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Center Partners with Northern Manhattan Women to Achieve Heart Health


Photo: Charles Manley
Heart Health in Action team and participants after an educational session. From left: Njeri Thande M.D., PGY3 in internal 
medicine; Alicia Ubiera, participant; Emily Hurstak, P&S 09; Elsa-Grace Giardina M.D., principal investigator; Melissa Laudano, P&S 08; Mercedes Ramos, participant; Stella Yala M.D., health educator; Darlene Castro, project coordinator; Rosa Tolentino, participant.
Heart Health in Action team and participants after an educational session. From left: Njeri Thande M.D., PGY3 in internal medicine; Alicia Ubiera, participant; Emily Hurstak, P&S’09; Elsa-Grace Giardina M.D., principal investigator; Melissa Laudano, P&S’08; Mercedes Ramos, participant; Stella Yala M.D., health educator; Darlene Castro, project coordinator; Rosa Tolentino, participant.
When it comes to maintaining heart health, women in Northern Manhattan face numerous challenges. Often burdened with the responsibilities of being sole providers for their families and caretakers for children or grandchildren and hampered by inadequate education and employment opportunities, many neighborhood women lack the time and resources to maintain healthy diets and exercise. A program envisioned by cardiologist, Elsa-Grace Giardina, M.D., professor of clinical medicine, is reaching out to women at risk for heart disease and stroke.
   The program, Heart Health in Action, identifies patients with components of the metabolic syndrome, which includes hypertension, an abnormal lipid profile characterized by low HDL-cholesterol and high triglycerides, high blood sugar, and increased waist size. The project has screening, education and awareness, behavior modification, and tracking and evaluation components. Dr. Giardina has been researching the health of minority women in Northern Manhattan since 2005. She and colleagues designed the project around a team concept by adapting a model from CUMC’s Center for Women’s Health and subsequently received funding from the Office of Women’s Health, U.S. Department of Health and Human Services. Nationwide, about 24 percent of women are thought to have the metabolic syndrome; in Northern Manhattan, however, because of increasing obesity and physical inactivity, the number is about 35 percent. Since heart disease is the leading cause of death in women, Dr. Giardina says that this puts the women of Northern Manhattan at even greater risk than the rest of the population.
   Heart Health in Action seeks out participants from the outpatient areas of CUMC, NYPH and the community, aiming to identify those who are not yet sick but are at risk for heart disease and stroke. Once a woman agrees to be included, the team coordinators discuss risks and suggest therapeutic lifestyle changes. All are given free pedometers and educational materials reinforcing the curriculum.
   “Our major goal is to help those in the program take steps to reduce weight and increase physical activity. Usually, the enrollees are very receptive because they see an effort being made to try to help them become healthier,” Dr. Giardina says. Study participants are followed for at least one year. When follow-up is completed this summer, Dr. Giardina plans to apply to the NIH to mount a larger scale program reaching more women.
   Heart Health in Action also conducts lectures for groups of six to eight women on hypertension, cholesterol, blood sugar, nutrition, and exercise. “We limit the session size so we can provide as much individualized attention as possible,” Dr. Giardina says.
   CUMC is one of six centers nationwide designated by the government to improve, enhance, and evaluate outcomes of comprehensive heart health care programs for high-risk women. Columbia’s focus on women in the community – in this case, Caribbean Hispanic and African American – is unique. The program is also set apart because it has no age cut-off. Participants range in age from 27 to 84. “We have no age limit because we recognize that limiting risk has to start early and continue late,” Dr. Giardina says.
   One of the challenges is that a significant number of the more than 200 participants still are deeply connected to their countries of origin and may leave the United States for months at a time. Dr. Giardina says that being able to work with the women, even during the time when they are in the States, still provides a critical intervention.
   “This has been a very positive experience for participants because we are partners in their health,” Dr. Giardina says. “The women have been very receptive to the program. The idea of improving health and awareness may be a luxury they have not been able to think about, but they see the importance of keeping healthy for themselves and their families.”

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