The facts are indisputable: African Americans and Latino Americans who are at high risk for heart disease are less likely to receive life-saving treatments. Age and gender are also significant risk factors. More women than men die of heart disease, although more men have heart attacks; and as people age, the risk of heart disease increases.
The Center for Disease Control reports that despite prevalence of heart disease across all racial and ethnic groups, women and people of color are treated at a lesser rate for cardiovascular disease than Caucasian men. The good news, however, is that recent research, plus widespread educational initiatives, are starting conversations about these disparities.
Dr. Sandeep Khosla, chief of cardiology and director of cardiac catheterization laboratories and endovascular therapeutics at Sinai Health System in Chicago, treats a diverse group of patients with heart problems. He recently spoke with us about the advances in cardiovascular treatment, the implications of heredity, preventive measures and warning signs as they relate to heart disease among people of color and women.
Q. What is cardiovascular disease? How is it different from heart disease?
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The cardiovascular system is made up of the heart and connecting blood vessels. This is the entire plumbing system, if you will, and it is susceptible to the same disease factors that can cause heart disease and heart attacks, such as high cholesterol and high blood pressure. So whatever affects the heart is likely to affect the rest of the vascular system, to some degree. This includes brain function, kidney and leg circulation.
Q. What are some symptoms of cardiovascular disease?
SK: Symptoms include, but are not limited to: shortness of breath, chest pain, dizziness, nausea, being fatigued or just not feeling well. All of these symptoms indicate problems with the cardiovascular system. Symptoms of heart disease and heart attack can vary in men and women. The most important thing to remember is to take all symptoms seriously, even if they seem insignificant at the time.Q. What role does family history play as it relates to contracting cardiovascular disease?
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SK: Family history is a major determinant of cardiovascular disease. Awareness of that history is important. Ask about prevalence of high blood pressure, diabetes and kidney disease in your family. Beginning to test for these things as early as age 35 is a good idea. That includes testing your levels of cholesterol and glucose and even having your eyes tested.
Q. How can pre-existing conditions impact the likelihood of having heart disease?
SK: African American patients tend to have very aggressive hypertension, which is a significant risk factor, along with high cholesterol. African Americans also tend to develop kidney damage and suffer from strokes more often than the general population.
If you are diabetic, you are at higher risk for heart disease, since diabetes impairs blood circulation. This causes skin breakdown and can lead to amputations. It’s also worth noting that African Americans generally take a higher number of medications, which can increase risk factors.Q. Are there external factors that impact the likelihood of people contracting cardiovascular disease?
SK: Smoking, poor eating habits and lack of activity play a major role in developing cardiovascular disease.
Q. How does diet relate to heart disease?
SK: Diet is tremendously important to preventing heart disease. Eating more vegetables and whole grains is an excellent start. At all costs, avoid eating anything that is high in calories—such as fried food or large amounts of red meat, which is high in high cholesterol. Sodium directly increases blood pressure, so avoid foods that are rich in salt, like canned foods. I suggest reading labels closely and rinsing canned foods prior to cooking. Also, avoid the salt shaker. The most important thing to remember when eating is moderation and reducing the size of your portions.
Q. What are some simple steps anyone can take to increase their heart health?
SK: There are many simple steps you can take right away. Exercise is important. Park further away from the entrance at the grocery store or mall. Take more steps around your home. Even if you have limited mobility, it is better for your heart to be somewhat active than to lead a sedentary lifestyle.
READ: GirlTrek: “When Black Women Walk, Things Change”Q. What types of advances have been made in the procedures and devices used to treat cardiovascular disease, like valve replacements and pacemakers?
SK: In the last 15 years, we’ve come a long way with minimally invasive procedures to treat heart disease. There is a 99 percent success rate for heart (coronary) stents that unclog arteries. This success rate has reduced the need for open-heart surgery by 60-70 percent. A stent placement is either a one-day or outpatient procedure. Additionally, the recovery period for these procedures is short. A patient can typically resume their normal activities within a few days.
With advanced surgical techniques, aging and hardened valves can be replaced. Other heart valve conditions, such as infections, can be treated medically, if necessary, with open-heart surgery. In cases where the electrical system of the heart degenerates over time, small electronic devices, called permanent pacemakers, can be installed. Pacemakers can have battery lives of up to 15 years, and are implanted under chest muscle so that they don’t interfere with daily life. All these services are available at Sinai Health System.
Q. How are women’s risk factors for heart disease different than men’s?
SK: I’ve found that there is not enough awareness that heart disease is the number one killer of women. We are still trying to educate generations of people who were brought up under the false assumption that hormones protect women from heart disease. Six out of 10 women who develop heart disease will die. Heart disease can appear in women in their sixties and older, but women as young as 40 can develop the disease. Lung and breast cancer do not kill as many women as heart disease, and that is directly proportionate to the awareness of heart disease and how it impacts women.
READ: Myths About Black Women & Heart DiseaseQ. What are some of the atypical symptoms women may experience?
SK: Certainly, the symptoms present themselves differently. Rather than the chest or arm pain that men experience, women may be tired or have pain between their shoulder blades. Other atypical symptoms include heartburn and gas.
Q. Any final thoughts to share?
SK: Don’t take anything for granted. Make sure you have a physician who will meet with you and do the basic things, including discussing your risk factors so he can get engaged in your care. Address your symptoms as early as possible. Preventive methods are less effective once you’ve developed heart disease. Any symptom above the belly button could be related to your heart. Most importantly, instead of trying to justify your symptoms, seek medical attention. Let a physician check it out for you. If the symptoms are not related to your heart, your physician can certainly refer you to another doctor who can help you.
About Dr. Khosla
Dr. Sandeep Khosla has served as Chief of the Section of Cardiology and Director, Cardiac Catheterization Laboratories and Endovascular Therapeutics at Sinai Health Systems since 1998. He has performed over 10,000 cardiac catheterization procedures and over 3000 stent and other minimally invasive procedures in heart, kidney and lower extremity circulations during his career. He also serves as Associate Chief of Cardiology at the Rosalind Franklin University of Health Sciences/The Chicago Medical School; and began serving as the Program Director of the Adult Cardiovascular Disease Fellowship in 2004, and Interventional cardiology fellowship in 2011. Dr. Khosla previously served as an Assistant Professor of Medicine at University of Chicago Pritzker School of Medicine from 1997-1998 and participated in a series of advanced cardiology fellowships at the Alton Ochsner Medical Foundation and the Finch University of Health Sciences (now Rosalind Franklin) between 1990 and 1997. Dr. Khosla completed his residency in Internal Medicine at Prince Georges’ Hospital in Maryland from 1989-1990.
Visit the BlackDoctor.org Heart Health center for more articles and tips.
