cardiovascular disease, health disparities, precision health



  1. Dickson, Victoria Vaughan PhD, RN, FAHA, FHFSA, FAAN
  2. D'Eramo Melkus, Gail EdD, ANP, FAAN

Article Content

With the continued rise of cardiovascular disease (CVD) worldwide and ongoing health disparities,1 there is an urgent need for research that elucidates the complexity of CVD among diverse populations. An emerging focus on precision medicine in CVD research and clinical care emphasizes "individual variability in genes, environment, and lifestyle for each person"2 to drive prevention and treatment plans. Precision medicine uses clinical and health record data that incorporates panomics (eg, genomics, transcriptomics, proteomics, and metabolomics)3 to optimize care based on an individual's unique phenotype. Precision medicine in CVD represents a paradigm shift from care based on common pathophenotypes4 with similar treatment plans to personalized medical care based on the individual's unique phenotype. However, much of the care and prevention of CVD occurs outside the clinical setting, includes a substantial role of the individual vis-a-vis self-care,5 and is influenced by contextual factors including family and community, social networks, and environment.6 Given the complexity of CVD prevention and management among diverse populations, research to reduce or eliminate disparities requires a broader precision health perspective.


Precision health, inclusive of precision medicine, considers individual lifestyle, genetics, behaviors, and environment context7 to inform interventions aimed at improving health and preventing diseases through personalized interventions.8 Although the "precision" aspect focuses on the individual, the "big picture" focus of precision health takes into account not only biological variability (ie, genetics, heritability) but also environmental factors, from family to peers to environmental exposures and their impact on biology (ie, epigenetics, physiologic response). Socioecological factors related to the individual, their family, culture, and community impact health and need to be considered as components of interindividual variability in condition severity and response to treatment. Precision health that advances CVD science includes discovery science in underlying mechanisms and symptoms of CVD, the identification of distinct phenotypes of groups of individuals that consistently demonstrate similar physiologic and behavioral responses, and the development of personalized interventions to address CVD risk, prevention, and management.


Precision health in cardiovascular conditions is highlighted in this edition of the Journal of Cardiovascular Nursing.9-11 Scott et al's9 brief report describes important advances in genetics and genomics that have informed precision health research and the implications for health disparities among African Americans with CVD, including an imperative for equitable progress. Although there have been significant advances in genetic/genomic-related CVD research, racial and ethnic minority populations have been historically underrepresented.12 For example, hypertrophic cardiomyopathy is the most common inherited cardiac disorder13 and the most common cause of sudden cardiac death in Black athletes.14 Research has documented substantial variability in disease expression, course, and outcomes15 but is significantly limited by the lack of representation of diverse populations.16 In a recent scientific statement from the American Heart Association, Mudd-Martin et al12 report that, for marginalized groups and indigenous populations, underrepresentation in cardiovascular genetic/genomic research contributes to polygenic risk scores that are less accurate in predicting disease phenotypes and may result in misclassification of novel population-specific genetic variations. Scott et al9 further describe the historical and social constructs of race and how underrepresentation in research challenges the potential of genomic research to address health disparities.


Advancing precision health in CVD includes research that explores how multisystem factors such as family, culture, and community not only impact an individual's genetic makeup but also may influence health behaviors and relevant exposures. Key et al10 conducted a secondary analysis of a study examining the impact of genetics on response to a CVD risk reduction intervention, "HeartHealth," delivered to community-dwelling adults in rural Kentucky. Their study results suggest that genotypic differences in individuals' responses to anxiety may increase the risk for inflammatory responses associated with CVD. These findings help explain the complex association of anxiety and anxiety-associated disorders with CVD that, to date, has been explained by behavioral and physiologic mechanisms, including autonomic dysfunction, inflammation, and platelet aggregation.17 Key et al's10 study underscores the promise of precision health research in identifying targeted, tailored CVD prevention strategies based on genotypic differences.


Nurse scientists are ideally suited to conduct CVD precision health research because they have been leaders in patient-centered care that includes the context of one's life and living situation. In 2018, the American Heart Association Cardiovascular and Stroke Nursing Council identified precision health as a cardiovascular nursing science priority.18 Nurse scientists as leaders in precision health research have a unique position across healthcare and community settings to promote health equity among populations with CVD.9 Many are already at the forefront of identifying genomic and epigenetic factors associated with CVD risk and outcomes in diverse populations,19-21 and examining biomarkers associated with disease progression11 that may be useful in developing targeted precision health approaches to CVD care.


Eliminating health disparities among vulnerable populations with CVD across the life span is a priority that must be addressed especially as these populations grow in number and proportion. Precision health research informed by various populations can elucidate root causes, underlying determinants, and inequalities of CVD health disparities and inform the development of personalized strategies to reduce and eliminate ongoing CVD disparities.




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