25% by 2050. Compared to non-Hispanic whites, Hispanics/Latinos have a higher prevalence of CVD risk factors such as obesity, diabetes, dyslipidemia, and physical inactivity. However, relatively little is known about what interventions for these risk factors are likely to be effective in Hispanics/Latinos.
Seventeen scientists, researchers, and clinicians who are experts in interventions that target CVD risk factors in Hispanic/Latinos participated. There were panels in the following five topic areas: 1) obesity, physical activity, and nutrition; 2) innovative approaches; 3) study design; 4) smoking and sleep; and 5) chronic diseases and risk factors – diabetes, hypertension, and dyslipidemia. Each panel a) summarized existing intervention research involving Hispanics/Latinos, (e.g., physical activity); b) identified research gaps and opportunities; and c) provided recommendations for future research.
Research Recommendations Targeting Obesity among Hispanics/Latinos
The workshop participants identified several research needs on how best to prevent CVD among Hispanics/Latinos. Workshop participants also stated that data from the NHLBI-supported Hispanic Community Health Study/Study of Latinos (HCHS/SOL) http://www.cscc.unc.edu/hchs/ should be reviewed to inform the development of future intervention approaches.
There was a consensus that future research should particularly target the prevention and control of obesity, given its high prevalence and relationship to other risk factors. Workshop participants argued for research to determine the effectiveness of community health workers , otherwise known as “promotoras,” in delivering interventions to prevent obesity.
Workshop participants identified seven key opportunities targeting obesity prevention:
- Target groups: There is a need to examine intervention effects in diverse groups of Latinos such as those with co-morbid conditions (e.g., high-risk groups with metabolic syndrome, pre-diabetes); pregnant Latinas; ethnic subgroups by context (e.g., Puerto Ricans living on the mainland versus Puerto Ricans living in Puerto Rico); men of different age groups, including children and adolescents; spouses and other family/peer members of obese individuals; and recent immigrants (including emerging Hispanic/Latino communities, such as those in the rural South) versus more acculturated Hispanics/Latinos.
- Outcomes: In addition to obesity-related outcomes, such as BMI, physical activity, sedentary behaviors, cardiovascular fitness, and diet, there is a need to assess what impact interventions have on metabolic factors among Hispanics/Latinos.
- Settings: There is a need to identify intervention settings (e.g., tiendas-small local grocery stores, churches, clinics, homes) appropriate for the population and context.
- Messages: There is a need to better understand how knowledge and perceptions are translated into behavior change within communities. In addition, research should focus on better understanding whether and how dietary/activity messages/interventions need to be tailored or targeted based on acculturation status.
- Sources of communications and intervention delivery tools: There is a need to develop and test interventions that incorporate various sources of information, such as multimedia technology (e.g., mobile phones), community health workers, physicians and other primary care staff, and peers.
- Research design and methodology: In addition to randomized controlled trials, investigators should consider addressing research questions with natural experiments, quasi-experiments, small group-randomized comparisons or time-series designs; expand opportunities to tailor and adapt interventions for maximum impact in Hispanic/Latino communities using qualitative and pilot phases that could be incorporated rapidly into pivotal randomized controlled trials; conduct cost-effectiveness, translational/dissemination research in particular as it relates to promotora-based interventions; and develop interventions combining individual approaches with broader community and policy level approaches.
- Infrastructure: To leverage limited resources and maximize the impact of future research, there is a need to work closely with central cultural and community organizations (e.g., non-governmental organizations, churches), to encourage work within multi-disciplinary teams, and to incorporate training and development of Hispanic/Latino researchers within projects and programs.
- Amelie Ramirez (chair)
- John Elder (chair)
- Elva Arredondo
- Guadalupe X. Ayala
- Hector Balcazar
- Olveen Carrasquillo
- Mary Charlson
- Andrea Cherrington
- Kim Gans
- Michael Goran
- Felipe Lobelo
- Jose Loredo
- Diego Osuna
- Deborah Parra-Medina
- Kevin Patrick
- Eliseo Perez-Stable
- Gregory Talavera
- Matilde Alvarado
- S. Sonia Arteaga
- Larissa Avilés- Santa
- Aleli Ayala (NIH summer intern)
- Diane Bild
- Josephine Boyington
- Jane Harman
- Catherine Loria
- Melissa McGowan
- Toni Nettles (NIH summer intern)
- Charlotte Pratt
For more information please contact:
S. Sonia Arteaga, Ph.D.
Clinical Applications and Prevention Branch
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute
National Institutes of Health
6701 Rockledge Drive, Suite 10018
Bethesda, MD 20892
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Last Updated: March 2012