Introduction: In recent years, there has been increasing awareness of the lack of diversity among clinical trial participants. Equitable representation is key when testing novel therapeutic and non-therapeutic interventions to ensure safety and efficacy across populations. Unfortunately, in the United States (US), racial and ethnic minority populations continue to be underrepresented in clinical trials compared to their White counterparts. Methods: Two webinars in a four-part series, titled “Health Equity through Diversity,” were held to discuss solutions for advancing health equity through diversifying clinical trials and addressing medical mistrust in communities. Each webinar was 1.5 hours long, beginning with panelist discussions followed by breakout rooms where moderators led discussions related to health equity and scribes recorded each room’s conversations. The diverse groups of panelists included community members, civic representatives, clinician-scientists, and biopharmaceutical representatives. Scribe notes from discussions were collected and thematically analyzed to uncover the central themes. Results: The first two webinars were attended by 242 and 205 individuals, respectively. The attendees represented 25 US states, four countries outside the US, and shared various backgrounds including community members, clinician/researchers, government organizations, biotechnology/biopharmaceutical professionals, and others. Barriers to clinical trial participation are broadly grouped into the themes of access, awareness, discrimination and racism, and workforce diversity. Participants noted that innovative, community-engaged, co-designed solutions are essential. Conclusions: Despite racial and ethnic minority groups making up nearly half of the US population, underrepresentation in clinical trials remains a critical challenge. The community engaged co-developed solutions detailed in this report to address access, awareness, discrimination and racism, and workforce diversity are critical to advancing clinical trial diversity.

Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.

Background: Attainment of the American Heart Association’s Life’s Simple 7 (LS7) metrics reduces cardiovascular disease (CVD) risk; yet, Black Americans have the lowest LS7 attainment among all communities, the highest rate of CVD mortality, and low clinical trial participation. Social support is positively correlated with chronic disease self-management. Here, we describe the role of social support in a single-arm pilot clinical trial of a community-based lifestyle intervention among Black American men. Methods: The 24-week intervention featured weekly team-based physical activity and LS7-themed education. Seventy-four Black men participated in the intervention; twenty agreed to participate in exit surveys via one of three semi-structured focus groups. Data were transcribed verbatim and analyzed using content analysis framed by House’s social support framework. Results: Participants reported support from both peers and health coaches. The sub-themes of social support among peers were: (1) acknowledgement, understanding, and validation, (2) inspiration, (3) sense of community, (4) fear of disappointing fellow participants, and (5) group synergy. The sub-themes of social support from the health coaches and study team staff included: (1) contemplation of current health status, (2) racial concordance of health coaches and study team staff, (3) investment of the research team, (4) incentives, (5) access to healthcare providers, and (6) the COVID-19 pandemic. Emotional support was the most frequently discussed theme. Conclusions: Social support, especially emotional support, from peers and health coaches was a driver of clinical trial participation among participants. The intervention created a positive social environment and decreased medical mistrust. This intervention may provide a framework by which to facilitate clinical trial participation among Black men.

Perimenopause, or menopause transition (MT), is a critical life stage that encompasses significant physiological, emotional, and psychosocial changes that impact women’s cardiovascular health and quality of life. The decline in estrogen during MT induces adverse metabolic changes that increase the risk of dyslipidemia, obesity, insulin resistance, atherogenesis, and poor downstream outcomes such as diabetes, hypertension, stroke, and other adverse changes. Concurrently, stress plays an important role in shaping overall cardiovascular well-being during MT and long-term heart health post-menopause. In addition, nontraditional risk factors—particularly social determinants of health (SDoH) such as economic well-being, access to health care, built environment, social support, and others—are key upstream determinants of cardiovascular disease in women during perimenopause. Coordinated efforts are needed to screen, identify, and address the primary SDoH for optimal heart health in the clinically vulnerable MT patient population. Patient-centered care pathways that focus on assessing social needs and connecting socially vulnerable patients with available community resources are much needed for holistically addressing patient needs. Community-centered efforts are key to addressing persistent inequities in women’s cardiovascular health via navigation and connection to community resources that may help address SDoH barriers.

Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women. With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015–2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18–44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile. The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%–73.3%) in 2015 to 75.9% (75.0%–76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%–58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%–72.6%; p<0.001) and Hispanic (75.1%–80.3%; p<0.001) women but not among non-Hispanic Black (82.7%–83.7%; p=0.48) or Asian (68.1%–73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile. There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.