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Heart Disease Kills Nearly 50,000 Black Women Yearly

Understanding the contributing factors is the first step toward addressing the problem.

Heart Disease Kills Nearly 50,000 Black Women Yearly

Medically reviewed in October 2021

Updated on October 8, 2021

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.

Close to 50,000 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 largely preventable illnesses.

But Black women die more frequently from cardiac events than white women, with a mortality rate that is up to 69 percent higher. They also have dramatically higher rates of high blood pressure—a major heart-disease risk factor also known as hypertension—and nearly twice the rate of hypertension-related deaths.

Reasons for high rates of 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?

One reason may be that Black women generally have poorer access to healthcare, particularly to specialists, says Vinayak Manohar, MD, an interventional cardiologist with Mercy Health in Grand Rapids, Michigan. Dr. Manohar notes that Black women encounter barriers to specialty care more often than do members of other groups.

Socioeconomic status is one contributing factor: U.S. Census Bureau data shows that 22 percent of Black people live in poverty, compared with 8.8 percent of the non-Hispanic white population, which may inhibit access to quality health care.

Cultural differences may come into play, as well. "Many women, in general, only see a doctor when they’re sick—not for prevention," Manohar says. Some research suggests that Black women have an added disincentive: distrust of the healthcare system.

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

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 aged 20 and older have high blood pressure, and the Centers for Disease Control and Prevention (CDC) estimates that 82 percent of black women are overweight or obese, due in part to less physical activity and unhealthy diets. Hypertension and obesity, 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, Manohar says.

The experience of racism may also play a role in higher levels of hypertension and heart disease among Black people. Facing discrimination on a daily basis in a variety of areas of life—from housing to education, employment, to interactions with the healthcare and criminal justice systems—can lead to unequal access to healthy food, healthy living environments, and preventive health resources. What’s more, research has shown that the chronic stress that results from confronting racism has an impact on mental and physical health, raising people’s risks of not only depression and anxiety, but also conditions including high blood pressure, diabetes, heart disease, and stroke.

Less definitive, but a possible contributor, is a genetic link that influences hypertension in both Black women and men. This factor appears to make Black people more sensitive to salt intake, and in turn, more vulnerable to high blood pressure. The AHA says that in those people 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 2018 study published in the Journal of the American Medical Association followed nearly 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 diet rich in fried, processed, fatty foods and sugar-sweetened beverages was the largest factor contributing to higher rates of hypertension among Black people, when compared to whites.

How Black women can reduce risk
Many experts agree that, as a starting point, the medical community can do a better job educating Black women about the risk of hypertension, heart disease, and stroke. One study published in 2012 in the Journal of Women’s Health found that 55 percent of white women between the ages of 25 and 60 identified 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 considered 130 mm Hg and up for systolic blood pressure (the top number in a blood pressure reading), or 80 mm Hg and up for diastolic blood pressure (the lower number). Readings can be taken at home, as well as at a healthcare provider’s (HCP’s) office. If you take medication to manage blood pressure, be sure to stick to it as closely as possible and ask your HCP if you have any questions about your prescription.
  • Engage in regular physical activity. To maintain a healthy weight and improve heart health, it’s important to move for at least 30 minutes or more each day, aiming for at least 150 minutes of moderate-intensity exercise each week. Even a regular habit of brisk 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. This is a case where Black people require special attention from HCPs, as they've historically been undertreated. Black women without heart disease should aim for a total cholesterol level of less than 200 mg/dl, with an HDL (aka “good” cholesterol) level of at least 60 mg/dl. It’s important to have regular testing to keep an eye on those numbers.
  • Quit smoking and using tobacco products. About 13 percent of Black women smoke. While, overall, they try to quit more often than other groups, they're typically not as successful, perhaps because medication and counseling aren't readily 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 adults are 60 percent more likely to be diagnosed with diabetes than non-Hispanic whites, and they 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 test.
  • Prioritize healthy eating. It can be hard to prepare fresh meals which day of the week, but emphasizing healthy dining whenever possible can go a long way toward reducing the risk of heart disease. That means reducing processed and fatty foods, and adding fruits, vegetables, whole grains, and beans and legumes. Produce doesn’t have to be farm-fresh to be wholesome. Frozen and low-sodium canned varieties pack the same nutrients and heart-healthy fiber as do fresh fruits and veggies. A good rule of thumb when apportioning meals: Fill half your plate with fruits or vegetables, one quarter with a whole grain (like brown rice), and another quarter with a lean protein, whether from animal sources (like chicken, fish, or lean cuts of meat) or vegetable sources (such as beans or tofu).

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 911 immediately, because fast treatment is crucial to survival.

Sources:

American Heart Association. Go Red for Women. Heart Disease in African American Women
Centers for Disease Control and Prevention. Women and Heart Disease. Page last reviewed January 31, 2020.
American Heart Association. Cardiovascular Disease: Women’s No. 1 Health Threat. Last Updated March 2018.
Williams RA. Cardiovascular disease in African American women: a health care disparities issue. J Natl Med Assoc. 2009;101(6):536-540.
American Heart Association. African Americans and Heart Disease, Stroke. Last Reviewed July 31, 2015.
American Heart Association. What About African Americans and High Blood Pressure? 2021.
Mary Dunklin. High blood pressure increasingly deadly for Black people. American Heart Association News. July 13, 2020.
Jessica L. Semega, Kayla R. Fontenot, and Melissa A. Kollar. Income and Poverty in the United States: 2016. Current Population Reports. United States Census Bureau. September 2017.
Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283-1289.
LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57 Suppl 1:146-161.
Centers for Disease Control and Prevention. Facts About Hypertension. Page last reviewed September 27, 2021.
Laura Williamson. The link between structural racism, high blood pressure and Black people’s health. American Heart Association News. April 15, 2021.
Thor Christensen. How Black women can take control of their blood pressure. American Heart Association News. September 28, 2021.
Howard G, Cushman M, Moy CS, et al. Association of clinical and social factors with excess hypertension risk in black compared with white US adults. JAMA. 2018;320(13):1338-1348.
Mochari-Greenberger H, Miller KL, Mosca L. Racial/ethnic and age differences in women’s awareness of heart disease. J Womens Health (Larchmt). 2012;21(5):476-480.
Melvyn Rubenfire, MD, FACC. Cardiovascular Health in African Americans: AHA Statement. American College of Cardiology. October 30, 2017.
Centers for Disease Control and Prevention. African Americans and Tobacco Use. Page last reviewed November 16, 2020.
U.S. Department of Health and Human Services Office of Minority Health. Diabetes and African Americans. Last Modified March 1, 2021.

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