Michelle A. Albert, MD, MPH: Preventative Care Crucial in Cardiology

One of the most effective way to improve cardiovascular health community wide is the implementation of more preventive health measures.

However, the circumstances in many minority communities make preventative health care a difficult task.

In part 2 of an interview with HCPLive®,Michelle A. Albert, MD, MPH, Professor in Medicine at the University of California at San Francisco (UCSF) and Director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center), explained how access to quality health care could be the most important factor in improving cardiovascular outcomes among minority patients.

HCPLive: Going back to preventative care, why do you think that is not currently being done to the levels we need and what can be done to increase the awareness of preventative care?

Albert: I’m not really sure it is about increasing the awareness. I think it gets back to the issue of the interplay between economic, social factors, and accessibility to quality health care because quality health care includes the continuum of preventive care, as well as secondary prevention type care.

A major factor that dissuades the ability to do preventive care is just simply socioeconomics of populations. I think primarily in this pandemic, it's significantly worsened if you're unemployed or underemployed and you have to think about feeding your family, there is competing priorities there.

I think that a large proportion of popular knows what they're supposed to do. I think that we have to get towards the point now, where we meet people where they live, work, and play in a very consequential manner, that then allows our populations to be able to work towards advantage health, and the whole thing has to be a team approach.

HCPLive: When we are testing new drugs and treatments, do we have the right patient populations in clinical trials.

Albert: We know that clinical trials, for the most part, do not include the proportion of minority populations that is Hispanic or Latinx individuals, and black individuals and native individuals are in clinical trials. Most clinical trials have zero to about 3% of those groups, given that the life expectancy differences, given the disease burden, there is great need to increase the numbers of minority patients in clinical trials.

Now, another thing that's important is to also increase the number of investigators from minority groups in clinical trials.

What I mean by that is the traditional approach for companies and institutions has been to design a clinical trial and say they need to set it to the appropriate number of minorities in trial, and then they'll reach out to organizations or groups that are minority facing and could you point us to those investigators. I do not think that is the appropriate approach.

The minority investigators need to have a seat at the table in order to help with the design of those trials. I believe that minority investigators need to be principal investigators.

And we're at a point in history where there are persons who were able to be principal investigators.

We also need to groom persons to be principal investigators, because it is bringing that diversity to the scientific mission and design that promotes innovation around how social factors social determinants can be incorporated into clinical trials, and provide the bridge to allow persons of color who were historically left out of the clinical trials to be involved.

HCPLive: Do you think we need to do more retrospective studies and population-based studied to learn the true impact of different factors like environmental factors and income on cardiovascular disease?

Albert: So, I’m also a researchers and my research is focused on epidemiology and the interface between epidemiology work and clinical trial work with academic community collaborations.

And what we do there is we look at the interplay between social determinants of health and biology.

For example, looking at the impact of things like cumulative psychological stress, defined by multiple factors including neighborhood stress, socioeconomic stress, stress from racism, and look at the relationship with cardiovascular health.

We also look at the relationship of sleep and cardiovascular health. Our group is at the forefront of that kind of work, which is multidisciplinary and involves not only cardiologists, but psychologists, neurologists, and other groups.

The next thing I want to say is that there is a host of data, showing that there's disparities by socioeconomic status and by race/ethnicity, certainly in cardiovascular disease. We need to still continue to have those studies in order to identify where the signals are going forward.

But what we really need right now is very thoughtful work looking at how we do novel implementation studies at the community level, using behavioral and other interventions that we know work.

HCPLive: Can you explain the importance of diversity in the cardiovascular workforce?

Albert: I think an important component of improving disparities in health, based on sociodemographic factors, is intimately tied into ensuring that the cardiovascular workforce is diverse.

That means that pre-medical school through the chain of leadership in cardiovascular disease, that that entire chain must reflect our population, demographics, and actually even maybe even beyond our population demographics, given the unmet needs, related to disparities.