1. Capstone Project PUBH 4900
Jacqueline McClain
January 6, 2015
Winter Term
Cardiovascular Disease
Prevalence &
the Study of Disease
Diversification

2. Impact of Cardiovascular Disease on Public Health &
Health Care Infrastructures
 According to the Centers for Disease Control and Prevention, just 5 years ago the
burden of costs associated with diseases of cardiac origin were estimated to have
reached $444 billion. This accounts for $1 of every $6 spent on health care
expenditures.
 The economic impact of CVD on the nation’s health care system is projected to
skyrocket to an even greater estimation (CDC, 2010) .
 More than 83 million or 1 in 3 U.S adults resides with one or more diseases of
cardiac origin (CDC. 2010).
 Annual estimates suggest that approximately 935,000 heart attacks and 795,00
strokes occur each year (CDC, 2010).
 68 million adults currently have high blood pressure and nearly 34 million do not
have the condition under control (CDC, 2010).
 71 million adults have high cholesterol and 2 out of every 3 do not have the
condition under control (CDC, 2010).
 Within the United States, cardiac and cardiac related deaths are the first and third
leading cause of fatalities and accounts for 33.6% of all U.S deaths (CDC, 2010)

3. Morbidity &
Mortality
Statistics 31.7
32.8
31.4
27.2
34
33 32.2
29.8
0
5
10
15
20
25
30
35
40
African Asian Caucasian Hispanic
2010 CVD Population Mortality Statistics
Male Female
Percentages Based upon population per
1000

4. African Asian Caucasian Hispanic
Male 31.7 32.8 31.4 27.2
Female 34 33 32.2 29.8
Male Prevalence 44.4 0 36.6 33.4
Female Prevalence 48.9 0 32.4 30.7
31.7 32.8 31.4
27.2
34 33 32.2 29.8
44.4
0
36.6
33.4
48.9
0
32.4 30.7
0
10
20
30
40
50
60
2010 CVD Population Morbidity Statistics
Male Female Male Prevalence Female Prevalence
Hypertension
46%
Physcial
inactivity
27%
Smoking
9%
Diabetes
9%
Diet
3%
Cholesterol
4%
Obesity
2%
undiagnosed
9%
Global Prevalence of Modifiable Risk
Factors
Hypertension Physcial inactivity Smoking
Diabetes Diet Cholesterol
Obesity
Epidemiologic
Trends
Gender
Family
History
Age
Non-modifiable Risk
Factors

5. Major Influences on
Cardiovascular Disease
Development: Social Factors
For most communities, chronic diseases aren’t
just the individual concern, but the entire
population invests in the health equity of the
population for the city or the state to meet
national health goals and objectives. Some
organizations that share information concerning
recommendations and proven strategies for
community (social) interventions are:
 Healthy People 2020
 Community Preventive Services Task Force
 Centers for Disease Control
 World Heath organization
 Local City Council and Health Departments
 One of the most influential factors in the development of disease for most populations are dependent
upon the conditions in which we live, work, play, learn, or worship. Healthy People 2020 describes
these conditions as social determinants of health.
 Several organizations including the Environmental Protection Agency, the Community Preventive Task
Force, the CDC, local government agencies, Healthy People 2020…etc., conjoin efforts to produce
effective programs and research that combat relatable risk factors within the social environments that
are common among all populations.
 Research from the World Health Organization in the past has pinpointed specific social determinants
that influence the development of CVD like air pollutants mixed among indoor/outdoor air supply. The
location of chemical or factor pollutants to neighborhoods, playgrounds, and schools…etc. Deeming
that a number of factors contribute to social environments and the development of CVD like limit assess
to fruits and vegetable, no sidewalks for exercise, no parks, lack of education, low socioeconomic
status, and industrialization.
 Although, CVD shows an overall rate of reduction some population groups are more prone to
developing CVD’s. The African American female demographic has shown the largest growth in fatality
statistics due to CVD and African American men still show a higher prevalence of CVD diagnosis than
any other population group. More information is desired to determine why.
 Currently, genomic studies (Genomics, Environmental Factors and Social Determinants of
Cardiovascular Disease in African-Americans Study) are recruiting participants from the African
American demographic to better determine the association between cultural predisposing phenotype
factors and the social environments that produce CVD and CVD related disorders among the
population (Clinical Trials.gov, 2015). The study is said to be completed by 2018.

6. Cultural Factors
• Cultural factors have always been a
determiner of the onset of disease. The
biggest example can be showcased
throughout the shift in CVD
demographics.
• Chronic diseases for the most part
have been a part of the health status of
citizens living within the United States,
and Tropical diseases the like for those
living in developing countries, yet the
aspect of culture seems to transpire all
of the norm in CVD diagnosis.
• Cultural factors can serve many roles when research seeks to determine why some cultures
are more afflicted by disease than others and why interventions aren’t as successful for those
whom rank among cultures that have experienced health care disparities in the past.
• To better understand, culture is the characteristics manifested in particular groups of people
whom share commonality in language, religion, cuisine, social habits, music, art (Zimmermann,
2012), and Gender (?).
• As noted previously, African American women are leading both the statistic in CVD fatality and
disability. A combination of risk factors for CVD also pinpoint this demographic with having the
highest prevalence rates in comparison to other cultural groups.
• New findings in research from Wake Forest Baptist Medical Center does shed some clarity on
the differences that transpire gender in cases of hypertensive disorders (number 1 risk factor
linked to CVD). ---Dr. Carlos M. Ferrario
• Studies show that females in particular need specialized treatments to combat
hypertensive disorders (Newswise, 2014).
• (Lower is always Better) Observational studies show that treating to low pressures
doesn’t reduce risks of cardiac events (Newswise, 2014).---Dr. Carlos J. Rodriguez
• Evaluation of new protocols (Newswise, 2014)
• Effective drugs
-combinations & dosages
-African Americans respond more positively to calcium channel
blockers than to typical angiotensin inhibitors
- Gender should determine hypertensive treatment methods (Newswise, 2015).

7. Behavioral Factors
• With the state of the modernizing world,
one of the most important factors in stress-
related, psychological health may be
impacting the role of CVD’s long standing
status in the 1st and 3rd positons in the
leading causes of mortality and morbidity.
• Dr. Stanley H. Fisher’s insight to the
psychological factors link to heart disease
seems to echo from the past, “Research
findings encourage us to think of heart
disease as purely physical along with the
implications of hereditary and dietary
problems” yet the ideals maybe resurfacing
in the psychological arena.
• Mental health and physical health are incoherently linked (HealthyPeople, 2015).
• In research, mental disorders like depression were significantly associated with risks,
onset, management, progression and the outcome of chronic diseases like diabetes,
hypertension, stroke, cancer, and heart disease (HealthyPeople, 2015).
• Outcomes of mental disorders like depression preceding conditions like chronic disease
often contribute to the inability of those diagnosed to participate and maintain optimal
health (HealthyPeople, 2015).
• Important factors to consider about behavioral influences on the development of CVD is
that overindulgences are often the determining factors among all populations and groups
of people.
• African American women often have higher BMI’s and waist circumference when
compared to the female demographics of other ethnicities. Additionally, they lead the
static among other major risk factors associated with CVD.
• Research reported in the National Institute Health journal confirms that health behavior
risk factors across age distributions can predict the develop of cardiovascular disease
diagnosis as a result of two risky health behaviors (age & obesity) alone can determine
whom will develop CVD, regardless of the ability to engage in adult activities like alcohol
and tobacco use (e.g., age is among the three risk factors that can’t be modified in CVD
prevention).
• Among other behavioral influences, age seems to play a prominent role in the
development of CVD among the American culture:
• Childhood Obesity
• Childhood diabetes
• Heart disease is the number 1 source of childhood morbidity cases
• Children watch more television than past generation leading to
familiarity with the physically inactive lifestyle and links to multiple
chronic disease risky behaviors.

8. Current and Emerging Behavioral Factors in CVD
Development
• Conditions of cardiac origins contribute significantly to the
onset of CVD.
• Having multiple risk factors can propel the rate at which
an individual progresses on the CVD continuum chart.
• First event heart attacks and strokes are pivotal markers
in lacking surveillance for better interventions.
• Second heart events are the most traceable, yet they are
closer to mortality statistics according to the CVD
continuum.
• Hypertension alone is the single most determining factor
of adverse heart health outcomes---the course of
intervening early is crucial.

9. Political Factors
• On November 14, 2012 USA today reported that according to new
studies smoking bans quickly reduced the number hospitalized for heart
attacks, strokes, and respiratory diseases (Liz Szabo, 2012).
• Heart attack hospitalizations reduced 15%
• Stoke hospitalizations reduced by 16%
• According to the Centers for Tobacco Control and Research and
Education, “The more comprehensive the law, the greater impact
on health” (Liz Szabo, 2012).
• With the ban on smoking extended to all workplaces
and bar environments in 2007, Heart attacks fell by
33%.
• Smoke-free laws were also significant in leading more people to
smoke less, as a result a Mayo Study confirms that the
percentage of smoke-free homes increased from 64.5% in 1999 to
87.2% in 2010 (Liz Szabo, 2012).
• The newest legislation in the war against cardiovascular fatalities
and remedying the linked social determinants of health on the
development of adverse health is the Affordable Care Act
insurability laws.
BAN ON SMOKING

10. Economic Factors
• The CDC explains the cost of treating chronic conditions like cardiovascular diseases among the
most prevalent, costly, and more preventable than all health problems.
• Annual cost imposed on state budgets are a significant burden (CDC, 2013).
• By 2030, 116 million people in the U.S or 40% will have some form of heart disease
(ScienceDaily,2014)
• Between 2010-2030, the cost of medical care in CVD cases are estimated to rise from
$273 billion (2008) to $818 billion.
• Within the next 8 years, the cost of treating Cardiovascular diseases for some states
will double or even triple the costs that were evident in 2003.
• Sick days contribute tremendously to loss productivity, increases will exceed the $172
billion mark in 2010 to $276 billion by 2030 (ScienceDaily, 2014)
• CVD accounts for 17% of the overall National Health Expenditures (ScienceDaily,
2014)
HARSH REALITY:
“If the ability to prevent
and treat heart disease
stays where it is
currently, cost to treat it
will triple in the next 20
years through
demographic changes in
population alone”---M.D.
Paul Heidenreich.

11. Environmental Factors
In cardiovascular disease research, the concept
of epigenetics has shown that environmental
factors among the most prominent risk factors
like heredity affect the characteristics of cells and
encourage the development of cellular changes
like gene expression and disease development
(Ordovas & Smith, 2010). Examples of modifiable
epigenetic markers in effective cardiovascular
research and treatment include:
• Nutrition
• Smoking
• Pollution
• Stress
• Sleep Disorders
• Epigenetic describe the mechanisms that enable cells to respond quickly to environmental changes
providing a link between genes and the environment (Ordovas & Smith, 2010).
• Variations in epigenetic modification of genes can explain a larger part of the phenotypic variations
observed in humans than differences in genotype alone (Ordovas & Smith, 2010).
• Relatable Example:
- Rising prevalence of Heart Disease in African American women as oppose to its
reduction in other cultures.
• Current associations concerning the improvement of household air pollutions (HAP) are derived from
studies that have been performed concerning the air quality outdoors, due to factors of accurate
associations with cardiovascular disease, the information hasn’t been included in global burden of
disease estimates resulting in consequences of health care allocations and national/international
priorities (Rajagopalan & Brook, 2012).
• 90% of global countries report that some type of partnership collaboration does exist for
implementing key Non-Communicable Disease activities, most of them are limited to
partnership for tobacco use and diabetes; cardiovascular collaborations are at an approximate
70% partnership level and aren’t the highest among health priorities(WHO, 2014).
• Understanding health risks, exposure characterization, epidemiology, and economic
correlations among household air pollution and cardiovascular disease are pivotal factors in the
unmet public health needs.

12. Cardiovascular Disease Strategic Programs
• The SRCP program is one of many
strategies funded by the CDC through
the division for Heart Disease and
Stroke Prevention to combat heart
disease and stroke at the source of its
primary cause; primary risk factors
(CDC, 2014).
• Elevated blood pressure increases the
risk of heart disease and stroke and as
much as an additional teaspoon of salt
or sodium has the potential of elevating
pressure readings (CDC, 2014).
• In 2010, National Health and Nutrition
Examination surveys found that
individuals 2 years and older on
average consumed more than 3,400
mg daily of sodium (CDC, 2014).
Program Goals
• Three areas of the SRCP program are
the most prioritized according to 2010
Dietary Guidelines for Americans:
• Promotion of local, state, and
national nutrition strategies
• Enhanced monitoring of
sodium intake and changes in
food supply
• Expansion of practice-based
and scientific literature on
sodium (CDC, 2014)
Program Outcomes &
Evaluation
• Sodium reduction programs are fairly
new to public health as emerging
programs, but for some evidence-
based models key factors make the
likelihood for success possible. Some
suggestion are:
• Know the environment and food
accessibility.
• Identify and build relationships with
key Partners and those who
promote sodium reduction.
• Involve restaurant or venue-specific
experts early.
• Link sodium reduction to other
nutritional strategies.
• Reduce sodium gradually.

13. • Funded through the CDC’s Division
for Heart Disease and Stroke
Prevention, WISEWOMEN program
provides aid to women with prominent
socioeconomic challenges avoid
chronic disease risk factors by
obtaining screenings, participating in
lifestyle programs, and service
referrals to prevent cardiovascular
disease.
• Operates on the local level in states
and tribal organizations (CDC, 2014).
• Service perks:
• Blood pressure screenings
• Cholesterol testing
• Testing for diabetes
• Physical activity
• Lifestyle programs that target poor
nutrition
• Healthy cooking classes
• Walking clubs
• Counseling
• Quit-smoking classes
• Interventions designed to promote
lasting, healthy lifestyle changes
(CDC, 2014)
Outcomes & Evaluations
• WISEWOMAN launched in 1995, the programs was
evaluated and the findings were;
• Offered screening test for chronic disease risk
factors in women are deemed feasible and well
accepted by providers and participants (CDC, 2006).
• Reports by participants supported lower fat diets and
becoming more physically active.
• 12,000 medically underserved women received
preventative service through the program by 2002
justifying:
• Expanded access
• Culturally diverse female populations
• Women helping women
• Developing partnerships (CDC, 2006).
• To provide low-income, underinsured, or
uninsured 40-to 64-year old women with
the knowledge, skills, and opportunities
to improve their diet, physical activity,
and other life habits to prevent, delay,
or control cardiovascular and other
chronic diseases (CDC, 2013).

14. A Program of the National Institutes
of Health
• The Heart Truth is a national
awareness and prevention
campaign about heart disease in
women sponsored by the
National Heart, Lung, and Blood
Institute. Major objectives of the
program surround three
important elements of the public
health infrastructure:
• Professional Education
• Patient Education
• Public awareness: The
Red Dress symbol
Program Goals
• Community increased awareness that
focuses on heart disease as the
number 1 killer of women in 25-60
age ranges (FNIH, n.d.).
• Encourage skill-building, goal-setting,
and social support that aides
behavioral changes to reduce factors
for CVD (FNIH, n.d. ).
• Promote The Heart Truth campaign,
the Red Dress symbol, and key
messages in Heart Disease reduction
in women (FNIH, n.d.).
• Heart Health education
• Lifestyle behaviors
• Personal risks
• Risk reduction
• Increase outreach to underserved women
• Women of color
• Women in rural areas
• Women with low-income status
• Engage stakeholders and key organizations in Heart Truth
outreach and educational activities (FMIH, n.d.).
• The NHLBI leads the nation in a landmark heart health awareness
movement that is being embraced by millions who share the common
goal of better health for women. Outcomes of community partnerships
through grant funded programs must objectively focus on:
• Active approaches to educational and outreach strategies that
are designed to engage and motivate women.
• Heart-health screening events and health fairs at community
centers, hospitals, clinics, and health centers on risk factors
HD.
• Community collaborations with stakeholders….etc.(FMIH, n.d).

15. Technological Impact from Current Systems in CVD Prevention
Surveillance
• Researchers are currently unable
to accurately estimate the annual
incidence for heart disease or
stroke or the prevalence of their
risk factors at state or local
levels. A comprehensive, national
surveillance system that provides
timely local data is needed. Such
a system would improve capacity
to monitor risk factor trends,
identify populations at greatest
risk, and evaluate the effect of
efforts to control risk factors for
cardiovascular disease (CDC,
2010).
Clinical Quality Measures
CDC conducts the following activities to help
prevent heart disease and stroke at state and
local levels:
• Evaluation. CDC conducts evaluation
research and helps states evaluate the
effectiveness of prevention programs and
policy and system-level changes.
• Monitoring and Tracking Disease. CDC
tracks data and trends in heart disease and
stroke to help states make informed
program decisions.
• Training and Technical Assistance. CDC
provides guidance and training to states and
partners on how to apply evidence-based
practices and develop effective programs.
• Translating Science into Practice. CDC
interprets the science of prevention and
translates it into practices and programs for
states and communities.
• Partnerships. CDC builds partnerships with
other federal agencies and national groups,
such as the Federal Interagency Committee
on Emergency Medical Services, to promote
policies and system improvements to
prevent heart disease and stroke nationally.
Digital Technology
• The Cardiac Arrest Registry to
Enhance Survival (CARES) program,
which began in 2004, is a database
that communities across the United
States can use to identify out-of-
hospital cardiac arrest events,
measure key aspects of prehospital
care, determine rates of survival, and
improve emergency cardiac care. In
2011, CARES participants include 40
communities in 25 states, with state-
level expansion planned for 7 states
(CDC, 2010).

16. Impact of Technology on Cardiovascular Diseases
Surveillance systems
• CDC has developed a National
Cardiovascular Disease Surveillance
System. The system is designed to integrate
multiple indicators from many data sources
to provide a comprehensive picture of the
public health burden of CVDs and
associated risk factors in the United States.
A key feature of the system is the interactive
Data Trends & Maps Web site, which
displays these CVD surveillance data. The
data are organized by location (national,
state, county, and selected sites) and
indicator, and they include CVDs (e.g., heart
failure), risk factors (e.g., hypertension), and
biomarkers (e.g., homocysteine). The data
can be plotted as 10-year trends and
stratified by age group, sex, and
race/ethnicity.
Clinical Quality Measures
Dashboard Mobile Technology: Precision
Medicine
• A major goal of the Health e-Heart
Study is to make health care delivery
more precise.
• The study allows participants to
submit data via a secure online
survey and uses smartphone
technology to measure a participant’s
heart rate, blood pressure and pulse
rate. The information is sent back to
researchers, who can make
recommendations to help prevent or
treat heart disease.
• To showcase progress on the ABCS
and understand gaps, Million Hearts®
has developed the Clinical Quality
Measures dashboard. This dashboard
displays data from select quality
reporting initiatives at the state, HHS
region, and national level including
performance on the ABCS,
demographics, and state-level
comparisons. We encourage public
and private partners to share
aggregate data with us for display in
the Million Hearts® Clinical Quality
Measures dashboard or display data
on their own website in a similar
manner.

17. CVD & ISSUES OF LEGAL AND ETHICAL CONCERN
• Recent technological advances create new moral, ethical, and legal challenges that must be addressed before the opportunities to improve
human health can be fully realized (Euan, 2012).
• Some of the procedures that substantially impact the practice of cardiovascular medicine and research hold true to concerns with
legality and ethics:
• Molecular genotyping (genetic tests)
• Genetic predisposition to disease
• Genetic evaluations (personal and family history)
• Examination
• Disparity
• Some forms of research in genetics require gene patents and in recent times, these activities are under the direction of court rulings and
scrutiny:
• The validity of some of the gene patents has been challenged in federal court, leading to renewed uncertainty of the
patentability of the ≈20,000 genes in the human genome (Euan, 2012).
• There are many patents associated with genes linked to cardiovascular disease (CVD) but few that have directly impacted
the availability of genetic testing. One example is the long-QT syndrome (LQTS), a disease responsible for a small but
significant fraction of sudden deaths in young people (Euan, 2012).
• Availability of genetic testing regardless of the benefits in CVD reduction has prevented competitors from taking
advantage of opportunities to further study genetic predispositions to the diseases for prevention methods (Euan, 2012)
• The case for gene patents fundamentally rests on the notion that isolated DNA is distinct from its existence in nature (Euan, 2012).
• Patent law is enshrined in the US Constitution in Article I, Section 8, and the principles imply that to be patent eligible, an
invention needs to demonstrate novelty, utility, and non-obviousness. As such, although the patenting of raw naturally
occurring materials has been generally rejected
• purified genes (or synthetic genes) are different from its naturally occurring counterpart (Euan, 2012)
• Genetic Information Nondiscrimination Act (GINA) was signed into law by President Bush in 2008. The new law protects the public against
health insurance or employment discrimination that is based on genetic information (Euan, 2012)

18. Ethics, Genetics, Challenges, & Accomplishments
• The passage of GINA was important for research and the increased use of genetic tools to enhance health care (Euan, 2012).
• GINA was signed into law in 2008, the regulations determining how it will be implemented were only finalized in November 2010. It is
therefore too early to evaluate its effect in encouraging the public to volunteer for clinical trials that involve genetic testing (Euan, 2012).
• The purpose of GINA was to limit discrimination based on genetic information, it does not extend to prohibiting health insurance providers
from using patient health or disease history to make health insurance coverage and underwriting decisions (Euan, 2012).
• GINA stops an issuer of health insurance from denying coverage to a person because they have a gene variant that increases their risk
of having a condition, it does not prevent the provider from denying coverage to a person who has been diagnosed with the condition
(Euan, 2012).
• GINA stops an issuer of health insurance from denying coverage to a person because they have a gene variant that increases their risk
of having a condition, it does not prevent the provider from denying coverage to a person who has been diagnosed with the condition
(Euan, 2012).
• Gap in patient protections was filled with the passage of the Affordable Care Act. When the law was fully implemented in 2014
(Euan, 2012).
• Data suggest that most Americans, including physicians, are not aware of GINA or the protections it affords. GINA will have a greater
effect in public willingness to volunteer for genetic research if educational campaigns that target the medical community and the general
public can be implemented (Euan, 2012).
• The American public is not completely protected against all forms of genetic discrimination. For instance, there is no protection against
the basing of life insurance underwriting on family history. Similarly, there are no protections with respect to long-term care insurance or
disability (Euan, 2012).
• To maximize the development and utility of genetic testing in health care, it is important that the federal law address this area to
ensure that patients can undergo such testing without financial or other penalty (Euan, 2012).

19. Cardiovascular Disease Prevention in Policy & Advocacy
Past
• The AHA's efforts to translate the
science of cardiovascular disease
and stroke into meaningful public
policy began in earnest in the early
1980s. The association established a
full-time office in Washington, DC, in
early 1981 that was initially focused
on increasing federal research
funding administered by the National
Institutes of Health.1 Other early
policy priorities included:
• tobacco control and support for
programs that increased access to
automated external defibrillators
(AEDs), new clinical preventive
benefits in the Medicare program,
and nutrition policy (Goldstein et al.,
2011).
Present
• Health in All Policies highlights the
important links between health and
broader economic and social goals in
modern societies. It is a political
choice and highly context specific. It
requires strategies to support the
required governance and
implementation of integrated policies.
Health in All Policies needs to be
viewed as a shared goal across
different government departments,
and be used as an innovative
approach to intersectoral action.
Examples of Health in All Policy:
• Subsidized housing policies
• Food & Nutrition Policies (WIC)
• Employee Safety Policies
(WHO, 2011)
Future
• No single sector on its own can
mount an effective response, new
systems and governance are required
to deliver a range of actions for
protection of cardiovascular health.
The lack of development of the
necessary governance and systems
to implement coherent policies across
government has been a significant
obstacle to progress.
• Key Factors Motivating Policies:
• Determinants of CVD lie
outside the health sector in
many other domains.
• Prevention and control of CVD
require a coherent policy
response and intersectoral
collaboration (WHO, 2011) .

20. Influential CVD Policy & Advocacy Partners
American Heart Association
• The AHA is a New York State–based
nonprofit organization with its national
headquarters (National Center) in Dallas,
TX, and 7 organizational regions
(affiliates) covering the entire country.
Influencing public policy is one of several
key work processes of strategic focus for
the association. The National Center
maintains an advocacy department to
guide and direct the AHA/ASA's overall
public policy work and to manage the
organization's advocacy operations in
the nation's capitol. Each of the affiliates
has the responsibility to resource, staff,
and implement advocacy strategies and
tactics directed to public policymakers at
the state and local levels. The
association's vast array of lay and
medical professional volunteers and
donors supports the AHA/ASA's
advocacy efforts every year by making
financial contributions, testifying before
federal and state legislatures, writing
comments to regulatory bodies, lobbying
federal and state lawmakers, developing
policy position statements, and engaging
in grassroots and media advocacy
activities (Goldstein, 2011).
Advocacy Work
• AHA/ASA's advocacy work is led by an
executive vice president and a vice
president for state advocacy and public
health based in Dallas, TX, and a vice
president for federal advocacy in
Washington, DC. The National Center
maintains a staff of more than 20 in
Washington, DC, who are responsible
for:
• federal legislative and regulatory
advocacy, media relations, policy
research, grassroots mobilization, and
federal agency relations (Goldstein,
2011).
• The National Center also maintains a
staff to provide strategic guidance and
technical assistance to affiliates and their
advocacy operations (Goldstein, 2011).
• many of the AHA/ASA's programs
applies equally to the association's
federal, state, and local public policy
advocacy initiatives (Goldstein, 2011).
More on Policy & Partnerships
• Nonprofit organizations use a variety of
strategies and tactics to influence public
policy. Those with 501(c)4 tax status
donate money to political campaigns to
obtain access to and to influence elected
officials (Goldstein, 2011).
• Organizations like the AHA/ASA, in large
part, derive their influence through the
science expertise and evidence-based
policy that they can offer public officials
(Goldstein, 2011).
• greatest asset of the AHA/ASA in public
policy advocacy is the respect that the
organization has cultivated over the
years with officials at all levels of
government. This respect emanates from
the association's steadfast commitment
and ability to translate credible and
robust science into public policy
solutions, to provide credible experts
from its grassroots network, and to make
these experts available to the media
(Goldstein, 2011).

21. Addressing CVD as a Scholarly-Practitioner
• According to the American Heart Association,
most program expenditures are allocated to
public health education. Likewise, the element of
public health education is an on-going practice for
a scholarly-practitioner.
• CVD has so many elements in the race to gain
meaningful and effective interventions that factors
responsible for giving the disease its vitality must
be investigated to change projections that are
described in this presentation and the additional
ones that may be emerging with our changing
environments.
• A day-in-the life of an epidemiologist is the path
that I’ve chosen in addressing the prevalence of
Cardiovascular Diseases as a Scholarly-
Practitioner.
What Epidemiologist Do to Advance the Understanding of Cardiovascular Disease in Population
• Epidemiologists are public health professionals who investigate patterns and causes of disease and injury in humans.
They seek to reduce the risk and occurrence of negative health outcomes through community education and health
policy. Epidemiologists typically do the following:
• Plan and direct studies of public health problems to find ways to prevent and to treat the problems
• Collect and analyze data—including using observations, interviews, surveys, and samples of blood or
other bodily fluids—to find the causes of diseases or other health problems
• Communicate their findings to health practitioners, policymakers, and the public
• Manage public health programs by planning programs, monitoring progress, analyzing data, and
seeking ways to improve them, among other activities
• Supervise professional, technical, and clerical personnel
• Epidemiologists collect and analyze data to investigate health issues.
• For example, an epidemiologist might collect and analyze demographic data to determine who is at the
highest risk for a particular disease. They may also research and investigate the trends in populations
of survivors of certain diseases, such as cancer, so that effective treatments can be identified and
repeated across the population.
• Epidemiologists typically work in applied public health or in research. Applied epidemiologists work for
state and local governments, addressing public health problems directly. They are often involved with
education outreach and survey efforts in communities. Research epidemiologists typically work for
universities or in affiliation with federal agencies such as the Centers for Disease Control and
Prevention (CDC) or the National Institutes of Health (NIH) (BLS.gov, 2014).

22. CVD & Creating Social
Change within Minority
Communities
• Tremendous importance lies in educating for life when it comes to factors that put
minorities more at risk for the development of CVD than any other ethnic group.
• Social change starts small, but each step contributes to the overall picture of behavior
modification.
• Research has empowered the ability to extract critical factors in CVD and create
materials that make understanding disease management possible for preventative
measures like:
• Hypertension is the silent killer and the most prominent factor in
CVD Development.
• Sodium intake increases blood pressure readings significantly.
• Change starts in settings that are most comfortable and familiar.
• Churches
• Schools
• Home environments
As a minority female, culture will play a role in
cultural competence as I work both academically
and professional to combat lacking health equity
among minority populations.
• Disparity fuels a lot of health concerns that
transpire minority communities (Latino,
Native, & African Americans…etc.,).
• Organizations like the American Heart
Association has worked to find primary
factors in CVD health disparity. Most minority
women reported:
• Lack of knowing risk factors
• Understanding of cultural
predispositions for cardiovascular
Disease
• Their current risks and health
screening numbers (AHA, 2015)

23. References
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http://www.sciencedaily.com/releases/2011/01/110124121545.htm
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CDC. (2006). Retrieved from WISEWOMAN WORKS: A Collection of Success Stories from Program Inception through 2002:
http://www.cdc.gov/wisewoman/docs/success_stories.pdf
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Killers: At A Glance 2011: http://www.cdc.gov/chronicdisease/resources/publications/AAG/dhdsp.htm
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http://www.cdc.gov/chronicdisease/resources/calculator/index.htm
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http://www.cdc.gov/dhdsp/programs/sodium_reduction.htm
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http://www.cdc.gov/dhdsp/ncvdss/
Euan et al. (2012). Genetics and Cardiovascular Disease: A Policy Statement from the American Heart Association. Circulation, 126: 142-157.
Fisher, S. H. (1963). Psychological Factors and Heart Disease. Circulation American Heart Association Journal, 113-116.
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24. References
Goldstein et al. (2011). American Heart Association and Nonprofit Advocacy: Past, Present, and Future. Circulation, 123:816-832.
HealthyPeople.gov. (2015, January 6). Evidence-Based Resource Summary. Retrieved from Recommendations for worksite-based interventions to improve worker's
health (Community Guide Recommendation): http://www.healthypeople.gov/2020/tools-resources/evidence-based-resource/recommendations-for-worksite-based-
interventions-to-1
Kim, L. (2013, March 19). University of California San Francisco. Retrieved from Study Uses Mobile Technology to Help Predict and Prevent Heart Disease:
http://www.ucsf.edu/news/2013/03/13695/study-uses-mobile-technology-help-predict-and-prevent-heart-disease
Michelle Cardi, Niki Munk, Faika Zanjani, Tina Kruger, K Warner Schaie, and Sherry L. Willis. (2009). Health Behavior Risk Factors Across Age as Predictors of
Cardiovascular Disease Diagnosis. Journal of Aging and Health, 759-775.
Million Hearts. (n.d.). Retrieved from The Initiative: Clinical Quality Measures Dashboard: http://millionhearts.hhs.gov/Docs/MH_CQM.pdf
Newswise. (2014, December 9). Wake Forest Baptist Medical Center. Retrieved from Research Points to Need for New Approaches in Treatment of High Blood
Pressure: http://www.newswise.com/articles/research-points-to-need-for-new-approaches-in-treatment-of-high-blood-pressure
NHGRI. (2015, January 5). Clinical Trials.gov. Retrieved from GENE-FORECASTSM: Genomics, Environmental Factors and Social Determinants of
Cardiovascular Disease in African Americans Study: https://clinicaltrials.gov/ct2/show/NCT02055209
OWH. (2011, November 14). Womenshealth.gov. Retrieved from The Heart Truth: http://www.womenshealth.gov/heart-truth/
Rajagopalan & Brooks. (2012). Indoor-Outdoor Air Pollution Continuum and CVD Burden: An Opportunity for Improving Global Health. Global Heart, 207-213.
Szabo, L. (2014, November 14). Smoking bans cut number of heart attacks, strokes: Smoke-free laws were followed by fewer hospitalizations for respiratory
diseases, among other conditions, according to new study. USA Today.
WHO. (2011). World Health Organization. Retrieved from Global Atlas on Cardiovascular Disease Prevention and Control: Policies, Strategies, and Interventions:
http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1

25. References
WHO. (2014). World Health Organization. Retrieved from Heath system response and capacity to address and respond to NCD: Partnerships and Health
Promotion: http://www.who.int/gho/ncd/health_system_resonse/partnerships_textt/en/
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sheets/cardiovascular-disease-risk-factors/
Zimmermann, K. A. (2012, July 9). LiveScience. Retrieved from What is Culture? Definition of Culture: http://www.livescience.com/21478-what-is-culture-
definition-of-culture.html