Perspectives: Recent advances in community-based interventions for cardiovascular disease disparities in the United States

Abstract

Despite decades of progress in prevention and management, cardiovascular disease (CVD) remains the leading cause of mortality in the United States (US) and globally, with persistent and even widening disparities in outcomes across racial, ethnic, geographic, and socioeconomic groups. As a complement to clinical care, community-based interventions have emerged as vital tools in promoting cardiovascular health, particularly in underserved populations. This perspective focuses on recent advances in US-based community interventions for CVD, while acknowledging global relevance, and explores the historical evolution, current landscape, and future directions of community-driven CVD prevention strategies. We highlight foundational models such as the Healthy Heart Community Prevention Project in New Orleans, Louisiana, and examine recent major studies and innovations in the field from the US and across the world. Community-rooted programs demonstrate growing potential to address upstream determinants of cardiovascular health. Their continued success, however, will depend on sustained investment, robust evaluation frameworks, and alignment with clinical care pathways and health policy infrastructure.

Keywords

Community interventions / Cardiovascular disorders / Hypertension / Disparities

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

References

[1] Martin SS, Aday AW, Allen NB, et al. 2025 Heart disease and stroke statistics: A report of US and global data from the American heart association. Circulation. 2025; 151:e41-e660. doi: 10.1161/CIR.0000000000001303

[2] Mensah GA, Fuster V, Murray CJL, Roth GA, Global Burden of Cardiovascular Diseases and Risks Collaborators. Global burden of cardiovascular diseases and risks, 1990-2022. J Am Coll Cardiol. 2023; 82(25):2350-2473. doi: 10.1016/j.jacc.2023.11.007

[3] Soltani S, Saraf-Bank S, Basirat R, et al. Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: A systematic review and meta-analysis. Public Health. 2021; 200:59-70. doi: 10.1016/j.puhe.2021.09.006

[4] Ndejjo R, Hassen HY, Wanyenze RK, et al. Community-based interventions for cardiovascular disease prevention in low-and middle-income countries: A systematic review. Public Health Rev. 2021; 42:1604018. doi: 10.3389/phrs.2021.1604018

[5] Redfern J, Usherwood T, Harris MF, et al. A randomised controlled trial of a peer support intervention for improving the health of patients with coronary heart disease: The “proactive heart” study. J Am Coll Cardiol. 2017; 69(3): 312-321. doi: 10.1016/j.jacc.2017.05.041

[6] Jafar TH, Gandhi M, De Silva HA, et al. A community-based intervention for managing hypertension in rural South Asia. N Engl J Med. 2020; 382(8):717-726. doi: 10.1056/NEJMoa1911965

[7] Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: A report from the American heart association. Circulation. 2023; 147(8):e93-e621. doi: 10.1161/CIR.0000000000001123

[8] Kazi DS, Elkind MSV, Deutsch A, et al. Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: A presidential advisory from the American heart association. Circulation. 2024; 150(4):e89-e101. doi: 10.1161/CIR.0000000000001258

[9] Dawber TR, Meadors GF, Moore FE Jr. Epidemiological approaches to heart disease: The Framingham study. Am J Public Health Nations Health. 1951; 41(3):279-281. doi: 10.2105/AJPH.41.3.279

[10] Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham heart study and the epidemiology of cardiovascular disease: A historical perspective. Lancet. 2014; 383(9921):999-1008. doi: 10.1016/S0140-6736(13)61752-3

[11] National Center for Health Statistics. Plan and operation of the third national health and nutrition examination survey, 1988-94. Series 1: Programs and collection procedures. Vital Health Stat 1. 1994; 32:1-407.

[12] Kong BW, Miller JM, Smoot RT. Churches as high blood pressure control centers. J Natl Med Assoc. 1982; 74(9):920-923.

[13] Mensah GA, Norris KC. Advancing health equity: Honoring the legacy of Dr. Elijah B. Saunders. Ethn Dis. 2015; 25(4): 381-382. doi: 10.18865/ed.25.4.381

[14] Kong BW. Community programs to increase hypertensioncontrol. J Natl Med Assoc. 1989; 81 Suppl:13-16.

[15] Ferdinand KC. The healthy heart community prevention project: A model for primary cardiovascular risk reduction in the African-American population. J Natl Med Assoc. 1995; 87 Suppl:638-641.

[16] Ferdinand DP, Nedunchezhian S, Ferdinand KC. Hypertension in African Americans: Advances in community outreach and public health approaches. Prog Cardiovasc Dis. 2020; 63(1):40-45. doi: 10.1016/j.pcad.2019.12.005

[17] Frieden TR, Berwick DM. The “million hearts” initiative- -preventing heart attacks and strokes. N Engl J Med. 2011; 365(13):e27. doi: 10.1056/NEJMp1110421

[18] Victor RG, Lynch K, Li N, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med. 2018; 378(14):1291-1301. doi: 10.1056/NEJMoa1717250

[19] Puska P, Jaini P. The North Karelia project: Prevention of cardiovascular disease in Finland through population-based lifestyle interventions. Am J Lifestyle Med. 2020; 14(5):495-499. doi: 10.1177/1559827620910981

[20] Minhas AMK, Talha KM, Abramov D, et al. Racial and ethnic disparities in cardiovascular disease - analysis across major US national databases. J Natl Med Assoc. 2024; 116(3):258-270. doi: 10.1016/j.jnma.2024.01.022

[21] Reddy KP, Eberly LA, Julien HM, et al. Association between racial residential segregation and black-white disparities in cardiovascular disease mortality. Am Heart J. 2023; 264:143-152. doi: 10.1016/j.ahj.2023.06.010

[22] Rosenblatt S, Blaha MJ, Blankstein R, et al. Racial and ethnic differences in long-term cardiovascular mortality among women and men from the CAC consortium. JACC Cardiovasc Imaging. 2025; 18:664-675. doi: 10.1016/j.jcmg.2025.01.013

[23] Graham JK, Jenkins D, Iris K, Knudsen M, Kelley C. The toxic stress of racism and its relationship to frailty. Clin Nurs Res. 2024; 33(5):301-308. doi: 10.1177/10547738241233050

[24] Pirzada A, Cai J, Heiss G, et al. Evolving science on cardiovascular disease among Hispanic/Latino adults: JACC international. J Am Coll Cardiol. 2023; 81(15):1505-1520. doi: 10.1016/j.jacc.2023.02.023

[25] He J, Bundy JD, Geng S, et al. Social, behavioral, and metabolic risk factors and racial disparities in cardiovascular disease mortality in U.S. adults: An observational study. Ann Intern Med. 2023; 176(9):1200-1208. doi: 10.7326/M23-0507

[26] Wali S, Hiscock EC, Simard A, Fung N, Ross H, Mashford- Pringle A. Learning from our strengths: Exploring strategies to support heart health in indigenous communities. CJC Open. 2023; 6(7):849-856. doi: 10.1016/j.cjco.2023.06.005

[27] Sekkarie A, Woodruff RC, Casper M, Paul AT, Vaughan AS. Rural-Urban disparities in cardiovascular disease mortality vary by poverty level and region [Published J Rural Health. 2025; 41(1): e12918. doi: 10.1111/jrh.12918]. J Rural Health. 2025; 41(1): e12874. doi: 10.1111/jrh.12874

[28] Tanumihardjo JP, Eversole C, Zhu M, Gunter KE, Peek ME. Glycemic control and patient-reported outcomes among patients with diabetes engaged with community health workers in rural settings. J Gen Intern Med. 2023; 38(Suppl 1):45-47. doi: 10.1007/s11606-022-07929-z

[29] Fujii Y, Streeter TE, Schieb L, Casper M, Wall HK. Finding optimal locations for implementing innovative hypertension management approaches among African American populations: Mapping barbershops, hair salons, and community health centers. Prev Chronic Dis. 2024; 21:E10. doi: 10.5888/pcd21.230329

[30] Nuño T, Torres MR, Soto S, Sepulveda R, Aceves B, Rosales CB. Feasibility and outcomes of Meta Salud diabetes behavioral health intervention: A pilot study of a community health worker-administered educational intervention to prevent cardiovascular disease and its complications among hispanic patients with type-2 diabetes. Int J Environ Res Public Health. 2023; 20(21):6968. doi: 10.3390/ijerph20216968

[31] He J, Ouyang N, Guo X, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): An open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023; 401(10380):928-938. doi: 10.1016/S0140-6736(22)02603-4

[32] Mills KT, Laurent J, Allouch F, et al. Engaging predominantly black churches in an intervention to improve cardiovascular health and reduce racial inequities. Ethn Dis. 2024; DECIPHeR(Spec Issue):89-95. doi: 10.18865/ed.DECIPHeR.89

[33] Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/ AHA guideline on the primary prevention of cardiovascular disease: A report of the American college of cardiology/ American heart association task force on clinical practice guidelines. Circulation. 2019; 140(11):e596-e646. doi: 10.1161/CIR.0000000000000678

[34] Ferdinand DP, Reddy TK, Wegener MR, et al. TEXT MY BP MEDS NOLA: A pilot study of text-messaging and social support to increase hypertension medication adherence. Am Heart J Plus. 2023; 26:100253. doi: 10.1016/j.ahjo.2023.100253

[35] Louisiana Clinical and Translational Science Center. LA CaTS. Available from: https://www.lacats.org [Last accessed on 2025 Apr 21].

[36] Katz ME, Mszar R, Grimshaw AA, et al. Digital health interventions for hypertension management in US populations experiencing health disparities: A systematic review and meta-analysis. JAMA Netw Open. 2024; 7(2):e2356070. doi: 10.1001/jamanetworkopen.2023.56070

[37] Cooper LA, Marsteller JA, Carson KA, et al. Equitable care for hypertension: Blood pressure and patient-reported outcomes of the rich life cluster randomized trial. Circulation. 2024; 150(3):230-242. doi: 10.1161/CIRCULATIONAHA.124.069622

[38] Kandula NR, Shah NS, Kumar S, et al. Culturally adapted lifestyle intervention for South Asian adults with cardiovascular risk factors: The SAHELI randomized clinical trial. JAMA Cardiol. 2024; 9(11):973-981. doi: 10.1001/jamacardio.2024.2526

[39] Sun T, Xu X, Ding Z, et al. Development of a health behavioral digital intervention for patients with hypertension based on an intelligent health promotion system and WeChat: Randomized controlled trial. JMIR Mhealth Uhealth. 2024; 12:e53006. doi: 10.2196/53006

[40] Kate MP, Samuel C, Singh S, et al. Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial. J Stroke Cerebrovasc Dis. 2023; 32(6):107107. doi: 10.1016/j.jstrokecerebrovasdis.2023.107107

[41] Wang Y, Guo D, Xia Y, et al. Effect of community-based integrated care for patients with diabetes and depression (CIC-PDD) in China: A pragmatic cluster-randomized trial. Diabetes Care. 2025; 48(2):226-234. doi: 10.2337/dc24-1593

[42] Castillo-Hernandez KG, Espinosa A, Molina-Segui F, et al. Lessons learned from a peer-supported diabetes education program in two dissimilar Mayan communities. Front Endocrinol (Lausanne). 2024; 14:1280539. doi: 10.3389/fendo.2023.1280539

[43] Thapa R, Zengin A, Neupane D, et al. Sustainability of a 12-month lifestyle intervention delivered by community health workers in reducing blood pressure in Nepal: 5-year follow-up of the COBIN open-label, cluster randomised trial. Lancet Glob Health. 2023; 11(7):e1086-e1095. doi: 10.1016/S2214-109X(23)00214-0

[44] Alves De Araújo W, Cardoso Santos IS, Souza Rosa R, et al. Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: A non-randomized clinical trial. Invest Educ Enferm. 2024; 42(1):e03. doi: 10.17533/udea.iee.v42n1e03

[45] Mbuthia GW, Mwangi J, Magutah K, Oguta JO, Ngure K, McGarvey ST. Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial. PLoS One. 2024; 19(8):e0293791. doi: 10.1371/journal.pone.0293791

[46] Division Faculty Promote Heart Health in School Outreach Program. Washington: University School of Medicine Cardiovascular Division. Available from: https://cardiology.wustl.edu/division-faculty-promote-heart-health-in/school/outreach-program [Last accessed on 2025 Apr 21].

[47] Shimbo D, Shah RU, Abdalla M, et al. Transforming hypertension diagnosis and management in the era of artificial intelligence: A 2023 national heart, lung, and blood institute (NHLBI) workshop report. Hypertension. 2025; 82(1):36-45. doi: 10.1161/HYPERTENSIONAHA.124.22095

[48] Orakwue CJ, Zahedi Tajrishi F, Gistand CM, Feng H, Ferdinand KC. Combating cardiovascular disease disparities: The potential role of artificial intelligence. Lancet Digit Health. 2025; 7(4):e264-e273. doi: 10.1016/S2666-6677(25)00027-3

[49] Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012; 50(3):217-226. doi: 10.1097/MLR.0b013e3182408812