Abstract for: Reducing Urban Cardiovascular Disparities Through Community Health Worker–Led Risk Management: A Simulation Study of ACHIEVE-GreatER

Cardiovascular disease (CVD) remains the leading cause of death in the United States and disproportionately affects residents of many urban communities with high cardiometabolic risk and barriers to preventive care. We evaluated the potential population health impact of scaling community health worker (CHW)–led cardiometabolic interventions to reduce CVD burden in Cleveland, Ohio. We developed a population-based system dynamics simulation model projecting cardiovascular disease dynamics in Cleveland from 2020 to 2050. The model integrated demographic processes, cardiometabolic risk factors (hypertension, diabetes, and obesity), and CVD incidence and mortality using epidemiological data and published literature. We simulated four scenarios. Outcomes included annual crude CVD incidence, CVD mortality, and the cumulative number of events and deaths prevented. Under baseline conditions, annual CVD incidence increased from 12.75 per 1,000 in 2020 to 14.92 in 2035, then declined to 13.53 by 2050, while mortality rose from 2.45 to 3.62 per 1,000. CHW-supported hypertension management reduced projected incidence by 11.6% and mortality by 17.7%, preventing about 27,335 CVD events and 8,774 deaths. Adding diabetes management and broader cardiometabolic interventions produced larger reductions in incidence and mortality. Scaling community health worker–led cardiometabolic prevention strategies could substantially reduce long-term cardiovascular burden in urban populations. Integrated interventions addressing hypertension, diabetes, and obesity generate the greatest cumulative benefits. Community-based prevention models supported by CHWs may represent a promising strategy for reducing cardiovascular health disparities and improving population health outcomes.