Emerging Precision Medicine Concepts and Cardiovascular Health in African Americans and Hispanics

The long-term goal of the landmark US Precision Medicine Initiative, now termed the All of Us Research Program, is to generate new knowledge based on research on individual variation in lifestyle, environment, and biological makeup that would lead to transformative personalization and improvements in health in all Americans. Using research data gathered over many years from one million or more participants, the All of Us Research Program holds great promise in health promotion, and personalized precision detection, prevention, treatment, and control of a wide variety of diseases including cardiovascular diseases. This promise in precision health is important to all Americans, but for cardiovascular diseases, it is particularly so in African Americans who shoulder the largest burden of cardiovascular mortality and morbidity in the United States. It is also important in Hispanic Americans and other underserved racial and ethnic minority populations in whom the prevalence of ideal cardiovascular health metrics remains very low. This chapter addresses the emerging concepts in precision medicine and precision public health for cardiovascular health. We begin with describing concepts of how race, ethnicity, and genetic ancestry are used in biomedical research today. We then address the huge challenge of Eurocentric biases that result from the lack of diversity in genomics research, and the real potential for current genomics tools and applications to exacerbate health inequities in underrepresented racial and ethnic minority populations. We conclude by addressing emerging concepts in trust and patient engagement in biomedical research and the role they play in African American, Hispanic, and other underserved racial and ethnic populations in the United States.