(BlackDoctor.org) — Almost 400,000 women die of heart disease in the United States each year, and a large percentage of them are black females. In fact, diseases of the heart and circulation, which include heart attacks, stroke, heart failure, kidney disease, hypertension, and diabetes, are responsible for killing more black women than anything else in our society. That includes cancer, although women tend to be more afraid of developing cancer than of getting heart trouble.
African American women are especially affected by heart disease in a negative manner. They have a higher mortality or death rate than white women and black men under the age of 55 years. The mortality rate from coronary heart disease is 69% higher than for white women. In addition, the first heart attack occurs at an earlier age in black women and is more likely to be fatal than is the case in white women. And pre-menopausal women who have hypertension, which is more common in black women, have 10 times the heart attack risk of those without high blood pressure.
The purpose of this article is to put African American women on notice that they are at great risk of dying or being disabled by what we call cardiovascular disease, or CVD, and that they need to take some precautionary steps to avoid being affected by these problems. Over the past several years, we have developed a knowledge base of information which allows us not only to look back and see what has happened to so many black women who have been affected by these disorders, but also to look ahead and to project what will happen to our women if certain corrective and preventive actions are not taken. An organization which I founded 30 years ago, called the Association of Black Cardiologists, has collected a great deal of that information and is currently conducting research on the subject through its Women’s Center in Atlanta, Georgia. More information about this organization and others that you may want to contact for more resource data is provided at the end of the article.
What we will do is to give you some very basic information about the heart and circulation as well as the disorders which can potentially affect you—and in fact, may already be doing so. In all cases, remember that this is being provided to alert you to the possibility of CVD dangers in yourself, and you should consult your doctor or health care provider for further information and possible needed action.
Understanding the Cardiovascular System
The cardiovascular system consists of a network of organs, including the heart and kidneys, which are connected by a vast conglomeration of blood vessels, mainly arteries, veins, and capillaries, through which blood flows in a closed system which never connects to the outside unless it is by means of trauma (injury) or deliberate surgery. The heart beats normally on a regular schedule, propelling the blood through the blood vessels to deliver oxygen and nutrients to all of the body’s tissues and organs and picking up wastes such as carbon dioxide, which are produced by metabolism within the body. One of the organs that is serviced by the cardiovascular system is the heart itself. For example, if it does not receive the oxygen supply that it needs because a coronary (heart) artery is clogged and blood flow is decreased, the heart muscle, which is called the myocardium, may become damaged. When it becomes partially starved of oxygen, we say that myocardial ischemia exists. When it becomes completely deprived of oxygen, the heart muscle will die, and we say that myocardial infarction (a heart attack) has occurred. The same thing can happen to the brain, leading to a stroke, or the kidneys, causing renal insufficiency. If the heart and blood vessels become overloaded with fluid, heart failure or high blood pressure (hypertension) may result. Of course, this is an oversimplification of what actually happens, but the main idea is that the cardiovascular system is very delicately balanced and if its function is disturbed, disease can occur. This is what African American women are prone to, and now we will explore some of the reasons for this.
Risk Factors in African American Women
Black women have the highest rates of what are called risk factors for cardiovascular disease in the country, when they are compared to men and women of their own race as well as other races. When you have a risk factor, which means that you are unusually likely to develop CVD, as opposed to people who have none. In addition, the more risk factors you have, the greater are the chance that you will have an adverse event involving the cardiovascular system such as a heart attack or a stroke. It has been well documented that African American women have the highest rates of the following risk factors:
- Smoking: 26% of black women smoke
- High blood pressure: about one-third of black women have hypertension
- Obesity: two-thirds of black women are overweight or obese
- Physical inactivity: the majority of black women do not exercise regularly
In addition, diabetes, which causes so many heart attacks that it is now considered a cardiovascular disease and a CVD risk equivalent, is found in a very high percentage of African American women.
It is interesting that women have a built-in protection against CVD when they are young or premenstrual. The protective element is estrogen, a sex hormone that occurs naturally in the body but declines as the woman grows older. As a result of estrogen’s protective action, women have their heart attacks about ten years later than men. However, smoking and diabetes completely nullify the protective advantage conferred by estrogen, and women who smoke and /or have diabetes may have heart attacks equal to the rate seen in men, and at the same age as men. Obviously, therefore, it is foolish for black women to smoke, especially if they have diabetes or any other risk factor, because then the risk of a cardiovascular event is multiplied. It has also been documented that the cardioprotective effects of aspirin are nullified by smoking.
In addition to the risk factors named above, there are others such as high cholesterol levels. Cholesterol is a sticky substance that plugs up the arteries of the body when it gets out of control, and when this happens to the coronary arteries that supply blood and oxygen to the heart or brain, a heart attack or stroke can occur. Cholesterol is in many of the foods that we eat, and it is also manufactured by the body. It is known as a lipid or blood fat. Some of the foods that contain high amounts of cholesterol are red meat, eggs, butter, and whole milk. There are many others. Trans fats, which are fats processed in a manner that preserves food longer, is especially dangerous, and you should avoid margarine and any food that contains it. Potato chips, fast food hamburgers, and many other products have it. If it is on the label of any food that you are thinking about buying, you should not buy that product. In general, any fried food you eat will contain excessive amounts of cholesterol, and these should be avoided. You can’t tell if your cholesterol is high unless you get it checked by a blood test done by a doctor. Fortunately, there are very effective medicines available to lower your cholesterol if needed, and eating the right diet definitely helps.
High blood pressure is very common in African Americans. It has multiple causes, one of which is heredity. It tends to run in families, and almost every African American person either has it or has a relative who does. Eating too much salt is definitely linked with hypertension, and this is something that is characteristic of the black diet. Fast fo
ods and fried foods contain a lot of salt, too. A diet called the DASH diet (Dietary Approaches to Stop Hypertension) showed particular benefit in black women and was based on the use of low-salt foods, fruits, nuts, whole grains, and vegetables.
Blood pressure is a measure of the force that the blood exerts on the arteries carrying it, and it is recorded in two components, called the systolic pressure, which is caused by the beating of the heart, and the diastolic pressure, which is caused by the squeezing effect of the arteries on the blood inside of them. Systolic is the upper figure and diastolic is the lower figure in the blood pressure recording. For example, 120/80 is considered normal. Your doctor knows how to interpret your particular blood pressure and can tell you if it is high, and he will advise you on what to do about it. Again, there are many very effective medicines he can give you if your blood pressure is out of control. If left undetected and uncontrolled, high blood pressure can lead to heart attacks, stroke, kidney failure, and blindness. More than 71,000 African Americans die each year from hypertension. It can also aggravate diabetes if it is present and make it more difficult to control.