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State of the Nation’s Cardiovascular Health and Targeting Health Equity in the United StatesA Narrative Review

Educational Objective
To delineate differences in cardiovascular health (CVH) metrics among various racial and ethnic groups in the US.
1 Credit CME

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.

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Article Information

Corresponding Author: Sadiya S. Khan, MD, MS, Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, 14-002, Chicago, IL 60611 (

Accepted for Publication: December 17, 2020.

Published Online: May 19, 2021. doi:10.1001/jamacardio.2021.1137

Author Contributions: Dr Khan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Diaz.

Drafting of the manuscript: Diaz.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Diaz.

Obtained funding: Khan.

Administrative, technical, or material support: Shah.

Supervision: Lloyd-Jones, Khan.

Conflict of Interest Disclosures: Drs Lloyd-Jones and Khan report grants from the National Institutes of Health and American Heart Association during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (grants KL2TR001424, P30AG059988, P30DK092939) and the American Heart Association (grant 19TPA34890060) to Dr Khan. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences (grant KL2TR001424; Dr Khan).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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