# Pathways to cardiovascular disease prevention and impact of specialty referral in under-represented racial/ethnic minorities with HIV

> **NIH NIH R01** · DUKE UNIVERSITY · 2021 · $581,429

## Abstract

There is an urgent need to determine pathways to cardiovascular disease (CVD) prevention for under-
represented racial/ethnic minorities with HIV and elevated cardiovascular risk. Such evidence will ultimately
inform clinical care guidelines and health system interventions to improve health for health disparity
populations with HIV. Thus, the long-term goal of this proposal is to generate evidence-based
recommendations for the management of CVD risk in PLWH. The overall objectives of this application are to
demonstrate the effect of cardiology referral on CVD health outcomes in a large racially/ethnically diverse
cohort of people living with HIV (PLWH), and to generate qualitative and quantitative evidence to guide
development of a future intervention. Our central hypothesis is that cardiology referral reduces incident CVD
events in Blacks/African-Americans and other racial/ethnic minorities with HIV compared to non-referral. The
rationale for our research is that, once it is known how these health disparity populations with HIV access
cardiology referrals and the subsequent impact on CVD outcomes, an interventional can be appropriately
designed to test new and innovative approaches to the management of co-morbidities for PLWH at elevated
CVD risk. We plan to test our central hypothesis and thereby accomplish our overall objectives by pursuing the
following three specific aims: (Aim 1) To measure the association between cardiology referral and CVD
outcomes in under-represented racial/ethnic minorities with HIV, (Aim 2) To identify the individual- and health
system-level factors that impact CVD outcomes for under-represented racial/ethnic minorities, and (Aim 3) To
develop a qualitative framework for an intervention to improve CVD outcomes in PLWH. We will retrospectively
analyze patient-level data from electronic health records from institutions in the U.S. Southeast “HIV-belt” and
“Heart Attack belt”, using PCORnet’s Common Data Model. We will retrospectively identify cohorts of African-
American and other under-represented racial/ethnic minorities and non-Hispanic white patients with HIV. Start
date will be first clinical contact after January 1, 2010 to create a contemporary cohort with at least 5 years of
longitudinal follow-up. The main independent variable is a clinic visit with a cardiologist, compared to not
having such a visit, prior to first CVD event. Our primary outcome is myocardial infarction, hospitalization for
heart failure, stroke, coronary heart disease, death or cardiovascular death after 5 years. Our scientific
contribution is expected to be significant because we are addressing a dire health comorbidity for PLWH. Our
group’s efforts are likely to contribute to greater understanding of how HIV-related CVD effects treatment
outcomes among under-represented racial/ethnic minorities with HIV. As a consequence of the work proposed,
we expect to identify the underlying pathways to ideal CVD care for under-represented racial/ethnic...

## Key facts

- **NIH application ID:** 10103850
- **Project number:** 5R01MD013493-04
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Gerald Samuel Bloomfield
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $581,429
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10103850

## Citation

> US National Institutes of Health, RePORTER application 10103850, Pathways to cardiovascular disease prevention and impact of specialty referral in under-represented racial/ethnic minorities with HIV (5R01MD013493-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10103850. Licensed CC0.

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