African-Americans have worse cardiovascular health and more deaths from heart disease than other groups, at least partly from less effective disease prevention and management efforts, according to a scientific statement from the American Heart Association (AHA).
“While African-Americans are more likely to experience many cardiovascular diseases, in particular strokes and heart failure, they are also more likely to die from cardiovascular diseases,” Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago told Reuters Health by email.
Because African-Americans develop nearly all cardiovascular diseases — heart attack, stroke, and heart failure — at a relatively young age, she continued, “higher rates of death may arise from the length of time that African-Americans live with these conditions.”
“Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” she said.
Traditional cardiovascular risk factors — high blood pressure, diabetes, obesity, and atherosclerosis — are more common and start at earlier ages among African- Americans, Carnethon and colleagues report in the journal Circulation.
Unfortunately, not much has changed since 2005 when a special issue of Circulation pointed out disparities in the rates of cardiovascular disease, disease management, and outcomes for African-Americans.
Many of the differences arise from unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong, the research team writes.
African-Americans also have higher rates of certain health conditions that predispose to cardiovascular disease – such as chronic kidney disease, sickle cell disease/sickle cell trait and HIV, for example.
Genetic differences between African-Americans and other ethnic groups appear to explain only a small part of the disparity in cardiovascular disease rates and outcomes.
Finding strategies that reach younger African-Americans and men with disease prevention messages remains a significant challenge, Carnethon’s team notes.
“Cardiovascular diseases are preventable with healthy lifestyles,” she said. “Unfortunately, many African-Americans do not have equal access to the resources needed to lead healthy lifestyles, specifically access to healthy foods, safe spaces for physical activity, and peaceful homes and communities that promote restorative sleep.”
“Despite the strides our country has made in broadening access to healthcare, many African-Americans, particularly those in lower income groups, are still unable to afford and prioritize preventive care visits,” she said.
Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota, who has worked to promote cardiovascular health in African-American communities, told Reuters Health there’s a need for “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.”
“By increasing awareness of this enduring and colossal issue, we can then in turn empower African-Americans to play a role in improving their own cardiovascular health in tandem with their healthcare providers and social support networks,” she said.
“The AHA Life’s Simple 7 provides an evidence-based, advantageous framework to increase population-wide awareness among African-Americans,” she said.
Clinicians, researchers, public health practitioners, social services and community stakeholders must work together “to develop an effective approach to improve cardiovascular health among all Americans,” Brewer said. “However, it will take a concerted effort to address not only the high burden of traditional risk factors among African-Americans, but also the plethora of social and environmental contextual barriers faced by this population.”
