While heart disease and stroke — and deaths from those diseases — have declined in the United States in recent decades, those advances have not been shared equally in the African-American community. A panel of experts has been trying to find out why.
The result is a new American Heart Association scientific statement about cardiovascular health in African-Americans that examines the challenges and proposes solutions.
“We still see higher rates of heart disease and risk factors such as obesity, high blood pressure and diabetes in African-Americans as compared to whites, and higher death rates from heart attack and stroke,” said Mercedes Carnethon, Ph.D., associate professor of preventive medicine at Northwestern University’s Feinberg School of Medicine and chair of the group that wrote the new statement. “We thought it was important to pull together all the information.”
The report points to cardiovascular disease as a prime cause of the gap between expected life spans of blacks and whites — more than three years for both men and women — and identifies a number of factors for the continuing disparity. The first, Carnethon said, transcends race.
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“What we see for all ethnic groups is notable differences by socioeconomic status,” she said. “High socioeconomic status provides access to health-promoting resources, access to a culture that promotes the ability to make healthy lifestyle choices, access to healthy foods and exercise, even the ability to prioritize good sleep.”
But even among different groups at the same economic level, she said, African-Americans lag behind. “We’ve got the information, we’ve got better therapies than ever,” she said. “So why aren’t they either received by all people or as effective?”
Age, the report said, is one key. Many African-Americans are developing risk factors, particularly obesity, earlier in life, which leads to high blood pressure and diabetes — and subsequently heart attacks and strokes — at younger ages than other groups.
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High rates of hypertension and less effective disease management are major contributors to the disparity, according to the report, as are the disadvantages of living in poor, underserved neighborhoods.
“The takeaway is we still face a significant problem,” Carnethon said. “We need to find ways to create a culture of health in the African-American community and prioritize a healthy lifestyle to prevent heart disease.”
To accomplish that, the report highlights the need for progress at every level of health care, from individuals to health care providers to policymakers. Among the recommendations is to invest in environments that promote healthy lifestyles, such as safe spaces for physical activity and supermarkets offering affordable, nutritious food that are often lacking in poorer neighborhoods.
Also advised in the report are programs that promote healthy diets and lifestyles, particularly through churches and other faith-based institutions, to raise awareness of cardiovascular risk factors and the need to lower them. Increased funding of medical research to help tailor treatment to African-Americans is also recommended, as are efforts to create a more diverse workforce in health care to enhance trust in the medical community.
“This is a call to action,” said Ivor Benjamin, M.D., director of the Medical College of Wisconsin’s Cardiovascular Center.
“It recognizes the complexity of the problem,” he said. “It’s not just about patients and health care providers. It’s about the public health system. It’s about the whole community, local health departments and legislatures. All of them should be actively engaged in improving cardiovascular health.”
Benjamin, who is president-elect of the AHA but not involved with the new statement, said the report “really gets into how can we take a more holistic approach that will improve the health of all communities. I think it will bring the right stakeholders to the table to address a multidisciplinary problem.”
Carnethon said the report’s panel hopes its work will help African-Americans better understand their health issues and communicate with their doctors, help doctors focus on the African-American community, and prod policymakers to make changes that will eliminate the disparities.
But on an individual level, she said, the message is universal. “It really starts on the prevention end, to maintain a healthy lifestyle so risk factors don’t develop,” she said. “However, once they do, it’s about taking ownership of your health, understanding the options and managing your risk.”
