State of the Nation's Cardiovascular Health and Targeting Health Equity in the United States: A Narrative Review

Abstract

Importance: Cardiovascular disease is the leading cause of death in the US. The burden of cardiovascular disease morbidity and mortality disproportionately affects racial/ethnic minority groups, who now compose almost 40% of the US population in aggregate. As part of the 2010 American Heart Association (AHA) Strategic Impact Goal, the AHA established 7 cardiovascular health (CVH) metrics (also known as Life's Simple 7) with the goal to improve the CVH of all individuals in the US by 20% by 2020. National estimates of CVH are important to track and monitor at the population level but may mask important differences across and within racial/ethnic minority groups. It is critical to understand how CVH may differ between racial/ethnic minority groups and consider how these differences in CVH may contribute to disparities in cardiovascular disease burden and overall longevity.

Observations: This narrative review summarizes the available literature on individual CVH metrics and composite CVH scores across different race/ethnic minority groups (specifically Hispanic/Latino, Asian, and non-Hispanic Black individuals) in the US. Disparities in CVH persist among racial/ethnic groups, but key gaps in knowledge exist, in part, owing to underrepresentation of these racial/ethnic groups in research or misrepresentation of CVH because of aggregation of race/ethnicity subgroups. A comprehensive, multilevel approach is needed to target health equity and should include (1) access to high-quality health care, (2) community-engaged approaches to adapt disruptive health care delivery innovations, (3) equitable economic investment in the social and built environment, and (4) increasing funding for research in racial/ethnic minority populations.

Conclusions and relevance: Significant differences in CVH exist within racial/ethnic groups. Given the rapid growth of diverse, minority populations in the US, focused investigation is needed to identify strategies to optimize CVH. Opportunities exist to address inequities in CVH and to successfully achieve both the interim (AHA 2024) and longer-term (AHA 2030) Impact Goals in the coming years.

Figure 1.. Census Population Distribution and Projections (in 100 000s) by Race/Ethnicity Group in the United States, 2010-2050

There is a growing population of racial/ethnic minority groups in the US that is projected to increase further by 2050. Data are accessed from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Data are not available on disaggregated Hispanic/Latino and Asian subgroups in the US.

Figure 2.. Distribution of Disaggregated Hispanic/Latino and Asian Subgroups in the United States, 2015-2019

Hispanic/Latino and Asian individuals in the US represent a diverse, heterogeneous group of cultures that can and should be further disaggregated in census reporting, research studies, and interventions. Data are accessed from the American Community Survey 5-year estimates (2015-2019). ^aThe other Asian category includes individuals who self-reported as Asian ancestry other than Chinese, Indian, Filipino, Vietnamese, Korean, or Japanese.

Figure 3.. A Multipronged Framework for Targeting Equity in Cardiovascular Health in the United States

A comprehensive agenda, as proposed here, must target all determinants of cardiovascular health (CVH), and the unique CVH profiles of individual groups and communities, to achieve health equity.