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Updated: Feb 9, 2026

In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
Cardiovascular Disease and Homelessness
Travis P Baggett1, Samantha S Liauw2, Stephen W Hwang3
1Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts.
Insights
Homeless adults face higher cardiovascular disease (CVD) death rates due to unique risk factors and healthcare barriers. Patient-centered strategies and collaboration are crucial for improving CVD outcomes in this vulnerable population.
Area of Science:
- Public Health
- Cardiology
- Health Disparities
Background:
- Homeless adults experience disproportionately high mortality from cardiovascular disease (CVD).
- This disparity is linked to prevalent traditional CVD risk factors (hypertension, diabetes, smoking) and significant psychosocial burdens (stress, depression, substance use).
- Barriers in healthcare access, diagnostic testing, and treatment adherence further complicate CVD management in this population.
Purpose of the Study:
- To identify and address the multifaceted challenges contributing to adverse cardiovascular disease outcomes among homeless adults.
- To propose practical, patient-centered strategies for mitigating CVD risk and improving management in this population.
Main Methods:
- Review of existing literature on CVD risk factors and healthcare barriers in homeless populations.
- Analysis of traditional and nontraditional risk factors contributing to CVD disparities.
- Synthesis of patient-centered strategies for improving CVD care access and adherence.
Main Results:
- Homeless individuals exhibit a higher prevalence of traditional CVD risk factors and a significant burden of psychosocial risk factors.
- Healthcare access, diagnostic delays, and challenges with medication adherence impede effective CVD management.
- Conventional risk estimation methods may underestimate CVD risk in this population due to unaddressed psychosocial factors.
Conclusions:
- Addressing the complex interplay of biomedical, psychosocial, and systemic factors is essential for improving cardiovascular health in homeless adults.
- Multidisciplinary collaboration and partnerships with specialized homeless healthcare programs are critical for developing effective interventions.
- Implementing patient-centered strategies can help overcome barriers to care and improve CVD outcomes for homeless individuals.
Abstract:
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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