It’s fitting that as we celebrate Black History Month and recognize American Heart Month, we feature a pioneer in medicine, LaPrincess Brewer, M.D., M.P.H.,  a cardiologist and assistant professor of medicine in the department of cardiovascular medicine at the Mayo Clinic.

Dr. Brewer spoke with us about her work and her commitment to improving heart health and eliminating heart health disparities among people of color who are disproportionately affected by cardiovascular disease.

What inspired you to pursue a career in medicine, and specifically cardiology, and focus on minority health and issues of health equity?

Growing up attending a Black church, I saw many congregation members suffering from preventable chronic diseases and prematurely passing away from heart attacks or strokes. I knew that focusing my medical career on cardiology would give me the opportunity to reach African Americans who are disproportionately impacted by heart disease. The stark differences in cardiovascular health between the Black community and other racial and ethnic groups inspired me to create a culturally relevant solution to promote healthy lifestyle changes in this population and to bring attention to psychosocial factors that facilitate or act as barriers to optimal cardiovascular health.

Heart disease in women, and how it presents, has finally begun to gain greater attention (though still not enough). How has that translated to women of color?

Heart disease remains the number one cause of death for African American women, so we must continue working to reach this population and effectively provide culturally relevant education on reducing risk and making lifestyle changes. In addition to health factors, the social determinants of health for women of color have a significant impact on cardiovascular health. This includes food insecurity, inadequate education or job opportunities, insufficient access to safe and affordable locations for physical activity, and many other barriers. This group of women faces a unique set of circumstances that often prevent them from living a heart-healthy lifestyle.

Overall, what are the goals of your research?

My research is focused on developing strategies that reduce and ultimately eliminate disparities in cardiovascular health faced by African Americans, specifically within the faith community and Black churches. I also have a special interest in digital health interventions. I work to promote cardiovascular health and wellness in a culturally relevant manner to prevent cardiovascular disease and develop tools for individuals who have already had a cardiac event to successfully recover and prevent additional incidents. I am the founding director of the FAITH! Cardiovascular Health and Wellness Program – FAITH! stands for Fostering African American Improvement in Total Health.  We currently partner with over 20 African American churches in the Rochester and Minneapolis-St. Paul metro area in authentic community-engaged research.

Tell us about some of your research projects:

• mHealth app: Is it available? How will it work?
  • The FAITH! app, our mHealth intervention, was co-developed with members of the African American community and our partnering African American churches. The app provides several beneficial resources, such as diet and exercise tracking, instructional videos, testimonials from previous users, an interactive sharing board, and even heart-healthy recipes of traditional African American recipes. The primary feature is a 10-week culturally tailored curriculum with educational videos from Mayo Clinic experts discussing several components of heart health. We currently have a prototype version of the app that is not yet available to the public. We are actively seeking funding and stakeholders to help us make it more accessible and to take the app to higher heights. 
• What have been the results of the FAITH! App so far?
  • We recently completed a clinical trial including the FAITH! App to evaluate its impact on cardiovascular health in 85 participants from 16 of those churches. Participants tracked their fruit and vegetable intake on the app and also received a Fitbit activity monitor, which automatically synchronized with the FAITH! app to track their daily steps. Additionally, over 10 weeks, they completed the curriculum with educational videos about several components of heart health. After the 10 weeks, participants continued to use the app independently for six months. At the start (or baseline) and end of the study, participants completed health assessments to determine the status of their cardiovascular health based on the American Heart Association’s (AHA) Life’s Simple 7, or LS7. This is a metric that assesses seven key health behaviors and clinical factors to measure and improve one’s cardiovascular health to prevent heart disease. We compared their LS7 scores from baseline to the end of the trial and found a significant improvement in overall cardiovascular health, particularly through diet and physical activity. This is impressive as these health behaviors are extremely challenging to change. Participants found the app engaging, helpful, and easy to use.

We published these results in a high-impact cardiovascular medicine journal and are currently seeking funding to continue this project by involving a larger number of participants and churches in different areas across the U.S. We are also updating the app content as the AHA has revamped the LS7 to Life’s Essential 8. I served as a member of the AHA Presidential Advisory Board, which added sleep health as a component of cardiovascular health.

• In addition to our clinical trial using the FAITH! app, we have engaged in several initiatives to provide our network of churches with the tools and resources necessary to develop or enhance their health ministries. During the beginning of the COVID-19 pandemic, we shifted our focus to emergency preparedness and thanks to funding support from the Association of Black Cardiologists, Inc., we were able to provide seed funding to our partnering churches for development of emergency preparedness teams to enhance their health ministries. As a part of this initiative, churches used the funds for a variety of projects, including automated external defibrillators (AEDs), CPR training, masks and hand sanitizer stations, and other health initiatives.

Because of our nation’s history, there is a distrust among Black Americans to participate in medical research. How do you address this? Have your efforts resulted in more people willing to participate? What are some of the suggestions you have for researchers who are trying to recruit Black participants?

The distrust and sense of skepticism toward medical research presented a challenge during my initial outreach to local African American communities. However, I knew that a different genuine approach was needed to demonstrate my authenticity and trustworthiness. I listened to their needs, priorities, and wisdom. The community is at the center of my research and it was important to me that they were engaged in every aspect so we could work together to create sustainable practices that truly worked for the benefit of the community. I also specifically aimed to work with predominantly African American churches knowing from personal experience that they are a pillar of the Black community and are a trusted resource that people seek out for reliable information.

I practice community-based participatory research, or CBPR, which highlights the importance of lifting up the strengths of the community and building upon these assets. We have a community steering committee made up of a diverse group of individuals including heart disease survivors, community advocates, community health workers, representatives of health organizations and academic institutions, and faith leaders. This committee guides our research program in all initiatives. Ultimately engaging with the community and keeping them at the helm – whether we are designing a study or disseminating results – has resulted in a trusting partnership and many more people have expressed interest in being involved in future research.

I encourage researchers with a genuine desire to partner with the African American community in research to take time to reflect on their intentions and own trustworthiness to a community that has had so much taken away from them. We should now aim to give back and take time for relationship-building as the first and most important step. Understanding the priorities, strengths, and experiences of the community you want to work with is essential. A true partnership includes transparency, trust, and accountability, and your work should be sustainable in that it will continue to benefit the community and evolve as needed based on their input. Study participants are truly partners in community-based research and should be involved from start to finish.

There are so many issues, including systemic racism and socioeconomic disparities, that contribute to poor health and health outcomes. How can we improve the health of people of color despite this? How do you empower people to make changes to improve their health?

Physical health is impacted by so much more than behaviors or health risk factors. The social determinants of health, psychosocial factors, and structural issues, such as racism, mean that African Americans cannot always focus on their own health and well-being. It is important that we continue to research these root causes of poor outcomes by designing studies that translate to viable solutions and policy changes to address systemic and environmental barriers to optimal health.

The FAITH! program in particular provides culturally relevant education and health promotion and engages churches to enhance their health ministries. Individuals afforded the social support inherent within places of worship can benefit from health education or behavior interventions provided through that channel. We also tap into their religious and spiritual practices to inspire healthy lifestyles as our research has shown the positive impact of faith on cardiovascular health. Ensuring that participants have a clear understanding of different modifiable risk factors to prevent heart disease helps to motivate them to make these lifestyle changes that can significantly lengthen their lifespan and quality of life.