Blacks Face Higher Mortality from Heart Disease, Stroke

–CV disease accounts for large portion of health disparities.

Cardiovascular disease led to the loss of more than 2 millions years of life in the African-American population between 1999 and 2010.

A new scientific statement from the American Heart Association, Cardiovascular Health in African Americans, makes clear that, compared to whites, African Americans suffer disproportionately from cardiovascular disease and have not benefited equally from the long-term population-wide reductions in heart disease and stroke.

Large disparities in overall health in general and cardiovascular disease in particular have long been known to exist in African Americans. The new report finds little improvement in the past decade.

In 2012, life expectancy of African American was 75.5 years compared with 78.9 years for whites — a discrepancy of 3.4 years. According to the CDC, cardiovascular disease accounts for 32% of the difference in men and 43% of the difference in women. Cardiovascular disease also starts earlier in African Americans.

Hypertension and Other Risk Factors

Hypertension, according to the statement, “is arguably the most potent risk to the cardiovascular health of African Americans, as well as the greatest area of opportunity for the prevention of disease if effectively managed and prevented.” Among African Americans, 42.4% of men and 44% of women have hypertension. The hypertension epidemic begins early in African Americans. 13.8% of African-American children have hypertension, compared with 8.4% in whites. Hypertension likely contributes to the greater toll caused by stroke in African Americans. Stroke mortality rates are 4.5 times higher in nonwhites than in whites.

Obesity is also more prevalent among African Americans. 20% of African-American children are obese, compared with 15% of whites. Among African-American adults, 58% of women and 38% of women are obese; among white adults, 34% of men and 33% of women are obese.

By contrast, African Americans have similar lipid levels as whites. They also have a lower prevalence of atrial fibrillation. But this is offset by the finding that, if they have atrial fibrillation, they are less likely to receive treatment with warfarin.

The scientific statement notes that “fewer socioeconomic resources” leads to “adverse social and environmental factors” contributing to the health disparities. Stress may also be an important factor: “Although most people experience stress from jobs and major life events, African Americans are more likely to have persistent economic stress and to face concerns about maintaining their health, including preventing weight gain and managing chronic conditions such as high blood pressure or diabetes,” explained Mercedes Carnethon (Northwestern), chair of the statement writing group.

Solutions

To address the problems raised in the statement the authors suggested leveraging some of the “strengths of the cultural environment … to disseminate behavioral health interventions (eg., the central role of the church for reaching women and older adults).” They recommend “targeting the macroenvironment via policy changes at the federal (eg., Affordable Care Act), state (eg., cigarette smoking bans), and local (eg., food availability in schools) levels.” But, they acknowledged, “finding strategies that reach younger African Americans and men with disease prevention messages is a challenge that must be met to change the trajectory of health in the African-American community.”

Garth Graham, a cardiologist who was formerly the Deputy Assistant Secretary for Minority Health at HHS and now is president of the Aetna Foundation, commented: “The statement accurately reflects what other science and evidence has pointed to over the years as it relates to heart disease and the African-American population, including what was published in the most recent National Healthcare Disparities Report.”

The statement, he continued, “does highlight challenging data on the impact of hypertension and obesity on African-American children, which urges us to be more proactive in finding solutions. The multifaceted nature of the problem, including socioeconomic status, stress and culture, requires a similar multipronged approach that targets the environment but also raises the importance of education and economic security and its impact on heart disease. The next step for us as a country is moving from describing the problem to focusing on how we make the necessary changes to improve these health outcomes.”