PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD), especially among Black adults with COPD. Black adults with COPD carry a disproportionate CVD risk factor burden compared to White adults, with higher diabetes and hypertension prevalence, lower physical activity levels, greater proportion of actively smoking individuals, and disparities in guideline concordant statin therapy. Black individuals with COPD describe several barriers to engaging in CVD risk reduction. For example, the complexity of COPD care leaves less time in clinic visits to proactively discuss CVD prevention. Breathlessness limits physical activity, a key strategy to improve COPD outcomes and decrease CVD risk. Black adults also face socially determined barriers and distrust in the health system. Prior behavioral interventions have successfully engaged Black adults in CVD risk reduction but are not designed to meet the unique needs of patients with COPD. Interventions to prevent CVD that simultaneously meet the needs of COPD patients and the Black community are urgently needed. The overarching goal of this proposal is for me to become an implementation scientist poised to lead clinical trials improving health equity. To accomplish this, I will conduct mentored research to adapt existing interventions for CVD risk reduction in Black communities into a novel multicomponent behavioral intervention called COPDHeart. COPDHeart will be tailored to the needs of Black patients with COPD to increase the uptake of evidence-based Life's Essential 8 cardiovascular health recommendations put forth in an American Heart Association Presidential Advisory. To accomplish this, I will in Aim 1, identify barriers from patients, providers and interventionists to engaging with a multicomponent CVD prevention intervention for Black adults with COPD; in Aim 2, iteratively refine the COPDHeart intervention with user-centered design; and in Aim 3 determine the feasibility, acceptability, and preliminary effectiveness of COPDHeart in a pilot clinical trial. I will combine didactics with experiential learning and mentorship to develop expertise in stakeholder-engaged research methods, behavioral intervention design, clinical trials, and implementation science. I have engaged an interdisciplinary mentorship team (Drs. Monika Safford, Fernando Martinez, and Neeta Thakur) and focused content advisors (Drs. Riffin, Benzo, Schoenthaler, Peña, and Banerjee). The results of this project will inform a large-scale randomized controlled trial of COPDHeart. This proposal will result in an innovative intervention focused on CVD risk reduction among Black patients with COPD, a population that has disproportionate risk of adverse outcomes. Given that comorbid COPD and CVD contribute to significant morbidity and mortality, especially among Black adults, this proposal has the potential for substantial public health impac...