Heart Disease Kills 48,000 Black Women Yearly
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Heart Disease Kills 48,000 Black Women Yearly

And, according to new research, a Southern-style diet may be partly to blame.

Black women face disproportionately high risks for heart disease and stroke, yet many are unaware of those risks. What's more, almost half develop these diseases at young ages—as young as 20—for reasons that are not yet fully understood.

Statistically, 48,000 black women in the United States die each year from cardiovascular diseases, the leading cause of death in this population and in all women, according to the American Heart Association (AHA). The AHA estimates that one woman in the U.S. dies every 80 seconds from these often-preventable illnesses.

But, black women die more frequently from cardiac events than white women, with a mortality rate that, some research suggests, is 69 percent higher. And, they also have dramatically higher rates of high blood pressure, a major heart-disease risk factor.

Reasons for more heart disease
Why do black women fare so poorly compared to other groups? And why are their risks so much higher at younger ages than other women?

“There’s a lot of speculation as to why,” says Vinayak Manohar, MD, an interventional cardiologist with Mercy Health in Grand Rapids, Michigan. One reason may be poorer access to healthcare, but especially to specialists, he says, as black women encounter financial barriers to specialty care more often than other populations. U.S. Census Bureau data shows 22 percent of black people live in poverty, compared with 8.8 percent of the non-Hispanic white population.

Cultural differences may come into play, as well. "Many women, in general, only see a doctor when they’re sick—not for [disease] prevention," Dr. Manohar says. And, some research suggests black women have an added disincentive: mistrust of their healthcare providers.

This is due, in part, to poor past care. Evidence also suggests there lies an implicit, or unconscious, bias against many black patients—particularly women. As a result, they often don't receive the same-quality treatment that white women do. This can lead to fewer preventive screenings for heart disease and other health concerns.

Manohar also cites two “stand-out” risk factors—hypertension and obesity—that are more prevalent, tend to be more severe and develop earlier in life in black women relative to white women. Almost half of black women age 20 and older have high blood pressure, and the Centers for Disease Control and Prevention (CDC) estimates that 82 percent of black women are currently overweight or obese, due in part to less physical activity and diets that favor salty, fried foods. These two conditions, which significantly raise the risk for coronary artery disease, act as gateways to other major health problems, including chronic kidney disease and type 2 diabetes, he says.

Less definitive, for now, is a possible genetic link governing hypertension in both black women and men, which makes them far more sensitive to salt intake, and in turn, more vulnerable to high blood pressure. The AHA says in those who carry the gene, as little as one extra gram of salt, or about half a teaspoon, can raise blood pressure significantly.

Research is also more thoroughly examining the link between diet and high blood pressure. A study published in the Journal of the American Medical Association in October 2018 followed about 6,900 American men and women over the age of 45 for a period of 10 years to identify risk factors associated with high blood pressure. The researchers found that a Southern-style diet—rich in fried, processed and fatty foods and sugar-sweetened beverages—was the largest factor contributing to higher rates of hypertension among blacks, when compared to whites.

How black women can reduce risk
On an individual level, Manohar and others agree that, to lower heart-disease and stroke risks, black women first need to be made more aware of that risk by the medical community. Research shows 55 percent of white women between the ages of 25 and 60 recognize heart disease as the leading cause of death in women, compared to about 34 percent of black women in the same age group.

To further lower the risk of cardiovascular problems, black women can:

  • Watch blood pressure levels. Though studies show black women are more aware of hypertension than white women—and likelier to take medication for it—monitoring is key to detecting changes in heart health. High blood pressure is now considered 130 mm Hg and up for systolic blood pressure, or 80 mm Hg and up for diastolic blood pressure. Readings can be taken at home, as well as at a doctor's office.
  • Engage in regular physical activity. To maintain a healthy weight and improve heart health, try moving 30 minutes or more each day. Even just moderate-intensity walking can help to lower risk.
  • Know cholesterol levels. Excess cholesterol and fat in the blood can narrow arteries and increase the likelihood of a heart attack or stroke. Dyslipidemia—excess blood fat and cholesterol—contributes to these conditions; black people require special attention from providers, as they're historically undertreated. Black women without heart disease should aim for a desirable total cholesterol level of less than 200 mg/dl, with an HDL of at least 60 mg/dl, and seek regular testing.
  • Quit smoking and using tobacco products, like snuff. Currently, about 13 percent of black women smoke. And while, overall, they try to quit more often than other groups, they're typically not as successful, perhaps because medication and counseling aren't used—or aren't available. To address this, the CDC created a guide, Pathways to Freedom, specifically addressing smoking cessation in the black community.
  • Get tested for diabetes. Black people are 1.7 times more likely to have diabetes than non-Hispanic white people; they also tend to develop it earlier in life. Since an estimated two-thirds of those with type 2 diabetes die of heart-related complications, it's important to be evaluated for the disease, which can be detected with a simple blood sugar test.

None of these changes have to be made all at once, and some risk factors, such as age or a genetic history of early heart disease, can’t be changed. But having just one risk factor is one too many, the AHA says, as risk factors tend to accumulate over time, worsening each other’s effects. The AHA suggests you start gradually, tackling each risk one at a time to prevent future cardiac and stroke events.

Finally, black women should also know the signs of a heart attack, which can differ—for all women—from those seen in men. In addition to typical red flags—such as uncomfortable pressure in the center of the chest or pain that radiates to the shoulder, neck and arms—women may experience sharp pain in the neck, back and jaw. They may also feel nausea, dizziness, unusual fatigue, shortness of breath and lightheadedness. If you believe you're experiencing a heart attack, dial 9-1-1 immediately, as fast treatment is crucial to survival.