# REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-4 (REGARDS-MI-4)

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $1,926,124

## Abstract

Black-White coronary heart disease (CHD) and heart failure
(HF) disparities persist in the US despite decades of research and national public health campaigns.
The role of social determinants of health (SDH) like structural racism in health disparities has been
studied in only 1% of published work. Few studies of SDH have taken a life course perspective related
to risk of CHD and HF. The ability to recover after the stress of an acute health event, or resilience, is
an important patient-centered outcome, but the influence of SDH on resilience is unknown. Few past
studies have examined both structural and intermediary SDH in the World Health Organization's (WHO)
Commission on SDH (WHOCSD) conceptual framework in a longitudinal national sample with
rigorously adjudicated CHD and HF endpoints, which is one of the aims of this application. We propose
a series of studies to fill these gaps, while also providing rigorously adjudicated CHD and HF events
and causes of death to a host of investigators interested in using these data (to date, over 500 have
used these data). We build on a track record of mentoring to propose a formal year-long career
development program for early-stage investigators (ESI), especially underrepresented minorities
(URM). The specific aims of this application are to: (Aim 1) conduct studies examining underlying
mechanisms of health disparities, guided by the WHOCSD conceptual framework, in three thematic
areas: a) the incidence and recurrence of CHD; b) the incidence and recurrence of HF with preserved
ejection fraction and HF with reduced ejection fraction; c) reserve and resilience after an incident or
recurrent CHD or HF event. (Aim 2) To continue to adjudicate CHD events, HF hospitalizations, and
causes of death to support a wide range of studies by investigators beyond our group, and to link the
cohort with Medicare data to support investigators conducting health services utilization studies. (Aim 3)
To support the development of researchers in CVD health equity, especially URMs, through a new
mentored research program for a cohort of early stage investigators, including analytic and statistical
support and an annual 2-day Health Equity Research Summer Institute of presentations, training, mock
study section, and networking. Early stage investigators will graduate with specific competencies in
CVD health equity research. The proposed grant will inform policy, advocacy, and the design of
interventions by generating new evidence on which SDH and disparities in health services lead to
population-level disparities in incident and recurrent CHD and HF, and on resilience in recovery after a
CHD or HF event. Our multidisciplinary team includes epidemiologists, sociologists, health services
researchers, biostatisticians, clinicians, and a participant Advisory Board, assuring rigor and relevance
of the proposed research. Continued funding for the REGARDS-MI infrastructure will support a host of
additional studies led by an expandin...

## Key facts

- **NIH application ID:** 10904966
- **Project number:** 5R01HL165452-03
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Emily B Levitan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,926,124
- **Award type:** 5
- **Project period:** 2022-09-10 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10904966

## Citation

> US National Institutes of Health, RePORTER application 10904966, REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-4 (REGARDS-MI-4) (5R01HL165452-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10904966. Licensed CC0.

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