Uptake and effectiveness of a primary cardiovascular prevention program in an underserved multiethnic urban community

Background and aims: Cardiometabolic risk is increased among disadvantaged people and ethnic minorities. Paradoxically, their uptake of primary cardiovascular prevention is rela- tively low. New strategies are needed to tackle this public health problem. Aims of this study were to assess the uptake (as well as its determinants) and effectiveness of a primary cardiovas- cular prevention program for communities devised to facilitate access of disadvantaged and in- clusion of ethnic minorities in addition to providing a state-of-the-art interdisciplinary personalized care. Methods and results: Single center, hospital-based, open study. All the residents in an under- served multiethnic urban community aged 40e65 years (n Z 1646, 43.6% immigrants) were pro- actively invited by post mail to participate in a cardiovascular prevention program and different approaches were adopted to promote accessibility and inclusiveness. Program uptake was 23% and individual features independently associated with program uptake were status of immigrant (OR [CI 95%]: 3.6 [2.6e5.1]), higher educational level (3.6 [2.8e4.7]), and female gender (1.6 [1.2 e2.1]). Retention was 82% at 6 months and 69% at 12 months. A predefined outcome of global cardiovascular risk improvement at 12 months in subjects with glycaemia >126 mg/dl, LDL-C >115 mg/dl, systolic blood pressure 140 mmHg or BMI >28 at baseline was reached in 35%, 33%, 37% and 7% of the patients, respectively. 20% of smokers quitted and significant favorable changes were reported in diet quality, anxiety, depression and physical activity. Conclusion: Access inequalities to effective prevention may be counteracted, but increasing global uptake requires further upstream sensitization and awareness actions. Registered in ClinicalTrials.gov: NCT03129165