Heart Health in the Black Community: Why heart disease disproportionately affects Black Americans

February is Heart Health Month, and in an effort to raise awareness for one of the most important organs in our body, the heart, we want to recognize the large-scale impact of heart disease in America.

However, to talk about American heart health without acknowledging that the Black community is disproportionately affected by the disease would omit an essential part of the conversation. African Americans make up 13% of the U.S. population however, the Black community is affected by heart disease at much higher rates than their white counterparts. How is that?

While health disparities are a complex issue, they are not new to the American healthcare system. Marginalized groups are far more likely to be affected by patterns of discrimination and substandard care, and in the case of Black patients, when environmental and socioeconomic factors merge with medical racism and a lack of health insurance, there’s no one singular solution to the problem.

To better understand the causes of higher rates of heart disease in the Black community, we dove into the data. Here’s what we found:

• Younger African Americans are living with or dying of many conditions typically found in white Americans at older ages—this includes heart disease. (CDC)
• Black people are twice as likely to die from heart disease than whites. (CDC)
• Nearly half of all African American adults have some form of cardiovascular disease. (CDC)

Understanding heart disease

Like any health condition that affects Black people at higher rates than their white counterparts, it’s impossible to understand the root of the problem without first understanding what causes the condition in the first place.

Here’s a quick overview of what heart disease is and what causes it.

Heart disease, or cardiovascular disease, is a comprehensive term that describes a range of conditions that affect your heart and blood vessels. The most common heart disease is coronary artery disease (CAD), also known as coronary heart disease (CHD). This condition is caused by narrow or blocked coronary arteries, which can lead to:

• Chest pain (angina)
• Heart attacks (myocardial infarction)
• Stroke (cerebrovascular accident or transient ischemia attack)

Other prominent heart diseases include:

• Congestive heart failure (heart failure)
• Heart rate or rhythm problems (arrhythmias)
• Congenital heart disease (heart disease at birth, often due to structural abnormalities of the heart)
• Endocarditis (inflamed inner layer of the heart, usually caused by an infection)

While there is no cure for heart disease, and heart muscle damage can have lifelong effects on your health, many forms of the condition can be prevented or treated with healthy lifestyle choices. More on that later. For now, let’s talk about how to spot the first signs of heart disease.

Heart disease can show up in a variety of ways and symptoms aren’t the same for everyone. For example, men and women often experience symptoms of a heart attack differently, which is why it’s not recommended to merely check symptoms off a list.

Note: If you or someone close to you is experiencing life-threatening symptoms or symptoms that could be a sign of a heart attack or stroke (chest pain or tightness, pain and numbness in limbs, etc.), seek medical attention immediately.

Causes of heart disease

While there is no singular cause of heart disease, certain factors can increase your risk of the condition. Some risks are linked to our habits and environments, and others are largely out of our control.

The risk factors for heart disease can be bucketed into two categories, and may include:

Modifiable

• High blood pressure
• Eating a diet high in salt (sodium)
• High blood cholesterol levels
• Eating a diet high in saturated fats, trans fat, or cholesterol
• Uncontrolled diabetes
• Obesity
• Tobacco use
• Increased alcohol consumption
• Physical inactivity

Non-modifiable

• Genes
• Age (Note: heart disease can affect anyone, at any age, but the risk increases with age)
• Race
• Biological sex

Why does heart disease disproportionately affect Black people?

Health is about more than a visit to the doctor’s office—it starts in homes, schools, workplaces, and neighborhoods. When we think about the ties between heart health and preventative lifestyle habits like eating healthy foods, it’s important to recognize that a lack of access in Black communities is largely tied to socioeconomics. These barriers can be broken into 3 main categories:

Economics

According to the 2017 Census, the average non-Hispanic Black median household income was $40,165 compared to $65,845 for non-Hispanic white households—that’s a nearly 40% income gap between races.

Individuals living below the federal poverty level are more likely to have high blood pressure compared with those living at the highest level of income. Nearly twice as many Black people live at or below the poverty level or experience unemployment compared to whites.

A “healthy” lifestyle, including buying whole foods and preparing meals at home, may be a financial burden for families just trying to get by each month. A fast-food combo meal or value menu that can feed a family of four can often present as more affordable and more accessible than a heart-healthy, home-cooked dinner.

Environment

The link between poverty and lack of food availability in America has been an issue for decades, but we see even higher rates of food insecurity in poor communities of color. Aside from the economic factors, food deserts play a big role in the lack of access to fresh and nutritious food.

"Food deserts" are areas in which residents are overburdened with finding affordable and healthy food options. Often, as a result of poor, urban development landscaping, formerly segregated and historically Black neighborhoods are more likely to fall into this category. One study found that Black and Hispanic neighborhoods have fewer large supermarkets and more small grocery stores than their white counterparts. This is a prime example of neighborhoods where fast-food chain restaurants and small corner stores packed with junk food are easier to come by than supermarkets and farmers markets with whole-grain, fresh foods.

Education

Promoting preventative measures like nutritious eating, daily exercise, and other essential lifestyle habits start with education. One study examined the effects of three behavioral risk factors for heart disease and diabetes in an African American community in North Carolina: low fruit and vegetable consumption, low physical activity, and cigarette smoking. The researchers found that by supporting community outreach, education, resources, and policy changes, health behaviors in the community played a key role in reducing health disparities.

How do health disparities play a part in Black heart disease risk?

In addition to the above mentioned economic, environmental, and educational hardships Black communities are more likely to experience than their white counterparts, issues related to health disparities play a part in the disproportionate risk for heart disease among African Americans.

For example, some studies suggest race-related stress and racial trauma can have mental and physiological consequences, and have a lasting effect on Black hearts.

While the underlying causes of health disparities are complex, they can range from institutionalized, systemic racism and healthcare discrimination to socioeconomic status and lack of access to healthcare. According to the CDC, over 12% of African Americans are uninsured or underinsured. Without proper access to healthcare, prevention and treatment are far less likely for those who cannot afford to see a healthcare provider than for those who have health coverage.

How do genetics and family history affect the risk of heart disease for Black Americans?

While scientists are still trying to understand inherited cardiovascular diseases, genetic factors likely play some role in high blood pressure, heart disease, and other related conditions. However, according to the CDC, it is also likely that people with a family history of heart disease share common environments and other factors that may increase their risk.

For example, people who grew up in households where smoking cigarettes and eating an unhealthy diet was the norm, are more likely to adopt the same habits. Both of these lifestyles are known to increase the risk for heart disease.

Tobacco use is a leading cause of death among African Americans and even though rates of teenage cigarette use in the U.S. are declining, children of current and former smokers face an elevated risk of smoking. This may be because Black children and adults are more likely to be exposed to secondhand smoke than any other racial or ethnic group.

Nearly 12% of African American adults smoke tobacco cigarettes, and although they usually smoke fewer cigarettes and start smoking cigarettes at an older age, they are more likely to die from smoking-related diseases than white Americans. This isn’t a coincidence; the tobacco industry has historically placed larger amounts of advertising in urban communities, targeting vulnerable populations, and exposing Black people to more cigarette ads than whites. The frequency and prominence of this kind of exposure to tobacco marketing can have a cyclical and generational effect on Black families.

How can you prevent heart disease?

Not only are Black people more likely to develop heart health issues, but they are more likely to develop them at an earlier age. This could lead to life-long health issues and potential future complications.

If you are looking for lifestyle changes that could help you prevent and minimize your risk for heart disease, consider adopting these habits:

• Quit smoking
• Monitor and control your blood pressure
• Check your cholesterol
• Keep diabetes under control, if applicable
• Exercise regularly
• Nourish your body with heart-healthy foods
• Consider adopting a plant-based diet (Note: Research shows that diets higher in plant foods and lower in animal foods may lower your risk of cardiovascular morbidity and mortality)
• Manage stress and get enough sleep
• Take care of your mental health

Need a partner in your health journey to help you adopt these habits? We offer over 30+ at-home lab tests to help you take control of your health from anywhere. Check in on your heart with our Heart Health Test and Cholesterol & Lipids Test, monitor your blood sugar levels with the HbA1c Test, learn more about your sleep hormones with our Sleep & Stress Test, and more.

How can healthcare providers help combat healthcare barriers for their Black patients?

Tackling health disparities at large must start in healthcare spaces. Marginalized groups are disproportionately affected by discrimination within healthcare, which must be addressed by healthcare advocates, providers and professionals.

Here are a few ways healthcare providers can work to combat health barriers for their Black patients:

• Learn about socioeconomic conditions that may put some patients at higher risk than others for having a health problem.
• Connect patients with community resources that can help people remember to take their medicine as prescribed, get prescription refills on time, and get to follow-up visits.
• Work with communities and healthcare professional organizations to eliminate cultural barriers to care.
• Collaborate with other physicians to create a comprehensive and coordinated approach to patient care.
• Encourage patients to ask questions to promote trust building.

We believe closing the gap in heart health care starts with raising awareness, advocating for the most vulnerable communities, removing systemic barriers to healthcare access, and supporting organizations that provide resources and lead the change.

To learn more about some organizations leading conversations around heart health in the Black community, visit the Black Heart Association and the African American Health Coalition.

If you’re among populations that are at a higher risk for heart disease, consider taking proactive steps to help prevent the condition. By living a healthy lifestyle, you can help keep your blood pressure, cholesterol, and blood sugar levels normal and lower your risk for heart disease and heart attack.

Want to better understand your risk for heart disease? The Everlywell Heart Health Test allows you to easily check on your heart health from the comfort of your own home. No waiting rooms, no surprise bills, no guesswork. You collect your own sample, mail it in, and receive physician-reviewed digital results in days. From there, you can consult with your healthcare provider to follow-up on your results.

References

1. Heart disease. Mayo Clinic. URL. Accessed February 9, 2020.

2. Prevent Heart Disease. Centers for Disease Control and Prevention. URL. Accessed February 9, 2020.

3. Know Your Risk for Heart Disease. Centers for Disease Control and Prevention. URL. Accessed February 9, 2020.

4. Does Heart Disease Run in Your Family? Centers for Disease Control and Prevention. URL. Accessed February 9, 2020.

5. Genetic Testing for Inherited Cardiovascular Diseases: A Scientific Statement From the American Heart Association. American Heart Association. URL. Accessed February 9, 2020.

6. Profile: Black/African Americans. U.S. Department of Health and Human Services, Office of Minority Health. URL. Accessed February 9, 2020.

7. The Intersection of Neighborhood Racial Segregation, Poverty, and Urbanicity and its Impact on Food Store Availability in the United States. US National Library of Medicine National Institutes of Health. URL. Accessed February 9, 2020.

8. The Effects of Race-related Stress on Cortisol Reactivity in the Laboratory. US National Library of Medicine National Institutes of Health. URL. Accessed February 9, 2020.

9. Improving Health Behaviors in an African American Community: The Charlotte Racial and Ethnic Approaches to Community Health Project. US National Library of Medicine National Institutes of Health. URL. Accessed February 9, 2020.

10. Celebrate African American History Month! Centers for Disease Control and Prevention. URL. Accessed February 9, 2020.

11. Race, Discrimination, and Cardiovascular Disease. American Medical Association Journal of Ethics. URL. Accessed February 9, 2020.