Harnessing Epidemiologic Data to Reduce Cardiovascular Disease

Innovations in Urology | Fall 2022

Despite significant advances in medicine over the last few decades, Cardiovascular Disease (CVD) is still the No. 1 killer in the United States and worldwide. Health care disparity and health inequities have resulted in even higher CVD mortality rates in certain underserved populations, such as African Americans and those in lower socioeconomic communities.

“As a medical community, we struggle to identify novel modalities to screen for early CVD risk factors,” says Ramy Abou-Ghayda, MD, MHA, MPH, urologist, University Hospitals Urology Institute and Network Provider, UH Cutler Center for Men. “Early diagnosis and providing high-quality, affordable and accessible healthcare to high-risk individuals can help prevent many unnecessary deaths. We already know most of the risk factors that lead to increased risk for CVD, so we need to get better at early screening for them, especially in higher-risk populations. This could be one health intervention that might help reduce the incidence of CVD-related deaths.”

Ramy Abou-Ghayda, MD, MHA, MPH

Unfortunately, he says, traditional models of health access and delivery have not been very efficient.

Tapping into Local Communities

To this end, Dr. Abou-Ghayda is leading a pilot project to determine if a culturally appropriate, community-based education and awareness model might make a difference.

“We want to involve all stakeholders, including patients, their communities and the UH medical system, and the best way to do this is to collaborate and build effective community partnerships to establish new channels of education, awareness and access to care,” he says. “Any community — housing developments, barbershops or churches, for example — can be considered a partner along this journey. We’ll proactively go into these communities, reach out to locals, provide education material about CVD and explain our novel study design to recruit participants who might ultimately benefit from early CVD screening.”

Erectile Dysfunction as a Predictor of CVD

One of the earliest indicators for CVD might overlap with another common condition that affects men: erectile dysfunction (ED). Dr. Abou-Ghaya wondered if talking about ED in a safe, private, anonymous setting could actually provide an opening to discuss CVD and its risk factors.

“We have scientific proof and published data that ED and CVD share a common pathophysiology. If we diagnose a man with ED, a good next best step is to refer him for a preventive cardiovascular workup and screening,” Dr. Abou-Ghayda says. “UH is at the cutting edge and forefront of preventive cardiology care. It is one of the few institutions around the world that offers cardiac CT calcium scoring for CVD screening — free of charge. The main goal of this test is to identify early evidence of atherosclerosis and to educate high-risk patients of their potential for CVD, and most importantly, provide them with efficient access to care at UH. Once an individual is identified to be at risk, the research team will connect them with a multidisciplinary team of primary care providers, preventive cardiologists and urologists. We’ll be reaching out to this population in their own community, rather than waiting for them to take the initiative and show up at our clinic.”

“Community-outreach and taking a proactive approach to cardiovascular risk screening and intervention will certainly contribute to a lower prevalence of CVD in the community and better long-term outcomes,” says Ian Neeland, MD, Director of the Center for Cardiovascular Prevention and lead preventive cardiologist for UH Harrington Heart & Vascular Institute. “Identification of individuals with high cardiovascular risk by going beyond the ‘traditional’ risk factors is a promising approach to more effective screening and better access to healthcare. Broaching the topic of ED with men in the community is a great start to opening up avenues of better understanding and education about CVD risk. Our health system is at the forefront of preventive cardiology – through patient care, research, and education – and we strive to help everyone lives healthier lives free from cardiovascular disease.”

This novel research approach and community partnership is crucial. Data have shown that men’s healthcare-seeking behavior, follow-up and adherence to treatment is inconsistent or even absent. Men are often diagnosed with diseases at more advanced stages and tend to have poor outcomes, with higher chances of treatment non-compliance. 

Dr. Abou-Ghayda says encouraging early CVD screening and facilitating access to CVD care could move the pendulum in the right direction. The outcome of this pilot study will determine if this approach can be generalized and confirmed with a larger-scale study. 

Social Determinants Drive Health and Health-related Behavior

Looking at the social determinants of health, such as transportation, healthcare affordability, race, education, socioeconomic status and access to care, and taking a holistic, rather than siloed, approach to treating diseases, may be a far more effective way to reduce CVD deaths. According to the U.S. Centers for Disease Control, investments to improve quality of life for individuals and communities positively affects health outcomes and health equity. Furthermore, improving prevention and early detection helps limit future costs of untreated or late-stage disease at diagnosis. 

“Instead of waiting for people to take the first step, we are going to where they live and work to educate them and increase their awareness of CVD using community partners to facilitate this process,” says Dr. Abou-Ghaya.

This is a multi-faceted project. If the pilot study shows community involvement is effective, UH and other healthcare institutions can develop more permanent and robust programs. 

“The way we’ve been practicing medicine should be more dynamic,” Dr. Abou-Ghayda says. “As health providers, we need to adapt to an ever-changing landscape in healthcare. Better outcomes will require us to adopt novel approaches. The success of this patient-centric model is contingent on acknowledging the social determinants of health and reducing health inequities.” 

For more information about this pilot study, email Dr. Abou-Ghayda at ramy.aboughayda@uhhsopitals.org.

Contributing Expert:
Ramy Abou-Ghayda, MD, MHA, MPH
University Hospitals Urology Institute
Assistant Professor
Case Western Reserve University School of Medicine