Heart disease continues to disproportionately affect Black Americans, driven by a complex mix of genetics, chronic conditions and social determinants of health.
Dr. Tom Schleeter, a cardiologist who specializes in advanced heart failure and cardiac imaging, said the causes are layered and interconnected.
“A lot of that’s not known, right?” Schleeter said. “There’s a fair genetic component to this.”
Schleeter serves as vice president and physician executive in charge of the cardiovascular product line for Community Health Network. He practices at Community Heart and Vascular Hospital and at a clinic in Westfield, which is set to become Community Hospital at Westfield in spring 2027.
National data show the stakes are high. Nearly 60 % of Black adults age 20 and older have some form of cardiovascular disease — including heart disease, stroke, hypertension and heart failure — compared with about 49 % of all U.S. adults. Nearly 60 % of Black males and females have cardiovascular disease, according to the 2026 Heart Disease & Stroke Statistics Update report. Meanwhile, age-adjusted cardiovascular death rates remain significantly elevated for Black adults compared with the overall U.S. population.
Disparities extend to key risk factors: diagnosed hypertension is about 26 % more prevalent among Black adults versus the total population, and Black adults are less likely to have their high blood pressure under control.
Experts say the reasons extend beyond biology.
“When we don’t have access to the tools that are helpful, we may make bad decisions,” Schleeter said, explaining how limited access to nutritious food, safe places to exercise and quality care can compound heart disease risk.
A press statement from the American Heart Association highlighted these disparities in its 2025 Heart Disease and Stroke Statistical Update: “Black communities continue to face disproportionately higher risks of heart disease, stroke and hypertension, contributing to equally disproportionate high death rates,” the association said in a release. “These gaps underscore the urgent need for lifesaving intervention through education, advocacy and equitable health solutions.”
Schleeter said socioeconomic determinants of health — like access to food, health care and safe environments — play a large role.
“It’s not only a genetic problem but also these broader factors,” he said. “We have to tackle those problems first and foremost.”
Chronic stress and structural inequities further contribute to risk, he said. Stress can influence behaviors such as dietary choices when healthier options are less accessible, compounding conditions like hypertension and diabetes that elevate heart disease risk.
Schleeter said delays in care among socioeconomically disadvantaged populations are particularly concerning.
“My worry and concern is … that care is being delayed,” he said. “Care being delayed, particularly in chronic illness, … leads to worsening outcomes.”
Breaking that cycle, Schleeter said, requires community support and awareness.
“We beat that with one of my favorite terms, which is community,” he said. “Having people that care and love about you … you can eat healthy where you have a partner or a group … to make better choices.”
He encourages people to know key health numbers, especially blood pressure. Ideally, a healthy systolic reading is under 120, he said, and small lifestyle changes — like short walks or healthier meals with a partner — can still make a meaningful difference.
Community-based screenings at churches and neighborhood centers can help close gaps in access, he added, but awareness is critical.
“It’s more important than only be there, but make those type of things aware … so the people who need the most help can get it,” Schleeter said.
Addressing disparities in heart disease, he said, is essential to repairing a broader health care system under strain.
“I think this is, if you look at trying to fix health care that’s broken in our country, fixing what we’re talking about is the best way,” Schleeter said.
For more information about heart disease risk factors and prevention from a national public health perspective, visit the Centers for Disease Control and Prevention’s heart disease facts page at cdc.gov/heart-disease/data-research/facts-stats/index.html.
This reporting is made possible by a grant from the Indianapolis African-American Quality of Life Initiative, empowering our community with essential health insights. https://iaaqli.org/
Contact Health & Environmental Reporter Hanna Rauworth at 317-762-7854 or follow her on Instagram at @hanna.rauworth.
Hanna Rauworth is the Health & Environmental Reporter for the Indianapolis Recorder Newspaper, where she covers topics at the intersection of public health, environmental issues, and community impact. With a commitment to storytelling that informs and empowers, she strives to highlight the challenges and solutions shaping the well-being of Indianapolis residents.
