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Why Black People Have a Higher Risk of Heart Disease in the US

Heart disease is the leading cause of death in the US, and it’s held that spot for decades. But there’s a disparity deeply rooted in this epidemic that’s not talked about enough: Black people make up roughly 12% of the US population—but account for at least 22% of all heart disease-related deaths. In fact, Black people are twice as likely to die from cardiovascular disease as white folks.1

The reasons are complicated but also familiar. First, it’s no surprise that your family history can play a role in your health. There are heart-related genetic predispositions that are more common in Black people, for example. And while they’re important to be aware of, the experts SELF spoke with say the risk factors you inherit are just one piece of a complicated puzzle.

Structural, systemic, and institutional racism—the deeply embedded bias in society that leads to discriminatory treatment toward people of color—is a “fundamental driver” of health disparities in the US, including those that persist in cardiovascular conditions, per the American Heart Association (AHA).2

Despite these complex barriers, there are things you can do to help reduce your chances of developing heart problems, Yvonne Commodore-Mensah, PhD, a cardiovascular nurse epidemiologist and an associate professor at the Johns Hopkins School of Nursing, tells SELF. She points to this stat: 80% of premature heart attacks and strokes are preventable, the World Health Organization (WHO) notes.

Here’s why Black people are disproportionately affected by heart disease—and why self-advocacy is often a necessary step in getting the care you deserve.

Genetics might play a role in your heart disease risk.

Black Americans are a diverse group of people with wide-ranging ancestries. “Your ancestry refers to, strictly speaking, traits in your genetic code that are inherited from your ancestors. In some ways that does correlate with the social construct of race, but not exactly,” Alanna A. Morris, MD, MSc, an associate professor of cardiology and the director of heart failure research at the Emory University Clinical Cardiovascular Research Institute, previously told SELF. “For example, I self-identify as Black, but if I were to go and [do DNA sequencing on myself], I would see that my ancestry is highly admixed, meaning I’ve got European ancestors and African ancestors, and maybe some from American Indian groups.”

These details matter because there are certain cardiovascular conditions linked to genetic variants that are more commonly identified in Black people, and these variants are often linked to ancestry. Take transthyretin amyloidosis, for example. The condition, which can cause a buildup of abnormal protein deposits in the body, is associated with an increased risk of heart failure, and the gene that’s linked to it is generally identified in people of West African ancestry. An estimated 4% of Black people in the US carry the gene variant.3

Familial hypercholesterolemia (FH) is another relatively rare genetic disorder that causes high cholesterol at a young age, even as early as childhood. And the stats are telling: One in 192 Black people has FH compared to one in 323 white people.4

Certain risk factors also disproportionately affect Black people. Lipoprotein(a), a type of cholesterol that is associated with heart attack, stroke, and other forms of cardiovascular disease, is based on your genetics. Up to 25% of the world’s population is thought to have an elevated amount of this fat-carrying particle in their blood, but research suggests Black people, specifically those who have African ancestry, tend to have the highest levels.5

But as we mentioned, “genetics is just one piece of the puzzle,” Dr. Commodore-Mensah stresses. “Overwhelmingly, we know that your zip code is a better indicator than your genetic code when it comes to predicting cardiovascular disease.”

Systemic racism permeates throughout everyday life and in the health care system.

Social determinants of health also play a big role in skewing Black people’s heart disease risk, experts say. This term refers to the “nonmedical factors that influence health outcomes,” as the WHO puts it; they’re the conditions in which you’re born, live, work, and grow. All of these factors are shaped by economic and social systems (and it’s worth noting that these systems were built on racist policies that spanned decades and persist today).1 Social determinants of health include things like your financial situation, access to grocery stores and clean public parks, the ability to find an in-network doctor in your area, as well as feeling safe in your community.

Black people “experience greater social disadvantage” compared to white people, and this has a direct impact on their heart disease risk, the authors of a review published in the journal Circulation note. “Disparities in cardiovascular disease…are one of the starkest reminders of social injustices and racial inequities, which continue to plague our society,” they write.1

Income inequality is a big example of how the effects of systemic racism can sway the risk of heart problems, Pamela Garmon Johnson, the national vice president of health equity and partnerships at the AHA, tells SELF. An average white family in the US has about six times as much wealth as an average Black family. “How much money we earn drives our access to everything,” Garmon Johnson says.

The most common advice for protecting your heart health is often framed as simple: Eat nutritious foods; exercise regularly; make a plan to quit if you smoke; get quality sleep; reduce your stress; and keep your cholesterol, blood pressure, and blood sugar in check.6 But all these things are much easier said than done if you lack a dependable income, Garmon Johnson says.

For example, if you have to choose between buying cheap, canned foods that are shelf-stable or pricier fresh produce that goes bad quickly, you’re likely going to pick up the packaged stuff to feed yourself and your family—even if it’s much higher in sodium. (As you likely know, consuming a lot of salty stuff may spike your blood pressure, a well-established precursor to heart disease). “People are faced with having to make very hard choices,” Garmon Johnson says.

And if you do eventually experience symptoms and decide to see a doctor, you may experience racial bias that can directly affect your quality of care too. Here’s just one example: A study of more than 1,100 hospitals across the US found that Black patients from marginalized neighborhoods were 24% less likely to receive a coronary artery bypass—a surgery that restores blood flow around a blocked artery in the heart—at “top-tier cardiac hospitals” compared to white patients from similar backgrounds.1

Research shows that implicit bias in health care providers runs rampant—and this can impact their treatment decisions, like whether you’re prescribed certain meds or offered a potentially life-saving procedure.1 “As much as we would like to say this discrimination doesn’t happen in our health care system, that would be far from the truth,” Dr. Commodore-Mensah says.

So what can you do to protect your heart?

It’s not individually up to you to fix a broken system—so focus on what is within your control. (Reminder: You can play your part by voting for policymakers who advocate for legislation that will meaningfully address health inequities.)

On a personal level, start with your family if you’re on good terms with at least some of your relatives. Talk to them about their health histories. They can help you figure out if any heart-related issues should be on your radar based on their own experiences. (And here’s what to keep in mind if you’re adopted.)

Even if you can only get an annual check-up on the books, a primary care physician can use the information you gather to help you figure out what your risk looks like. From there, you can discuss preventive actions you should consider taking, like how to make certain lifestyle changes or schedule specific tests.

Understandably, you may have a hard time trusting your doctor if your symptoms have been dismissed or your concerns have been invalidated in the past—or you’ve simply read about how all of the factors above can lead to harrowing injustices, like the high maternal mortality rates in Black women.

One potential way to find empathetic care is to seek out a provider who looks more like you. “If a Black patient receives medical care from a Black physician, the likelihood of receiving superior quality [of] care is higher compared to receiving care from a provider of a different racial background,” Dr. Commodore-Mensah says.7 This isn’t a blanket rule, of course, but it’s a route to think about if you’ve had multiple bad experiences and need a fresh perspective. (Some online platforms like Zocdoc let you search by specialty and insurance coverage, while also showing what available providers look like and how their past patients have reviewed them.)

Then, do your best to advocate for yourself, which means preparing for an appointment with the right questions, getting a second opinion if your feelings aren’t being heard or your needs aren’t being met, and recruiting friends and family (or a patient advocate, if necessary) for support.

All of this can be really frustrating, time-consuming, and physically and mentally draining. It shouldn’t have to fall on your shoulders, but the effort is worth it. Speaking up for yourself now might save your heart from major trouble down the road. “You must be the CEO of your health. Period,” Garmon Johnson says. “Nobody is going to care about your health more than you.”

Related:

Sources:

  1. Circulation: Cardiovascular Quality and Outcomes, Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease
  2. Circulation, Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association
  3. BMC Global and Public Health, Uneven Burden of Cardiac Amyloidosis in People of African Descent — Global Imbalance in Resources and Access
  4. Frontiers in Genetics, Familial Hypercholesterolemia Prevalence Among Ethnicities—Systematic Review and Meta-Analysis
  5. American College of Cardiology, An Update on Lipoprotein(a): The Latest on Testing, Treatment, and Guideline Recommendations
  6. American Journal of Lifestyle Medicine, Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease
  7. Journal of Racial and Ethnic Disparities, Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations

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