Lalika, Mathias

Background: Increased arterial stiffness, a marker of cardiovascular disease (CVD), is prevalent among African American (AA) adults and contributes to persistent CVD disparities. The Cardio-Ankle Vascular Index (CAVI) is a validated measure of arterial stiffness and predictor of adverse CVD outcomes. However, its relationship with the novel American Heart Association’s Life’s Essential 8 (LE8) cardiovascular health (CVH) construct has not been examined among AAs. Hypothesis: We hypothesized that increased arterial stiffness would be associated with lower CVH among AA adults. Methods: We analyzed baseline data from AA adults in the Techquity by FAITH! Trial, a 2-arm cluster randomized controlled trial conducted across 18 AA churches in Rochester and Minneapolis–St. Paul, Minnesota. Eligible participants (age ≥18 years with suboptimal diet or physical activity [PA]) completed validated electronic surveys (e.g., PA patterns) and clinical assessments (e.g., blood pressure [BP], lipids). CAVI was summarized as mean and categorized as normal (<8), borderline (8 to <9), or abnormal (≥9). CVH was assessed using the LE8 score (range 0-100 points) and categorized as low (<50), moderate (50-79), or high (≥80). Associations between CAVI and LE8 were assessed using multivariable linear regression adjusted for age, sex, and income (continuous) and Fisher’s exact test (categorical). LE8 components were compared across CAVI categories using Kruskal–Wallis tests. Results: Among 140 participants (mean age 53.0 years [SD 14.6]; 68% female), the mean LE8 score was 62.7 (SD 14.0). Nicotine exposure LE8 score was the highest (84.6 [SD 26.6]) and diet was the lowest (40.7 [SD 13.7]). Mean CAVI was 7.9 (SD 1.5), with 50% of participants classified as normal, 22% borderline, and 28% abnormal. No association between continuous CAVI and LE8 scores was observed after adjustment (unadjusted R 2 = 3.5%). All participants with high LE8 had normal CAVI, while abnormal CAVI was more prevalent among those with low (40%) and moderate (30%) LE8 scores (p<0.001). LE8 scores differed across CAVI categories for BP (median 50 in normal CAVI vs 30 in borderline/abnormal CAVI; p=0.003) and glucose LE8 scores (median 100 vs 60; p=0.014). Conclusions: Greater arterial stiffness was associated with lower CVH categories, with notable component-level differences in BP and glucose. Although not independently associated with overall LE8, integrating CAVI and LE8 categories may improve CVD risk stratification among AAs.

The FAITH! (Fostering African-American Improvement in Total Health) Cardiovascular Health and Wellness Program is more than a decade-long community-based participatory research initiative aimed at addressing cardiovascular health disparities among African-Americans in Minnesota. Founded in 2013, the program employs a culturally tailored, community-driven approach by partnering with African-American faith communities to promote cardiovascular health through education, digital health tools, and multilevel interventions targeting the social determinants of health. Grounded in community-based participatory research principles, FAITH! prioritizes equitable academic-community partnerships, co-learning, community capacity building, and shared ownership in all aspects of research and implementation. The program’s exemplary innovations include the NIH-funded FAITH! Trial, a randomized clinical trial, testing a mobile health intervention (the FAITH! App) co-created with the African-American community, and the Techquity by FAITH! study. Techquity by FAITH! evaluates the effectiveness of a culturally relevant, community-informed mHealth intervention supported by a Digital Health Advocate network to improve overall cardiovascular health and digital health literacy. During its evolution, FAITH! has addressed emergent public health crises, including the COVID-19 pandemic, by adapting programming to provide emergency preparedness resources, health education, and vaccine outreach. Key outcomes include sustainable church-based health ministries, increased research participation, and successful translation of research into practice. The program has also contributed to research workforce development by mentoring and training diverse early-career scholars and community leaders in community-based participatory research and cardiovascular health equity research. Lessons learned highlight the transformative impact of community-based participatory research in building trust, facilitating culturally relevant dissemination, and sustaining health equity initiatives. The FAITH! model demonstrates a scalable, community-led strategy for advancing cardiovascular health in underserved populations and provides a blueprint for future initiatives aiming to reduce racial health disparities.

Background African Americans have a higher prevalence of cardiovascular risk factors, leading to higher cardiovascular disease mortality than White adults. Our culturally tailored mobile health (mHealth) lifestyle intervention ( FAITH! App) has previously demonstrated efficacy in promoting ideal cardiovascular health in African Americans. Methods We conducted a secondary analysis from a cluster randomized controlled trial among African-Americans from 16 churches in Minnesota that compared the FAITH! App to a delayed intervention control group. A subgroup of participants with ≥ 1 diagnosis of overweight/obesity, hyperlipidemia, hypertension, or diabetes was examined. The primary outcome was a change in LS7 score—a measure of cardiovascular health ranging from poor to ideal (range 0–14 points)—at 6-months post-intervention. Results The analysis included 49 participants (intervention group: n = 20; mean age 58.8 years, 75% female; control group: n = 29, mean age 52.5 years, 76% female) with no significant baseline differences in cardiovascular risk factors. Compared to the control group, the intervention group showed a greater increase in LS7 score across all cardiovascular risk factors at 6-months post-intervention, with statistically significant differences among those with overweight/obesity (intervention effect 1.77, p < 0.0001) and 2+ or 3+ cardiovascular risk factors (1.00, p = 0.03; 1.09, p = 0.04). The intervention group demonstrated a higher increase in the percentage of participants with intermediate or ideal LS7 scores than the control group, although these differences were not statistically significant. Conclusions Our culturally tailored mHealth lifestyle intervention was associated with significant increases in LS7 scores among African Americans with preexisting cardiovascular risk factors, suggesting its efficacy in improving cardiovascular health among this population.

Abstract Background Despite advances in cardiovascular (CV) care, African American adults experience worse CV disease (CVD) outcomes than White adults, warranting the investigation of CVD prediction biomarkers. Plasma ceramides are bioactive lipids that are biomarkers of adverse cardiovascular risk for both primary and secondary prevention. However, racial/ethnic differences in ceramide levels and their link to CV health (CVH) in African American adults remain underexplored. Purpose This study aimed to: 1) assess the association between ceramide scores and CVH and atherosclerotic CVD (ASCVD) risk among African American adults and 2) compare ceramide scores between African American and White adults. Methods Health surveys and ceramides measurements were conducted for African American and White adults, both recruited from population-based observational study cohorts. Ten-year pooled cohort risk ASCVD scores were calculated based on American College of Cardiology guidelines. CVH was assessed using Life’s Essential 8 (LE8) scores, as per American Heart Association rubrics. CV risk factors in the two cohorts were compared using Chi-squared tests. Linear regression and Pearson correlation assessed the association between ceramide, LE8, and ASCVD risk scores. Linear regression, adjusted for age and sex, compared ASCVD risk and ceramide scores between the two cohorts. Results In total, 58 African American (mean age [SD] 54.5 [11.9] years, 67.9% women) and 1103 White (mean age [SD] 64.5 [11.9] years, 52.1% women) adults were included (Table 1). Compared to White adults, African American adults had a higher prevalence of overweight/obesity (92.9% vs 33.6%; p&lt;0.001), hypertension (69.6% vs 42.5%; p&lt;0.001), diabetes (30.4% vs 12.2%; p&lt;0.001), and hyperlipidaemia (42.9% vs 30.0%; p=0.03). No difference in mean ASCVD risk was observed between the African American (12.8% [SD 10.4]) and White (12.6% [SD 11.1]) cohorts (p= 0.91). African American adults had lower 18:0 (0.08 [0.03] vs 0.10 [0.04] μmol/L) and 24:1 (0.91 [0.31] vs 1.17 [0.33] μmol/L) ceramides compared to White adults (p&lt;0.001). Ceramide scores among African American adults were not associated with LE8 scores (p=0.077) or ASCVD risk scores (r=-0.12, p=0.428). Adjusting for age and sex, African American adults had lower ceramide scores compared to White adults (mean [SD] 1.90 [1.97] vs 3.48 [2.88], p=0.006). Conclusions In our study comparing African American and White adults in the community, the association observed between ceramide scores and CVH or ASCVD risk scores in the African American cohort did not reach statistical significance. Interestingly, despite a more suboptimal cardiometabolic profile, African American adults had lower ceramide scores compared to White adults. Our findings suggest that ceramide profiles may not accurately reflect cardiovascular risk in African American adults, warranting further exploration of alternative sphingolipid biomarkers of risk for this population.

Background: Physical inactivity and poor adherence to healthy eating guidelines impact cardiovascular health (CVH) outcomes in African American (AAs). Our randomized controlled trial (RCT) testing the FAITH! App, an mHealth lifestyle intervention, showed efficacy in promoting ideal CVH, particularly diet and physical activity (PA) among AAs, warranting exploration of underlying factors. Psychosocial factors (e.g., self-regulation, self-efficacy, social support) are key to healthy behavior adoption. Hypothesis: The intervention group would have greater improvements in diet and PA-related psychosocial factors than the control group after using the FAITH! App. Methods: A 2-arm cluster RCT was conducted among AAs from 16 churches in Minnesota comparing the FAITH! App intervention to a delayed intervention control group. The FAITH! App included culturally relevant, CVH-focused education modules, diet/PA self-monitoring and a sharing board. The outcomes were change in diet and PA self-regulation and self-efficacy (primary) and social support and barriers (secondary) at 6 months post-intervention. The intervention effect was assessed using linear regression. Results: Sixty-eight participants were included (71% female; mean age [SD]: 54.7 [12.6] years) ( Table 1 ). The intervention group showed a significantly greater increase in diet self-regulation [planning/tracking nutrition] (+0.66, p<.03) and PA self-regulation [step count strategies] (+0.47, p=.003) than the control group. Within groups, the intervention group demonstrated significant improvements across diet and PA self-regulation measures, while the control group showed an improvement only in fruit/vegetable and grain intake. No effect was observed in self-efficacy, social support, or barriers. Conclusions: Our culturally tailored mHealth lifestyle intervention was associated with notable increases in diet and PA self-regulation, suggesting a potential mechanism by which the FAITH! App improves healthy eating and PA among AAs.

Background Cardio-ankle vascular index (CAVI) is a measure of arterial stiffness associated with cardiovascular (CV) events and mortality. African American (AA) adults have a higher prevalence of CV risk factors (RFs) and adverse social determinants of health (SDOH) leading to a higher CV mortality risk than White adults. These disparities may be associated with arterial stiffness, however limited research exists on the association of CV RFs, SDOH, and CAVI among AAs. Hypotheses We hypothesized that CV RFs (eg, diabetes) and SDOH (eg, income) would be associated with CAVI among AA adults. Our secondary hypothesis was that AA adults would have a higher prevalence of abnormal CAVI scores (≥8.0) than White adults. Methods In the FAITH! HH+ study, CAVI measurements, CV RFs, and SDOH surveys were obtained. We collected CAVI readings and CV RFs from a secondary cohort of White adults (n=600), referred for echocardiography and without structural cardiac disease. The association of CV RFs, SDOH and CAVI scores among AAs was assessed via ANOVA and univariable linear regression. We compared CV RFs among both cohorts using Chi-squared tests and ANOVA, followed by comparing CAVI scores between cohorts using a multivariable linear regression model. Results In total, 48 AAs were included from the FAITH! HH+ cohort (mean age [SD]: 54.2 [11.5] years, 67.4% women). There was no significant association between CV RFs or SDOH with CAVI scores. In the 600 White adults assessed, mean age was 59.5 [14.7] years and 45.7% were women. Compared to White adults, AA participants had a lower burden of hyperlipidemia (43.5% vs 61.4%; p=0.017), but a higher burden of hypertension (73.9% vs 57.7%; p=0.031), diabetes (28.3% vs 9.3%; p<0.001), and obesity (71.7% obese vs 36.0%; p<0.001). There was no significant difference in CAVI scores between groups when adjusted for age, sex, and CV RFs (AA cohort: mean: 8.0 [1.4] vs White cohort: 8.4 [1.5]; p=0.790). Conclusions In this pilot study, SDOH and CV RFs were not associated with CAVI scores among AAs. There was no significant difference in CAVI scores between AA and White adults, despite a significantly higher burden of CV RFs in the AA cohort. Further studies are warranted to identify factors linked with onset and progression of arterial stiffness among AAs.