Community health workers (CHW) may be effective in tackling the burden of cardiovascular diseases in low- and middle-income countries (LMIC). This review examines whether CHWs can improve the identification and control of cardiovascular risk factors in LMIC. We searched for studies that used CHW as a basis for cardiovascular risk factor management. Our search yielded 11 articles that targeted cardiovascular risk factor assessment, hypertension, diabetes, smoking, diet and physical activity. There were 4 randomized controlled trials, 3 quasi-experimental studies, 3 cross-sectional studies, and 1 retrospective analysis. Eight studies reported positive results with CHW being able to effectively screen for cardiovascular risk factors, decrease systolic blood pressure, decrease fasting blood glucose, increase quit rates of smoking, decrease weight, and improve diet and physical activity. Our review demonstrates that CHW may be effective in helping tackle the burden of cardiovascular disease in LMIC.

Background: Long term exposure to particulate matter <2.5μm in diameter (PM 2.5) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM 2.5 , higher cardiovascular mortality. Whether exposure to PM 2.5 and ozone is associated with patients' health status and quality of life, is unknown. We used data from two prospective myocardial infarction (MI) registries to assess the relationship between long-term PM 2.5 and ozone exposure with health status outcomes one year after a MI. Methods and Results: TRIUMPH and PREMIER enrolled patients presenting with MI at 31 U.S. hospitals between 2003 and 2008. One year later, patients were assessed with the diseasespecific Seattle Angina Questionnaire (SAQ) and 5-year mortality was assessed with the Centers for Disease Control's National Death Index. Individual patients' exposures to PM 2.5 and ozone over the year after their MI were estimated from the EPA's Fused Air Quality Surface Using Downscaling tool that integrates monitoring station data and atmospheric models to predict daily air pollution exposure at the census tract level. We assessed the association of exposure to ozone and PM 2.5 with 1-year health status and mortality over 5-years using regression models adjusting for age, sex, race, socioeconomic status, date of enrollment and comorbidities. In completely adjusted models, higher PM 2.5 and ozone exposure were independently associated with poorer SAQ summary scores at 1-year (β estimate per +1 SD increase = −0.8 (95% CI −1.4, −0.3 p=0.002) for PM 2.5 and −0.9 (95% CI-1.3, −0.4 p<0.001) for ozone). Moreover, higher PM 2.5 exposure, but not ozone, was independently associated with greater mortality risk (HR = 1.13 per +1 SD (95% CI = 1.07-1.20, p<0.001). Conclusions-In our study, greater exposure to PM 2.5 and ozone was associated with poorer 1year health status following an MI, and PM 2.5 was associated with increased risk of 5-year death.

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